Tehran University Medical Journal
Year:2005 | Volume:63 | Issue:9|Papers Count:16

Background: The side effects of benzoyl peroxide gel produced in Iran are high and its efficacy is low. Therefore, physicians are prescribing imported benzoyl peroxide with high price, compared to Iranian ones. This study was designed, therefore, to compare the side effects and efficacy of benzoyl peroxide 10% from Tehran-Chimi, compared with the ones prepared in pharmacy from benzoyl peroxide of Merk Company and imported ones (Ziko).Methods and Materials: In a double blind clinical trial, 90 patients with papolopostular acne, designated in one of three drug groups, based on their tern of visits. Patients were visited, three more times and their acne and drug side effects counted and compared with the ones before drug usage. Results: The best response with high grade was observed in patients who used Ziko gel (91%). 12% patients who used Tehran-Chimi gel and 27% patients who used pharmacy made gel responded with this grade. Erythem was the ;most frequent side effect with 17%, 87%, and 40% for above-mentioned drug groups, respectively. Redness with scale was in 7%, 47% and 37%, patients and dryness in 7%, 40%, and 30% patients, respectively. Conclusions: Better response and less side effects for pharmacy made' gel shows that if the material is prepared from good companies, we can prepare drugs with good quality. For this, we need to consider higher price for high quality products.

Background: Our purpose was to compare outcome of labor in women who underwent two management policies: early amniotomy or leave the fetal membranes intact as long as feasible.Material and methods: We carried out a prospective randomized trial on women admitted for spontaneous labor at term. A total of 80 women at early labor were randomized to either early amniotomy (early amniotomy group, n=40), or leave the fetal membranes intact as long as possible ( control group, n =40). Main outcome measures were duration of labor, mode of delivery, lack of progress, oxytocine use, fetal distress, Apgar scores, five-minute Apgar score below 7, and neonatal. morbidity. Data were analyzed using student-t, Fisher- exact, and Mann whitney-u Tests. P<0.05 was considered statistically significant. . Results: Early amniotomy was associated with shorter labor. The average time from the beginning of active phase of labor to delivery was 47 minutes shorter in early amniotomy group ( 274 Vs 321 minutes,P=<0.05).The cesarean- section rate was similar in the two groups (7.5 % Vs 2.5%, P=>0.05). The groups were similar with respect to the occurrence of dystocia, need to oxytocin or abnormal fetal - heart –rate tracings during labor (P=>0.05). There were no statistically significant differences in outcome between the infants delivered by the women in the two groups.Conclusion: Early amniotomy is an effective method of shortening the duration of labor and has not any detrimental effects on maternal and neonatal health.

Background: Amitryptiline and other tricyclic antidepressants are widely used in chronic pain states in humans. The clear expression of local analgesic action with antidepressants raises the possibility that this class of agents could be given topically and may be useful as peripherally acting analgesics in humans. Methods and Materials: In this study, effect of alpha-2 adrenoceptors and 5-HT2 serotonergic receptors antagonist on the analgesia induced by amitryptiline in rat was investigated. Subcutaneous injection of different doses of amitryptiline (4,8,16 mg/kg) induces dose-related analgesia in rat. Results: The alpha-2 adrenoceptors antagonist, yohimbine (2mg/kg) reduced the response induced by amitryptiline but 5-HT2 serotonergic receptors antagonist, ketanserin (lmg/kg) increased the response induced by amitryptiline. Conclusions: It seems that Ketanserin increased the pain threshold. It may be concluded that amitryptiline-induced analgesia is through alpha2- adrenoceptors mechanism.

Background: In search for a reliable objective test for early evaluation of hearing impainnent, we have tried to compare the results of pure tone audiometry with results of distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) in normal subjects, patients with meniere's disease (MD) and patients with noise induced hearing loss (NIHL).Methods and Materials: Hearing thresholds (HT) of the MD were significantly worse than the nonnal group at all frequencies (p<0.01). HTs of the NlHL group were significantly worse than the nonnal group higher frequencies (p<0.03). MD had significantly worse hearing thresholds than NlHL group at 2000 Hz and lower frequencies (p<0.03). Wave V absolute latency for NlHLL was higher than MD and normal groups (p=0.01 and p=0.002, respectively).Results: Distortion product (DP) for the NlHL and MD was significantly lower than the normal group at all frequencies (except 7270 Hz). A subset of subjects with hearing thresholds of less than 30 dB in all frequencies was selected from the three groups. NlHL subjects (but not MD group) had significantly lower DPOAE levels (p<0.05) in all frequencies (except for 7270Hz) as compared to the normal subjects. Conclusions: The results of this study provide a description of DPOAE results for normal and disease populations and support the concept that DPOAE may be used for early detection of NlHL.

Background: Difficult intubation, often unexpected, remains a primary concern for the anesthesiologist. The purpose of this study was to compare the sensitivity and specificity of Mallampati score with thyromental distance in predicting difficult intubation.Materials and Methods: In a prospective study three hundred patients undergoing general anesthesia were included. In all patients thyromental distance the Mallampati score were evaluated preoperatively. Thyromental distance equal or less than 6 cm and Mallampati score of 3 or 4 were assumed difficult intubation. The Cormack grade was .determined after the induction of anesthesia and grade 3 or 4 was considered difficult intubation. Sensitivity and specificity of these tests in predicting difficult intubation were calculated.Results: In 25 (8.33%) patients was difficult. In 45 patients the Mallampati score were 3 or 4 and in 64 patients thyromental distance were less than 6 cm. the sensitivity and specificity of Mallampati score in predictivg difficult intubation was 88% repectively and for thyromental distance were 80% and 84.28% (P<0.05, Chi- Square). With simulanoeus using of these tests under POC curve and sensitivity improved but specificity and accuracy decreased.Conclusion: Concomitant use of Mallampati scoring and thyromental distance greater than 6 cm is more sensitive in predicyting difficult intubation.

Background: Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant women. Materials and Methods: In a cohort study, 1500 pregnant women attending Hazrat Zaynab Hospital for prenatal care and delivery in the period 1379 to 1380,without any risk factors for preterm delivery and low birth weight were included. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery. Linear and logistic regression models were used to analyze data. Results: Sever anemia (hematocrit< 24%) was associated with a significantly increased risk of low birth weight «2500g) and preterm delivery « 37 weeks gestation). High hematocrit values (> 40%) did not increase the risk of low birth weight and preterm delivery. Teenagers, women with short height or low body mass index had significantly higher risk of delivering low birth weight infants. Conclusions: Sever maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvement in the nutritional status of young women could contribute to improvement health among their infant.

Background: Hypertension is a very common and important disease. There is conflicting report about cadmium, a trace element in the genesis of hypertension. Meterail and Method: In this study we examined the relationship between blood cadmium level and hypertension prevalence in a population-based sample of hypertensive and normotensive patients in the Shariate and Imam Khomeini hospitals in Iran. Cross sectional samples of 370 patients (age:40-70), who participated in a physical examination from these hospitals' survey conducted in 2004. Result :The range of blood cadmium levels from patients was 0 to 69.45 JIgll.The mean blood cadmium levels of nonnotensive patients (42.05±2.52mg/l) were higher than hypertensive patients (26.26±3.62 mg/l).There was a significant difference in mean blood cadmium levels of normotensive men (43.25±2.65 mg/l) and hypertensive men (27.01±4.29 mg/l) in this study (P<0.0001).The comparison of blood cadmium levels of normotensive women (30.76±6.5 6 mg/l) and hypertensive women (24.81±6.56 mg/l) did not show a significant difference. This difference were not affected by age sex, smoking. Conclusion: In this population we concluded there is no positive relationship between the concentration of blood cadmium and hypertension.

Background: A cross sectional study has done to know the rate and cause of using alternative & complementary medicine In Tehran hospitals.Methods and Materials: In the cancer, internal medicine and emergency wards of three hospitals of Tehran we search demographic information of patients. We used SPSS/windows version 10 for statistic analysis to find the relationship of variables with non-medical treatments.Results: we studied 591 patients suffering from cancer, chronic or acute disease. Mean & median age of patients was 49 year. About 57% were women and 43% men. About 50% had complete remission, 32% partial response and 18% no response to treatment. 27% didn't pass any educational courses, 32% had primary school and 41% had high school or university certification. The most common type of alternative medicine used by patients was herbal products. Patients used them for palliation of symptoms, 30% without notice to doctors. There was statistically significant relationship between alternative/ complementary therapies and more educational courses, longer duration of disease and lower response to medial treatment.Conclusions: We hadn't done the study in general population but patients in these 3 hospitals who almost all suffering from cancer or chronic disease, had strong desire to use non medical treatments, especially herbal products. Our medical society needs to know more about these therapies, with doing randomized clinical trial in comparison to placebo. Otherwise we wouldn't know the affectivity and side effects of these therapies.

Background: To evaluate the impact of HRT wit three regimens (conjugated estrogen alone & with 2.5mg or 5mg MPA) on lipid profile, FBS, OGTT & body weight of postmenopausal women. Methods and Materials: In this prospective randomized clinical trial, 70 menopause women who had come to "Mirza Koochak-Khan Hospital" (Tehran University) for receiving HRT in 2 years (1381-1382) entered randomly in 3 groups of study. All participants received 0.625 mg conjugated estrogen daily. One group received 2.5 mg MPA and another received 5 mg MPA too, continuously for 6 months. FBS, TG, Cholesterol, HDL and LDL measurement was done before starting HRT and after *1), (3) and (6) months of therapy. OGTT was performed before study and after 3 and 6 months. Results: There were no significant difference between groups before treatment. Although  beneficial effects on cholesterol, LDL and HDL occurred in all groups, but were greatest with conjugated estrogen alone (p< 0.05) (with 6 months change of: total cholesterol: -21.2 mg/dl, HDL: +9.16 mg/dl, LDL: -21.87 mg/dl). TG levels elevated significantly in this group (+34.41 mg/dl) (p< 0.05). In 2.5 mg MPA group, beneficial effects on lipid profile were slightly attenuated and TG level elevated less significantly. In 5 mg MPA group, beneficial effects of estrogen on cholesterol, LDL and HDL had greater attenuation and there was no overall change in TG level. FBS level decreased in estrogen group (-8.16 mg/dl in 6 months, P< 0.05), there was less beneficial effect on 2.5 mg MPA group and negative effect on 5 mg MPA group (+5.4 mg/dl in 6 months, P< 0.05). Similar effects were occurred in OGTT levels. Body weight increased in all groups, with more significant change in 2.5 mg MPA group (+2.56 kg, P< 0.05) and the least change in 5 mg MPA group (0.22 kg, P> 0.05).Conclusions: By adding 2.5 mg MPA to conjugated estrogen, mild attenuation in beneficial effects of estrogen on lipid profile, FBS and OGTT occurred and adverse effect of estrogen on TG level decreased. By increasing MPA dosage to 5 mg, greater attenuation in beneficial effects on FBS and OGTT occurred and adverse effect of estrogen on TG completely reversed.

Backgrounds: One factor that greatly influences the success of labor induction is the state of cervix. Studies have established that prelabor cervical status highly correlates with the inducibility of labor and cervical ripening agents improve the success of labor induction.The present study was conducted to compare the efficacy between Foley catheter and intravaginal Misoprostol for prelabor cervical ripening. Methods and Materials: A prospective, randomized controlled trial was conducted 100 women who were undergoing labor induction, with a singleton gestation≥ weeks and an unfavorable cervix (Bishop score≤), were assigned to one of two groups:(1) Intravaginal Misoprostol 50 microgram every 6 hours for 2 total doses. (2)Intracervical 16F Foley catheter until spontaneous expulsion and if this did not occur, the catheter was deflated and removed after 12 hours.Results: Among 100 patients, 50 patients were assigned to Misoprostol, and 50 patients were assigned to Foley catheter. Improvement of Bishop score was significant in each group and comparable among two groups (Misoprostol 3.943+1.434 with p<0.0001, Foley catheter 4.394+0.S49 with p<0.0001).There were no statistically significant differences in vaginal delivery rates (Misoprostol 7S%,Foley catheter 70%) and interval between induction to delivery (Misoprostol 674.6±291.6 min,Foley catheter 624±271.4min),intrapartum complications and neonatal outcomes among two groups.Conclusion: Intravaginal Misoprostol and intracervical Foley catheter are comparable for preinduction cervical ripening.

Background: Preclampsiais a pregnancy specific syndrome with adverse effect on multiple organs of the body. In this study we evaluated maternal and neonatal outcome in women with recurrent preclampsia and compared it with women who developed preclampsia for the first time. Methods and Materials: the study was conducted on 40 women with recurrent preeclampsia and 100 women of the first time preclampsia. Maternal and fetal variables were preclampsia severity, preterm delivery, abruptio placentae, cesarean delivery, intrauterine growth restriction, neonatal intensive care unit admission, birth weight, apgar score, blood sugar and hematocrit of the neonate and prenatal death, data were compared by using chi-square and T-test analysis.Results: preterm delivery <37 week's gestation was 57/5% in recurrent preclampsia and 26% in first time prec1ampsia (P=0.01). NICU admission in neonates of recurrent preclampsia was 25.6% compared with 10/2% in first time preclampsia (P=0.03).There was no statistically significant difference in preclampsia severity between two groups.Conclusions: compared to first time preclampsia, women with recurrent prec1ampsia had significantly higher rate of preterm delivery and NICU admission independent of preclampsia severity.

Background: Asthma is one of the most common acute and chronic conditions in child and the pediatricians are expected to provide the important part of asthma care in this age group, but there is no published information describing the different aspects of their practices about children asthma. This study was done to characterize the knowledge and practice of the Iranian pediatricians about the diagnosis, treatment and education of asthma in children.Methods and Materials: Validated questionnaires were completed by 200 pediatricians from different parts of Iran during the International Congress of Pediatrics in Tehran I October 2002.Results: A total of 193 returned questionnaires (96.5%) were eligible for the survey and analysis. About 49% of the respondents were male and 18% were sub specialists. Wheezing was the most common mentioned symptoms for thinking about asthma. About 40% of these physicians had no plan for doing spirometry in eligible children and 35.2% of them didn't have familiarity to peak flow meter. Also about 17.6% of them had no regular visits for their asthmatic patients. Only 7.3% of the respondents indicated they would prescribe inhaled corticosteroids for a 6-y-old child with moderate persistent asthma and 37.3% of them would prescribe inhaled bronchodilator (Salbutamol) for acute asthmatic attack as the first drug, while 17.1 % of them use epinephrine injection for this purpose. About 42.2% of the respondents didn't consider any education or action plan for their patients, and only 60.6% of them had access to standard guidelines and educational programs. Conclusion: The results show that there are numerous aspects of children asthma management in Iran which are not consistent with standardized guidelines and recommendations. This survey and resulted information suggest areas for interventions to improve the pediatrician knowledge about asthma and the disease management.

Background: Coronary artery disease is one the most common causes leading to death in current societies. Coronary artery bypass grafting is considered as an important therapeutic measure. However, there are various factors affecting the survival and the outcome of the patients. This study has been performed with the aim of defining the prevalence of different risk factors in patients with coronary artery disease and the relationship of post-operative mortality with these risk factors. Material and Methods: In a case- series study, the medical records of 543 patients who underwent elective coronary artery collected data was analyzed using SPSS soft ware. bypass graft surgery in Imam Khomeini Hospital during the year 2003 were studied retrospectively.Results: The mean age of the patients was 55.81(±19.35) years, including 439 men (80.8%) and 104 women (19.2%). Of the men, 20.3%hC had diabetes mellitus, 27.3% were hypertensive and 35.5% had hypercholesterolemia. The prevalence of diabetes mellitus, hypertension and hypercholesterolemia in women was 30.8%, 54.8% and 48.1% respectively. A total of 177 patients were hypertensive, 121 had diabetes mellitus, 206 had hypercholesterolemia and 199patients were smokers. Overall hospital mortality was 2.6%.Ofthe patients who died, 35.7% were diabetic (P=0.016), 21.4%had hypercholesterolemia (P=O.013), 28.6% had hypertension and 58.3% were smokers (P<0.05). The rate of mortality in patients above 60 was more than twice in comparison with younger patients (P= 0.013).Conclusion: Our findings showed that diabetes mellitus, hypertension, hypercholesterolemia and smoking had close relations with post operative mortality in patients underwent CABG. We found no statistically important difference between the mortality of men and women. However, age played an important role in postoperative mortality.