TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2006 | Volume:63 | Issue:12|Papers Count:12

Background: Tracheal intubation may be accomplished with remifentanil and a nonopioid intravenous anesthetic agent without a muscle relaxant. In this study, we compared propofol + remifentanil with thiopental + remifentanil without using muscle relaxant for hemodynamic responses and intubation conditions.Materials and Methods: In 100 ASA class I and II patients scheduled for elective surgery less than 1 hour duration were randomly assigned to two equal groups. After premedication with midazolam 0.03 mg/kg intravenously, remifentanil 4mg/kg were given in each group. In group I, propofol 2.5mg/kg and in group II, thiopental 5mg/kg were given intravenously. After 90s, trachea was intubated. Intubation conditions were classified by the anesthesiologist performing the intubation as: excellent, good, fair and poor. Systolic, mean, diastolic arterial blood pressure and heart rate were recorded as baseline, after the induction and 1, 3, 5, 10, 15 min after the intubation. Data were analyzed by chi-square, independent t-test, paired t-test and fisher's exact test. P<0.05 was statistically significant.Results: The tracheal intubation conditions were excellent in 60%, good in 32% and fair in 16% of group I and 42%, 42%, 16% in group II (p=0/166). In group I, 52% and in group II, 24% need intravenous ephedrine for treatment of hypotension (P=0.004). Atropine were given intravenously in 4 patients of group I and non of group II for bradycardia (P=0.059).Conclusion: The results suggest that propofol 2.5 mg/kg + remifentanil 4mg/kg compared with thiopental 5mg/kg + remifentanil 4mg/kg has no priority for tracheal intubation condition but with more hemodynamic changes.

Background: Rate and eventual success of healing of bone fractures depend on factors such as: age, hormonal milieu, degree of trauma and particularly mechanical environment. Several investigators have demonstrated positive effect of controlled cyclic mechanical strain on fracture healing, but optimal parameters have not yet been established. The purpose of this study was to examine the effect of a well defined mechanical stimulation, externally applied to bone fixator, on the process of bone healing.Materials and Methods: A randomized, prospective in vivo animal study was designed. Sixteen skeletally mature white rabbits (2-2.5 kg) were randomly assigned to four groups of four animals. A four- pin, double bar external fixator was fixed to the right tibia. The mid shaft of the tibia was then osteotomized, leaving a 2 mm gap.External stimulation was performed on eight rabbits with the use of a motor- driven actuator unit. The actuator could provide a well controlled axial cyclic compressive movement to the osterotomized gap with frequency of Hz, amplitude of 0.5 mm and duration of 15 minutes per day; started 1 week after the operation and continued for 2 or 3 weeks. A force transducer built into the actuator measured the resisting force during application of the strain to keep the force lower than 50 N. The animals were sacrificed on postoperative day 14 or 21. callus quality and area were assessed by X-ray radiographs, and mechanical properties of healed bone were determined using a standard three- point bending test.Results: Statistical significance was evaluated using nonparametric Mann- Whitney U test. Callus quality and area, and applied forces and total energy absorbed at failure point were significantly superior on the stimulated groups compared to the controls (P< 0.05). These differences were higher in 3 weeks postoperative. Conclusion: Current study demonstrates the sensitivity of fracture healing to direct low frequency low amplitude mechanical stimulation. Our findings are consistent with the other's observations that there is an interesting relationship between bone formation and mechanical strain histories. Continuing studies with more sample size with aim to the precise strain environment and its relationship with potential mechanisms of bone healing.

Background: Many women enjoy regular Exercise and may wish to continue exercise after they become pregnant but poor knowledge of basic safety techniques could lead to injuries. On the other hand exercise during pregnancy has many advantages that both mothers and fetus could benefit from. The main aim of this study was to determine knowledge of pregnant women who refer to prenatal clinic in Shariati Tehran University. Imam Khomeini and Mirza Kouchak - Kahn Teaching hospitals.Materials and Methods: Four hundred pregnant women were asked to complete a valid questionnaire. Providing an erasure visor of women's knowledge.Results: The level of their knowledge was as fallows: 7 (1/8%) very good 42 (10/5%) good 67 (16/8%) moderate. 121 (30/3%) poor and 163 (40/8%) very poor. There was no significant difference in women with higher level of education and lower level of education.Conclusion: However this study indicated that most women had poor knowledge about method' and intensity of exercise during pregnancy. Which urges raising awareness in mother to be!.

Background: In recent years, the rate of cesarean section has been increased in the country because of several reasons. The most important cause was recognized to be no suitable intervention. This study was descriptive due to determine relationship between nullipara admission at latent phase and active phase on rate of cesarean section and cause of cesarean section.Materials and Methods: This study performed on 795 women referring to Hospital. The first line of Approach for the two groups was vaginal delivery. The first group include 466 patients nullipara admitted during the latent phase in labor room and the second group included 329 patient nullipara admitted during the active phase in labor room.Results: The rate of cesarean section in first group was 65 percent and second group was 25 percent. (p<0.001). The most common cause for performing cesarean section in two groups were been fetal distress. In the latent phase group fetal distress was 37 percent and in the active phase group fetal distress was 51/2 percent. The second leading cause of cesarean section in two groups showed that dystocia. (p=0/13).Conclusion: from the results of this study it is concluded that more cesarean section operation are performed in women admitted during the latent phase of labor.

Background: Transient tachypnea of the newborn (TTN) occurs in of deliveries. It seems that it's more frequent in cesarean deliveries, therefore the frequency of TTN and its relationship to probable risk factors was assessed in term cesarean deliveries in Shariati hospital.Materials and Methods: In a retrospective study on 762 mothers and 774 neonates which had been delivered by cesarean method maternal age, gestational age, neonatal gender, maternal asthma and diabetes and frequency of TTN was determined and the relationship between TTN and maternal asthma and diabetes was assessed by X2 and Fisher exact test.Results: There were 11 (1.4%) cases of TTN in 774 neonates. There were a significant statistical relationship between TTN and maternal diabetes (8% v.S. 1.8%, p= 0.014 cr = 95%) and maternal asthma (30% v.s 1%, P = 0.005, cr = 95%).Conclusion: The study showed that TTN is more frequent in cesarean deliveries and maternal asthma and diabetes are risk factors for its occurrence.

Background: The nuchal cord is a common phenomenon at birth so there is somehow a general belief that it is a natural part of intrauterine life. Is the nuchal cord cause fetal distress? and if there is relationship between nuchal cord and number of coils with birth weight. Low birth weight is one of the sign of fetal distress. Low birth weight at birth cause reduction of quality of life and induce long term morbidity so these fetus should recognized and they should receive more and better care. Materials and Methods: In this cross sectional survey 252 neonates with nuchal cords that were borne in Mirza Kochak Khan hospital in 1381-1382 were evaluated.Maternal factors like age, gravidity, parity, history of nuchal cord in previous pregnancy, birth weight maternal weight gain, diabetes mellitus, hypertensive disorder were evaluated. Neonatal factors like gestational age, sex of neonate, birth weight, number of nuchal cord were detected.Results: Range of maternal age was 17-43 years old, most of mother with neonatal affected by nuchal cord were multipara, one coils in 179(71%), two cords in 25/8%, 3 coil in 7 case, 4 coils in 1 case was found.111 female, 141 male neonates were present in this survey. gestational age was between 30-42 weeks, 185 normal vaginal delivery and 67 cesarean section was done.Conclusion: We find that if number of nuchal cord is high, it has reverse relationship with birth weight. Neonatal sex has no effect, but number of male sex was higher, in term incidence of nuchal cord is increased. The relationship was not statistically significant, may be due to more and better care in Mirza hospital that is a university center, with educated patient.

Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management. But due to nonspecific signs and symptoms it's diagnosis in children is difficult. Recently procalcitonin has been used for diagnosis of serious bacterial infections like bacterial meningitis. We conducted a prospective study in children for evaluation of procalcitonin in differential diagnosis of acute bacterial and viral meningitis. The aim of this study was the Evaluation of sensitivity and specificity of CSF proca1citonin levels in differentiation between bacterial and viral meningitis in children older than two months, in Markaz Tebbi hospital, during 1382-1383.Materials and Methods: In a prospective process research, we measured CSF procalcitonin levels in 43 children older than two months referred to Markaz Tebbi hospital. According to the results of universal PCR the patients were divided into two groups: bacterial meningitis (n=11) and nonbacterial meningitis (n=32). To analysis the results, Mann-Whitney test was used.Results: CSF proca1citonin level in bacterial meningitis was significantly higher than viral meningitis (1.72±0.9ng/ml and 0.71±0.04 ng/ml respectively, P value= 0.00). A serum procalcitonin level> 0.5 ng/ml had high sensitivity and specificity (90.1% and 97.1% respectively) in the diagnosis of bacterial meningitis.Conclusion: CSF procalcitonin level seems to be a valuable marker in differentiating between bacterial and viral meningitis.

Background: Bacterial meningitis is a serious and occationaly lethal infection that affects central nerves system. Reamophilus influenzae type b, streptococcus pneumonia, E. coli, and streptococcus agalactiae are agent 95% of pediatrics meningitis.Materials and Methods: Custom laboratory methods such as culture that used for detection agent-caused meningitis take up 36 hours. In addition following antimicrobial therapy prior sapling, its found that efficacy of culture in detection of meningitis caused microorganisms is about 30 %. Then non-culture methods such PCR are used. Thirty thousand of CSF from Tehran Medical Center of Children was collected during from 1381 to 1382. Then culture and PCR by using specific primers was done for detection.Results: Thirty-two samples out of 300 total samples was culture positive, that Rib was detected in 5 cases. In addition of five cultural positive cases of Rib, two other cases were detected by PCR.Conclusion: This study showed that Rib is agent 15.6% of pediatrics bacterial meningitis. Also comparison culture and PCR showed that later method have sensitivity and specificity, 100% and 99%, respectively. With regarding to rapid detection and cure of meningitis is essential, then providing exiting instrument for PCR, using of this method is advised.

Background: In recent years there have been considerable cases of respiratory tract disease with high morbidity among Hajj pilgrims. Therefore, prevention and control of the disease will be necessary and needed to know its etiologic agent. It is obvious that environmental microbial agents have important causative role in respiratory tract diseases. Among them fungi include a diverse array of organisms which are found widely in nature. The spores of fungi spread through the air and remain airborne for prolonged periods. Fungi in the air are being proposed as a cause of adverse health effects and exposure to fungi has been reported to cause infections, allergies and even toxic effects. The present study was undertaken to determine the role of fungi as presumptive etiologic agents of respiratory tract disease in Iranian Hajj pilgrims during Hajj 1383 (2005).Materials and Methods: This study was carried out by culture of environmental specimens which obtained from the Iranian pilgrims' campus in Mecca, Medina, Mina and Arafat for detection of fungal elements and using serological tests for diagnosis of fungal infections in 146 Hajj pilgrims. These tests were done on two blood samples within 8 weeks intervals in each case.Results: Culture of environmental specimens totally yielded 3521 colonies of 23 different genus and species of fungi. Isolated organisms consisted in filamentous saprophytic fungi 79%, filamentous pathogenic fungi (dermatophytes) 3.6% and yeasts 17.4%. Aspergillus spp. were the most common (43.4%) isolated fungi in this study. The results of counter-immuno-electrophoresis and latex agglutination tests that were used for diagnosis of aspergillosis, candidiasis and cryptococcosis among the pilgrims all were negative.Conclusion: Although the results of this study don't implicate the role of fungi as causative agents of respiratory tract disease in Hajj pilgrims. But since exposure to fungi cause different adverse health effects and clinical diagnosis of them is difficult and because the fungi have effects on immune system and predispose the patients for other infections or fungal diseases manifestate as secondary infections, further study VDI.63.NDIYI.ear 2DD6I will be needed if the respiratory disease of Hajj pilgrims will be continues in future 152 years.

Background: The present study was undertaken to define prognostic factors in adult acute meningitis patients to improve the therapeutic strategy for this disease.Material & Methods: Over ten years (1991-2001), 131 patients were identified in a cross sectional study as having bacterial meningitis in three university referral hospitals (Imam, Shariati, Sina ), and prognostic factors evaluated to determine CNS complications and outcomes.Results: Age and patients mental status on admission and delay in referring to hospitals were important predisposing factors. (p=0.003, p<0.001). The most frequent pathogen in CSF culture was pneumococcus and although gram negative bacterial were rare, but they have fatality rate of 90 percent.Conclusions: Despite the availability of new antibiotics, bacterial meningitis is associated with a high mortality and squeal rate, so efforts should be directed toward early initiation of appropriate antibiotic therapy, especially in old age groups and patients with initial changes in mental status in this potentially fatal disease.

Background: Daily activities have dynamic muscle contractions, which produce non-stationary myoelectric signals in electromyographic recording. When muscle force changes, some variations occur in number of motor unit, sites of nervous system, value and kinds of motor units. These factors affect on shape of motor unit action potential (MUAP). Therefore can produce significance changes in electromyography evaluations. The propose of this study is to determine ability of spectrum frequency values, in detection of changes following muscle force variations.Materials and Methods: Twenty healthy subjects participated in this study. Electromyography was recorded during maximum isometric contraction of biceps bracheii muscle in two angles of 45 and 90 degrees of elbow flexion, against dynamometer. Median and mean frequency of muscle activities, muscle force estimation and muscle torque were measured and analyzed.Results: Median and mean frequency in 45 angle in comparison to 90 angle reduced significantly (p< 0.05). There was significance difference between torque that produced from two different angles. So as in 45 degree increase of torque appeared (P< 0.05). There was negative correlation between torque in 90 angle with mean and median frequencies respectively (r = - 0.77, P = 0.01), (r=- 0.69, P = 0.03).Conclusion: Muscle geometry has high effect on torque and frequency spectrum in maximal contraction. Following variations of length and joint angle, mean and median of frequency spectrum will be change, and therefore these two variables can produce valid estimation of muscle performance.