TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2006 | Volume:64 | Issue:4|Papers Count:16

The purpose of this paper is to provides general information about avian influenza (bird flu) and specific information about one type of bird flu, called avian influenza A (H5N1), that has caused infections in birds in Asia and Europe and in human in Asia. The main materials in this report are based on the World Health Organization (WHO), world organization for animal health (OIE), food and agriculture organization of the United Nations (FAO) information and recommendations and review of the published literature about avian influenza.Since December 2003, highly pathogenic H5N1 avian influenza viruses have swept through poultry populations across Asia and parts of Europe. The outbreaks are historically unprecedented in scale and geographical spread. Their economic impact on the agricultural sector of the affected countries has been large.Human cases, with an overall fatality rate around 50%, have also been reported and almost all human infections can be linked to contact with infected poultry.Influenza viruses are genetically unstable and their behavior cannot be predicted so the risk of further human cases persists. The human health implications have now gained importance, both for illness and fatalities that have occurred following natural infection with avian viruses, and for the potential of generating a re-assortant virus that could give rise to the next human influenza pandemic.

Background: The aim of this study was to determine the effect of two different regimes, containing different carbohydrate to protein ratios on performance, serum glucose and insulin after exercise in soccer players in Tehran; Iran.Methods: Nineteen male soccer players under training [age=; 17/5 +/-1.5 (SE) yr] were selected and completed two sequential trials separated by 1 week, in a paired cross-over study design. In each trial, subjects after running to fatigue; received one of three regimes, using a random- order design as follows: HPRO (CHO 56%, PRO 19%& fat 25% of total energy); HCHO ( CHO 64%, PRO 11% & fat 25% of total energy) or control ( CHO 60%, PRO 15% & fat 25% of total energy). The calorie of 3 regimes was equal. After consumption of meal up to 120 min, blood was obtained before and at intervals. After 3 hours athlete performance was measured.Results: The study indicates no significant difference in the serum insulin and glucolie response among three regimes (P>0.05).There was no difference in performance between three regimes after 3 h (p>0.05).Conclusion: The results suggest that post exercise regimes have no influence on performance, serum glucose and serum insulin. Thus total energy content and carbohydrate content may be important in recovery after exercise.

Background: Pruritus is one of the most common problems in patients suffering chronic renal failure. Twenty five - 35% of predialysis patients and 60-80% of patients during dialysis complain pruritus.The exact pathophysiology of pruritus is unknown; however, some possible interactive factors include: histamine release from mast cells and basophiles, uremic skin, cutaneous mast cells proliferation, adipose cells atrophy, electrolyte imbalance, and accumulation of bile acids. Since histamine is the main proposed mediator in pruritus, the goal of this study was to evaluate the role of antihistamines in controlling of pruritus of patients with chronic renal failure. This study was done as a before - after study during one year period in dialysis department of Imam Khomeini hospital.Methods: Thirty patients complied with inclusion criteria were entered in the study.Treatment strategy was: 2 weeks treatment with hydroxyzine 25 mg TDS, followed by one week wash-out period, then 2 weeks ketotifen therapy 1mg BID and finally two weeks treatment with chlorpheniramine 4mg BD following one week washout period after ketotifen therapy. Pruritus severity before and after each treatment period was evaluated with Pruritus Severity Score (PSS) chart.Results: The mean PSS reduction by hydroxyzine, ketotifen and chlorphenirarnine, were 33%, 4.5% and 20%, respectively.Conclusion: PSS improvement with hydroxyzine and chlorpheniramine was statistically significant (p<0.001). However, ketotifen induced pruritus reduction was not considerably significant.

Background: Injection drug use (IDU) in Iran is not rare and is one of the main factors in opioid overdose. The objective of this study was the qualitative assessment of overdose, related factors, and available interventions.Methods: A qualitative method was employed. Six districts of Tehran with a population of 400,000 inhabitants were selected. The districts were different in socioeconomic characteristics, urban structures and prevalence of IDU and crime. A total of 81 key informants from different sectors and 154 injection drug users (IDUs) were selected by purposeful, opportunistic and snowball sampling, and interviewed individually or in groups. Ethnographic observations were done for studying the life situation of IDUs.Results: In one district no cases of IDU were found. In other districts, overdose in IDUs was reported to be common. Heroin injection alone or in combination with other drugs was the main reported cause of overdose. Reportedly, wrong estimation of drug purity was the most important reason. Even in the districts with highest rate of IDU and overdose, most clinics and hospitals did not have enough facilities necessary for management of acute opioid overdose.Conclusion: According to the high prevalence of overdose, provision of preventive education of drug users and their relatives and availability and accessibility of emergency services is highly recommended.

Background: The etiology of End Stage Renal Disease (ESRD) in every community differs according to genetic, nutrition, and public health status. ESRD, the terminal stage of chronic renal failure, needs replacement therapy otherwise could lead to death.The aim of the study is to determine the relative frequency of ESRD etiology in hemodialysis patients of Gilan province.Methods: This descriptive study was performed on 407 patients who were being hemodialysisin all hemodialysis centers of the Gilan province from September 2002 to September 2003. The original data was collected from the medical records of patients.Results: The most prevalent causes were: hypertension 35.4%; unknown etiology 16.2%; diabetes mellitus 13.8%, glomerulopathies 9.6%, urologic causes 9.1%, cystic kidney diseases 7.6 %; other causes 5.9 %; congenital 2.5%.Conclusion: In our study hypertension was the first etiology of ESRD, followed by unknown causes, however nephrology textbooks indicate diabetes mellitus as the primary and hypertension as the secondary etiology of ESRD.

Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory.Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40), elective C/S under general anesthesia (n=35) and C/S under spinal anesthesia (n=25).Duration of anesthesia and its effect on blood gas and infants apgar were assessed.Results: In the first group (vaginal delivery) mean blood gase parameters were; pH=7.306±4.73, PO2=25.24±6.87, HCO3=20.56±2.03, Apgar=8.82±0.38 and pCO2=41.82±6.57. In the second group (general anesthesia) mean blood gaze parameters were: pH=7.304±4.73, PO2=38.70±4.02, PcO2=43.26±5.87, HCO3=21.111±3 and apgar score=8.17±0.7. In the third group (spinal anesthesia) mean blood gaze parameters were: pH=7.301±4.50, pCO2=44.1±4.99, HCO3=21.38±2.15, PO2=26.62±5.5 and apgar=8.60±0.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO. With increasing duration of anesthesia, PO2 was reduced. Between the type of delivery and anesthesia duration with PH, PO2 PCO2 and HCO3 were not meaningful relationship (P<0.05).Conclusion: Then: was no significant difference between type of delivery and umbilical blood gas parameters. Neonatal apgar score in NVD is higher than the other groups. With increasing duration of general anesthesia in C/S, mbilical Po2 is reduced.

Background: Although many agents have been used for migraine prophylaxis, little evidence is available to support their efficacy in children. Sodium valporate is one of the drugs that has been proved effective in adults. To compare the effectiveness and safety of sodium valportate and propranolol in childhood migraine, this study was designed.Methods: A 15 months open labeled crossover clinical trial was carried out having a 4 week medication free baseline phase and a 8 week treatment phase for each drug and a 4 week wash out period before crossing over. Fifty two patients started the study and we missed 4 of them due to poor compliance. Forty eight patients (23 girl and 25 boys) were randomized to sodium valporate or propranolol (1:1 ratio) treatment group.Results: The response to treatment was evaluated on basis of frequency and severity of migraine attacks. Sixty percent of valporate treated patients and 78 percent of propranolol treated ones showed 50% or greater reduction in headache frequencies from the baseline phase.Thirty one percent of valporate and 45 percent of propranolol treated group revealed at least one grade improvement in functional restriction. McNemar statistical analysis didn't show remarkable difference between groups concerning both frequency (κ2=2.4) and severity (κ2=3.36). No serious side effect was seen during treatment.Conclusion: Sodium valporate was generally well tolerated in this study and showed favorable efficacy in childhood migraine.

Background: Rotator cuff tendon tear injury is one of the most frequently seen orthopaedic conditions, and surgical repair of rotator cuff tears is a common procedure.The purpose of the present study was to determine the results of full-thickness rotator cuff repair and to look for predictors of outcomes.Methods: we studied 27 patients (17 men and 10 women with a mean age of 57.7 years) who underwent open rotator cuff repair surgery for full-thickness tear between 2001 and 2005 at the Imam Khomeini Hospital and were subsequently followed-up for 6 and 12 months after surgery. The shoulder function was assessed by Constant classification and factors potentially associated with outcomes were.Results: The mean of preoperative Constant score (CS) was 45.8±14.1 after 12 months, 6 patients (22.2%) had good results and 21 patients (77.8%) had excellent result according to CS. Pain relief was generally satisfactory. Using multiple regression analysis, treatment was significantly correlated preoperative CS and acromio-humeral interval (AHI) however, no correlation was found between the result of the treatment and pretreatment atrophy, tear size, acromial morphology, preoperative symptom duration and age.Conclusion: In this study, a standard rotator cuff repair technique reduced pain severity and was associated with good results, however larger studies are necessary to define the long-term outcome of this procedure.

Background: The aim of the study was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant women.Methods: In a cohort study, 1,500 pregnant women attending Hazrat Zeinab Hospital for prenatal care and delivery in the period 2000-2001, 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 and gestation at delivery. Linear and logistic regression models were used to analyze data.Results: Severe anemia (hematocrit< 24%) was associated with a significantly increased risk of low birth weight (<2500 g) 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.Conclusion: Severe 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. Improved nutritional status of young women could contribute to improved health among their infant.

Background: Non-palpable undescended testis (NUDT) is one of the problems encountered in pediatric surgery. As studies show, about 30-40 % of NUDT is associated with intraabdominal testis (IAT), in the case of IAT various surgical techniques have been presented for example multistage orchiopexy, orchiopexy by microvascular anastomosis, orchiopexy by transaction of spermatic vessels at two stages, hormonal manipulation, in which there is no definitive success and there are several associated complications. Orchiopexy in one stage by transaction of spermatic vessels of the base of vas artery is a suitable method.Methods: This study is descriptive and prospective and was performed in Bahrami and Tehran children hospital from 2000-2001 on intraabdominal undescended testes. The patients were followed for at least 2 years.Results: From 31 patients, 70.9% were over 4 years old, 93.5% were hospitalized over 3 days, and operation time in 64.5% was lower than 3 hours.The most common early complication was vomiting (16.1%) and the most common late complication was wound infection (6.5%). There was a %80/6 chance of testicular anomaly. In follow up period, there was no decreasing in testicular size.Conclusion: One stage orchiopexy by spermatic vessel transaction is a safe technique with high success rate and low complication rate with acceptable increase in operation time and hospital stay. Based on our experience, we recommend this technique for non-palpable undescended testis.

Background: Acute bacterial sinusitis is one of the most common causes for antibacterial treatment.Oral Penbactam (ampicillin- sulbactum or Sultamicillin) is a broad spectrum antibiotic and it has no significant side effect.To our knowledge, this is the first study in Iran in which, oral Penbactam has been prescribed for patients with acute bacterial sinusitis.Methods: A randomized clinical trial was performed on 44 outpatients diagnosed with acute bacterial sinusitis in Amir- Aalam Hospital from March 2003-2004 to August 2004. Patients were randomized in 2 group: 23 to oral Penbactam (375 mg twice daily), and 21 to oral Co-amoxicolav (625 mg three times daily). Duration of treatment was 10 days for both groups.Results: Both groups showed a significant clinical improvement after 10 days of treatment. In the Penbactam group, 19 of 23 (86.36%) and in the Co-amoxicolav group, 18 of 21 (85.71%) showed clinical improvement.In the Penbactam group, one patient (4.3 %) developed diarrhea and the medication was discontinued.Conclusion: Oral Penbactam is an effective and safe antibiotic in the treatment of acute bacterial sinusitis and could be used as an alternative medication for acute bacterial sinusitis.