TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2005 | Volume:63 | Issue:2|Papers Count:13

Background: This Study aimed to validate the temperament and character inventory (TCI) in an Iranian sample of men and women with different ages. TCI contains subscales designed to measure seven different personality traits and characteristics.Materials and Methods: In the first step, subjects (n=1212) completed the questionnaire. In the second step, to examine the reliability of the questionnaire, 101 randomly chosen subjects were re-tested one to two months after the first test. Also, in order to examine the validity of the questionnaire, 100 subjects were interviewed by two psychologists using a checklist based on the Cloninger"s biological theory of personality. The interviewers, who were blind to the subjects" scores on the seven subscales, rated each subject for the seven traits and characteristics on a 10-point rating scale (from 1 to 10).Results & Conclusion: The results showed normative data for the subscales novelty seeking (NS), harm avoidance (HA), reward dependence (RD), persistence (Per), self directiveness (SD), cooperation (Co) and self transcendence (ST) for different gender and age classes. Correlations between the scores and ratings of the test and re-test revealed significant coefficients, confirming reliability for all subscales. A good internal consistency was found for each subscale. The results also showed no significant correlations higher than 0.40 among NS, HA, Per and RD; the temperament subscales were independent from each other. The only significant correlation, higher than 0.40, among the character subscales was between SD and Co. Applied and clinical implication of the present findings will be discussed.

Background: This research have presented focuses upon the cultural side of managerial coordination and control as manifested in Telemedicine Technology. Specifically, the research seeks to analyze and determines the attitude of clinical physicians about the role of specific dimensions of organizational culture and organizational structure may have upon effective managerial coordination and control in Telemedicine Technology in TUMS hospitals.Materials and methods: We assessed the attitude of 82 clinical physicians in five randomly selected TUMS teaching hospitals in a mixed method of pooling Quantitative and Qualitative data using unstructured interview technique.Results: For successful telemedicine utilization, most of clinical physicians believed that we need organic organizations that have involved leadership, open and free communication of mistakes and success, desire to experiment with new ideas, support for continuing education, support for new things, clear rules to follow and acknowledge performance goals.Conclusion: The data indicate that organizational is most important to utilize successfur telemedicine technology.

Background: Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. The aims of this prospective study were to: 1) determine the rate of blood culture contamination 2) determine variety and frequency of contaminant bacteria 3) compare the duration of hospital stay and antibiotic administration in patients with true bacteremia vs those have false positive blood culture.Materials and Methods: Cross-sectional study conducted April through July 2004 among patients aged 14 years or younger who were admitted at Doctor Garib Children Medical Center of Tehran and had a blood culture obtained as part of their care. Bacterial isolates were identified to species level and medical records were reviewed in all cases with a positive blood culture. A number of clinical and laboratory criteria were used to deciding whether a blood isolate is a pathogen or a contaminant. These include the identify of the micro-organism itself, clinical features such as fever and leukocytosis; the proportion of blood culture sets positive as a function of the number of sets obtained and to have an indwelling vascular catheter or prosthetic device.Results: During the study period, 2877 sets of blood culture were evaluated and the rates of positive blood cultures associated with significant bacteremia and contamination were 1.04% and 5.4% respectively. Among the positive blood cultures, over the 84% of isolates were due to contamination and only 15.95% of isolated strains associated with true infection. The frequency of isolated bacteria with respect to true infection and contamination are as following: S. Aureus (infect: 9.0%, contam:0.0%), S. Epidemidis (infec: 0.0%, contam: 13.3%), Micrococcus sp. (infec: 0.0%, contam: 4.3%), pseudomonas and related species other than P. aeruginosa (infec: 2.1%, contam: 60.6%), viridans group of streptococci (infec: 1.1%, contam: 2.1%), E.coli (infec: 1.06%, contam: 0.0%), Klebsiella pneumoniae (infec: 0.53%, contam: 0.0%), Enterobacter cloacae (infec: 0.53%, contam: 0.0%), and Acinetobacter baumannii (infec: 0.25%, contam: 0.53%). The mean of hospital stay for patients with true bacteremia, 14.83 days, was not significantly higher than that for patients with false-positive blood cultures (10.08 days). 43 patients had administrated one to three antibiotics after false-positive blood cultures.Conclusion: The findings indicate that blood culture contamination rate in studied hospital is higher than standard levels, and very high rate of contamination with environmental pseudomonas species shows an unusuall epidemic condition. The findings also suggests high resource utilization and prolong patients stay due to pseudobacteremia.

Background: The combined MMCOA deficiency and Hemocystinuria results from defect in cb1c & cb1d & cb1F genome. Until now only 100 cases of this disease has been reported. Most of them with cb1c deficiency. Due to this enzymatic defect, mild to moderate retention of Hemocystin (MMA) and their precursors in the body fluids (blood and urine) ensues. Although, acidemia, Hypoglycemia & megaloblastic anemia are common but hyperamonemia and hyperglycemia were not reported in these patients. Our case is a 3 years old girl with known MMCOA deficiency and Hemocystinuria who needed G.A for partial resection of the mandible because of osteomilitis.Materials and Methods: In this report we explain the preoperative preparation of the patient, induction and maintenance of Anesthesia, and discuss the biochemical, lab results during & after surgery.Results & Conclusion: Due to our result, the urine and blood hemocystin & MMCOA were not increased. This case is interesting because no theoretical or practical report on the G.A of these patients exists.

Background: Chang in the serum K+ level may increase perioperative morbidity and mortality in kidney transplant recipients. Thus this research was done with the aim of evaluated of K+ change in kidney transplant recipients. Hence the following study was carried to evaluate the fluctuation of potassium ion in the kidney transplant recipient patients.Materials and Methods: In a simple randomized clinical trial the serum K+ level was assessed in 40 kidney transplant candidates as following interval, pretransplantation, during renal art, anastomosis, after diuresis and post transplantation period. After hydration with 5 ml/kg normal saline all patient were undergone general anesthesia identically. They were premedicated fentanyl (2µg/kg), induction was performed by thiopental sodium (5 mg/kg). Tracheal intubation was facifitated with atracurium (0.6 mg/kg). Anesthesia was maintained with N2O + O2 50%, halothane 0.1% and fentonyl 1 µg/kg every 30 min.Results: The least mean K+ level was during anastomosis (ie. 3.5±0.24 mmol/L) and showed a decrease in the serum K+ level compared to preoperative period (mean 4.4±0.48 mmol) (P< 0.001). The maximum serum K+ level detected preoperatively and postoperatively were 5 (mmol/ L) and 4.7 (mmol/L) respectively.Conclusion: Despite the above results we inferred that range of serum K+ level was maintained within normal. Therefore with suitable pereoprative assessment hyperkalemia is a rare occurrence in transplant recipients.

Background: One of the most important concerns in orthopedic medicine is the low back. Considering the importance of muscle function in preventing LBT by controlling too much load and stress applied on the spinal joints and ligaments.Materials and Methods: The aim of this research was to determine the timing and level of activities of lumbopelvic muscles in response to postural perturbations caused by unexpected loading of the upper limbs in standing on three different supporting surfaces (neutral, positive slope, negative slope) in 20 healthy females 18 to 30 years old (X= 23.20 SD = 2.55 ). The electromyographic signals were recorded from the deltoid, gluteus maximus, internal oblique abdominis and lumbar paraspinal muscles of the dominant side of the body to evaluate the onset time, end time, level of muscle activity (RMS) and duration of different muscles in one task and one muscle in different tasks.Results: The results showed that the agonists (posterior muscles) activated at first to compensate the flexor torque caused by loading and then the antagonists (anterior muscles) switched-on to compensate the reaction forces caused by agonist activities. With regards to continuous activity of internal oblique and its attachments via thoracalumbar fascia to the transverse processes of the lumbar vertebrae, it can be considered as one of the major stabilizer muscles of the trunk .Conclusion: Finally the results indicated that supporting surface type didn’t have any effect on timing and scaling of muscle activities in different tasks suggesting that probably spinal and trunk priprioceptors are just responsible for triggering postural responses and they don’t have any role in determining timing and scaling.

Background: It was believed that Inhabitant of Islamshahr avoid referring to their health centers and health posts to receive bargain medical services. In search for the rate and causes of such neglect, this study was formed.Materials and Methods: In a cross-sectional study from all urban centers and health posts under the supervision of Islamshahr health network, 712 files were selected randomly.Results: Investigating the selected files it revealed that 25% were complete, 51% were defective and 24% were blank. In other words, only 25% of the files were complete and 75% of the files showed lack of full participation in primary care services. In the process of evaluation of each separate service unit, more defective files were found in family planning and oral health programs. But in the prenatal care and growth observation units, the number of complete files was a little higher than the number of defective ones. This is probably justifiable de to free vaccination of children and pregnant women, which causes the customer to refer to the mentioned units. In search for the causes of this lack of participation, 533 defective files were selected and those families were interviewed through some questionnaires. Conclusion: In family planning and growth observation and prenatal care, the interviewees believed that there was no need for them to seek such services. This in turn shows their lack of knowledge about the necessity of these cares. In case of oral health, lack of such unite in the health center was mentioned as the reason. More details are discussed in the article.

Background: The present study was carried out for determination of prevalence of cryptosporidiosis among infected children in Khooram-Abad city, Iran, 2002-2003. Materials and Methods: In this survey fecal samples of both rural and urban children were studied.Results & Conclusion: From all samples, 4.75% were infected. The infection rate was higher in summer and autumn. Also the results showed that the infection rate in Khooram-Abad was higher than Shiraz (3.5%), Bandarabbas (2.4%), Ahwaz (2.23%) and Rasht (1.57%) and the infection rate about equlity Ghazvin (4.75%) and Hamadan (5.3%) and lower than Isfahan (16.9%), Mashhad (14.6%), Urmia (105), Naghadeh (9.2%) and Tabriz (6.15%). Our observations indicated that the infection rate was higher in males (1.5%), equal between rural and urban children. Another finding was accompanying of cryptosporidiosis with some other infections like Shigellosis (15.7%) and giardiosis (5.26%) in some cases.

Background: Drivers are exposed to whole body vibration, which shakes and strains the disks of the spine. A number of research studies have investigated possible association between driving and low back pain. Generally there studies have found significant results.Materials and Methods: This prospective cross-sectional study was conducted among drivers in Tehran. We evaluated low back pain in 125 bus drivers and 115 non-drivers in the year 2001.Results & Conclusions: Low back pain was more common in bus drivers (70.4%). Combination of long–term vibration exposure from driving, smoking and not exercising increased the chance of low back pain. There was a significant relation ship between bus driving and low back pain (P<0.05)

Background: This study was conducted to evaluate results of urethroscopic management of iatrogenic urethral injuries due to gynecological operations.Materials and Methods: From November 2001 till November 2003, 12 iatrogenic urethral injuries which were managed with mean time 12 hours (Range= 6-72) after gynecological operations were included in this study. 3 months after urethroscopy and distending, patients were evaluated with IVP. Mean time of clinical follow up was 12 months (range= 4-29).Results: 7 patients with urethral stricture were found and considering fluoroscopy guided urethral dilatation with balloon in 2 of them, urethroscopy and distending was successful in 6 patients (85/7%).In 5 patients with complete dissection of urethra, urethroscopy and distending was successful only in 1 of them (20%). All patients were discharged after 24 hours and in follow up IVP after 3 months. Results were satisfactory in 6 of 7 patients. One of patients needed re-distending due to stricture.Conclusion: Urethroscopic approach as first step in management of iatrogenic urethral injuries seems reasonable and cost benefit, specially in ligating lesions.