TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2003 | Volume:61 | Issue:5|Papers Count:15

Background: This article is to verify mortality rate, cause of death, severity of injury (ISS),GCS, patient fate in hospital, pattern of specific organ injuries and some other characteristics among injured pedestrians and car occupants referred to three trauma centers in Tehran (Sina hospital, Shohada Tajrich hospital, Fayazbakhsh hospital) from May 1996 until May 1997. Materials and Methods: 57367 patients were admitted to emergency department of these centers among which, 6027 victims of motor-vehicle accidents were included in this study.Results: 71% of cases were pedestrians and rest was car occupants. M/F ratio was 1.8/5. Mean age was 29y. Motor vehicle accidents occurred most commonly during nights. The patients GCS at arrival in emergency department had similar distribution in both groups. The most commonly injured organs in both groups were: integument, head and neck, extremities and bony pelvis. Thoracic and spinal injuries were more common among car occupants. Extremities and boney pelvis injuries were more common among pedestrians. The mortality rate was the same between both groups. Mortality rate was affected by GCS at arrival and severity of injury. Mortality rate among the old was 4 times the rate among the children. The accidents most commonly occurred on metropolitan roads and streets. The most common cause of death between both groups was head injury. Surprisingly head injury was a more common cause of death among the car occupants. Conclusion: Pattern of specific organ injuries was different form the pattern in previous studies as the pattern was virtually the same between both groups except for spinal and thoracic injuries were more common among the car occupants.

Crimean-Congo hemorrhagic fever (CCHF) was first described in the Crimea in 1944 and then in 1956 in congo. CCHF is a viral hemorrhagic fever of the Nairovirus group that belongs to Bunyaviridae family virus. It is transmitted to human by tick bite. The most efficient and common tick that is the vectors of CCHF is a member of the Hyalomma genus which infected many mammals such as livestock, this tick is the main reservoire of virus in nature. Humans also become infected with CCHF virus by direct contact with blood or other infected tissues from livestock or human patients (nosocomial infection). Disease has been found in saharic Africa, Eastern Europe, Pakistan, India and Middle East (specially Iran and Iraq). This disease recently spread in Iran so in 1999 to 2001 at least 222 suspected case(81 definite case) reported that led to the death of 15 of 81 cases . It is estimated that 30 percent of the countrys cattle are contaminated with this virus. In humans, after a short incubation period it appears suddenly with fever, chills, myalgia and GI symptoms followed by severe bleeding and DIC that led to death If the patient improved, has a long (2-4 weeks) convalescence period. Disease diagnosed by clinical manifestations, serologic tests, viral culture and PCR and its specific treatment is oral ribavirin for 10 days. for prevention of disease personal protective measures from tick bite, spraying poison of mews to reduce of ticks crowd, isolation of patients and dis-infection of contaminated personal equipments that who suffering from CCHF is recommended.

Background: Knowledge of axillary lymph node Status is essential in treatment planning and in prognostic evaluation of breast cancer. Materials and Methods: Preoperative high resolution Sonography of axilla, were performed on 100 patients with breast carcinoma (T1-T2) clinical, before axillary lymph node dissection and pathologic evaluation.Results: The Sensitivity of ultra Sonography in detection of axillary metastasis was 78% with specificity of 79% and accuracy of 79% PPV was 85% and NPV was 70%.Conclusion: Preoperative ultra sonography, alone, is not optimal for detect ion of axillary lymphnode metastasis.

Background: This study was conducted to estimate the prevalence of sub-fertility in Tehran (Iran). Materials and Methods: The survey method was descriptive- Interview in 22 Municipal district (Iran) and a representative sample of women who were in their fertility age (2545) were selected. After exclusion of 13 cases not meeting age criteria and 190 non-respondent cases 1987 remained. Results: For this large city with a population of about seven million at the time of the study, we estimated the cumulative incidence of sub-fertility in 2001 to be 12.6% (95% confidence interval 11.2-14.1%).About 2.8% of this population was left with an unresolved infertility. Conclusion: Between 11.2-14.1% of population of couples in Tehran experienced sub-fertility in their life and about 2.8% had unresolved infertility; this must arise serious consideration to health programmer in Iran.

Background: Because of high prevalence of upper limbs pain and carpal tunnel syndrome and the need of proofing of diagnosis by nerve conduction study (NCS) testing of median nerve is one of the most common exams in electro-diagnostic centers. In interpretation of findings of nerve conduction study; presence of a normal range for findings is one of the most important points. Materials and Methods: In this study we obtained the findings of nerve conduction study of median nerve in 60 normal persons. Results: The mean of motor distal latency was 3.09 ms (SD: 0.36). The mean of sensory distal latency measured to peak of response was 3.04 ms (SD: 0.28) with increasing age; mean of motor and sensory distal latencies increased. Most of findings had no significant difference with other references. Conclusion: There is no problem in using of the normal ranges of the other countries for Iranian patients.

Background: Eustachian tube connects middle ear space to the nasopharyngeal space. Upper airway obstruction, with any cause, can derange Eustachian tube function. Nasal septal deviation is one of the prevalent causes of upper airway obstruction which can affects the ventilation function of Eustachian tube. Materials and Methods: This study was conducted on the patients who underwent septoplasty due to severe septal deviation leading to unilateral nasal obstruction in Amiraalam hospital from summer of 1378 till the spring of 1379. Results: There was 140 patients whose data were as: female patients 34 (24.3%) male patients 106 (75.7%), mean age (22.7). Median age (20) years and mode of age (18) years of age. they were from 12 to 40 years of age. Conclusion: Comparison between preoperative and postoperative middle ear pressures shows no any significant statistical difference (p=0.798).

Background: The aim of the present investigation was to determine the prevalence of metabolic syndrome. Materials and Methods: Metabolic syndrome was defined by the presence of three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL-C, high blood pressure, and high fasting glucose. Results: In this study, 10368 of the adults (4397 men and 5971 women) aged 20 years and over, participated in Tehran Lipid and Glucose study. The unadjusted prevalence of metabolic syndrome in the study population was 30.1% (CI 95%: 29.2-31.0), and age-standardized prevalence was 33.7% (CI 95%: 32.8-34.6). The prevalence increased with age in both sexes. Metabolic syndrome was more commonly seen in women than men (42% vs. 24%, p< 0.001). Low HDL-C was the most common metabolic abnormality in both sexes. Except for high FPG, all abnormalities were more common in women than in men (p<0.001). Most of those with metabolic syndrome had 3 components of the syndrome (58%). 33% had four, and 9% had five components. Conclusion: This first report on metabolic syndrome mom Iran shows a high prevalence of this disorder, imposing serious impacts on health care system. Efforts on promoting healthy diets, physical activity, and blood pressure control must be undertaken.

Background: The objective of this study was to determine wether a urine collection of less than 24 hours duration accurately assesses the level of preteinuria in inpatients being evaluated for preeclampsia. Materials and Methods: Patients admitted to the Mirza Kouchak-Khan hospital between years 2001 to 2002, underwent 3 consecutive collections consisting of two b hour and one 12 hour collection. Each volume, and urine creatinine. A concurrent serum creatinine value was obtained. The protein: creatinine ratio and creative clearance were calculated. Pearsons correlation/sensitivity, specificity and positive and negative predictive values were assessed. Results: A total of 32 patients (98%) were preeclamptic. Total protein and serum creatinine were significantly correlated and the protein: creatinine ratio was moderately correlated between the collections. The 1st 6 hours collection (8 Am to 2 pm) had a sensitivity and specificity of 100%. The second 6 hours had a sensitivity and specificity of 96% and 86.6%. The first 12 hours had a sensitivity and specificity of 100% and 93.2%. The 2 and 12 hours (8 Am to 8 pm) had a sensitivity and specificity of 80% and 93.3% respectively. There was a significant diurnal pattern of proteinuria. Conclusion: In conclusion based on the results achieved it can be concluded that a 6 and 12 hours urine collection/especially the first 6 hours after patient awakening can accurately assess proteinuria in the hypertensive gravida.

Background: Persistent air leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent air leak causes longer patients hospitalization. Materials and Methods: We used autologous blood pleurodesis in patients with persistent air leak for 30patients with more than 8 days air leaks, during a three years period 1377-1380 (1999-2002). Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and/or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mls. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patients complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients air leak ceased. In six patients because persistent air leak autologous blood pleurodesis repeated, two patients after 48hours air leak ceased, remaining four patients underwent for thoracotomies. success rate was 86.6%.Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent air leak is a reliable, effective, and no complicated procedure for persistent air leaks.

Background: Shigellosis is a acute inflammatory colon disorder that was developed by variety strains shigella and have high prevalence in infants, preschool children and Tropical climates particularly Iran. The purpose of the present study was to determine the frequency rate of neurologic complications with shigellosis. Materials and Methods: In a cross sectional study, 390 patients with shigellosis that were hospitalized in Bahrami Hospital of Tehran in period of 5 years 1997-2002 were evaluated with Neurological Manifestations and Complications . Results: This study revealed a frequency rate of 80% for Neurological complication (encephalopathy alone= 15.38%, convulsion alone= 43.08%), convulsion and encephalopathy= 18.47%, Ekiri syndrome= 3.07%). Conclusion: The reason of difference this study with other world studies is probably restricted of this study in the hospitalized patients and over diagnosed of convulsion by parents and Medical personalies. This results suggest that neurologic complication particularly seizure commonly associated with shigellosis also Ekiri syndrome in this study has had relatively high frequency rate. For this reason serious prevention and Rapidly Treatment of shigellosis is necessary.