TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2007 | Volume:64 | Issue:10|Papers Count:18

Background: Microalbuminuria (MA) is associated with increased cardiovascular risk in hypertensive patients, but not many studies have specifically examined the effects of MA-lowering on regression of left ventricular hypertrophy (LVH) among pediatric patients with hypertension.Methods: Fifty-five patients with essential hypertension, 11 to 19 years old were prospectively studied. All patients received concomitant therapy of hydrochlorothiazide and angiotensin- converting-enzyme inhibitor. Five patients also required angiotensin- receptor blocker to achieve the blood pressure goal. Baseline and 12-month follow-up measures of left ventricular mass index (LVMI) determined by echocardiography and urine microalbumin/ creatinine ratio (MA/Cr) were collected. MA was defined as MA/Cr>30. LVH was defined as LVMI>38.6 g/m2. The primary end points were 25% or more reductions in MA and the LVMI.Results: Weight (r=0.83), body surface area (r=0.85), body mass index (BMI) (r=0.86), systolic blood pressure (SBP) (r=0.57), diastolic blood pressure (DBP) (r=0.49), mean arterial pressure (r=0.53) and MA (r=0.87) were all univariate correlates of LVMI. In a multiple regression analysis, MA, BMI and SBP were significant correlates of LVMI. MA alone explained 76% of the variance of LVMI, whereas BMI and SBP explained only 1.6% and 0.4% of the variance, respectively. MA was the most significant correlate of follow-up LVMI after BMI and SBP were included in the overall multiple regression models.Conclusion: MA is a strong predictor of LVH in hypertensive children and adolescents. MA-lowering halts the progression of LVH or induces its regression.

Background: The currently accepted treatment of scoliosis is bracing and surgery. Two-stage anterior and posterior spinal fusion is used to correct scoliosis. It seems that the application of a longitudinal force to the axis of the spinal column as a means of stabilizing by halo traction may increase the correction of the curve. The aim of this study was to evaluate the effect of halo traction used between the two stages of corrective surgery, anterior and posterior spinal fusion, on the correction of scoliosis curvature.Methods: In this randomized clinical trial twelve scoliotic patients, aged from 12-19 years old, were treated by two- stage anterior spinal release and fusion (ASF) and posterior spinal fusion (PSF). The patients were divided in two groups: 6 scoliotic patients without any traction between ASF and PSF surgeries (group A), and 6 scoliotic patients were undergone halo traction for one week between ASF and PSF surgeries (group B). Major curve angle was measured before surgery, one week after ASF and one year after PSF surgeries. Data were collected and analyzed using SPSS v.13.5.Results: The mean baseline curve angles were 90o (SD=18.70) and 94.17o (SD=28.18) in groups A and B, respectively. Whereas, the mean final curve angles (one year after PSF) were 51.17o (SD=29.59) and 39.17o (23.11( in groups A and B, respectively. Final angle improvement was 46.58% (SD=20.31) in patients without traction and 61.32% (SD=14.02) in patients with halo traction. The major curve angles showed significantly better correction in patients with traction one week after ASF [38.67o (SD=7.86) vs. 25o (SD=6.28), P=0.012]. This difference persisted at the end of the first year after operation. [55o (SD=8.94) vs. 38.83o (SD=11.65), P=0.022].Conclusion: Application of halo traction between ASF and PSF surgeries may lead to better improvement of the scoliotic curvature and short time application of halo traction decreases possible complications.

Background: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. The clarithromycin–based regimen is not cost – effective for developing countries and also there is a lot of evidence about increase of clarithromycin resistance H-pylori. Furazolidone is a good substitute, but several side effects, limit its widespread use our previous revealed that most of side effects occurred in the beginning of second week of treatment, so decrease the period of furazolidone therapy to one week may be considered. The aim of the present study was to assess the efficacy and side effect of one week furazolidone in combination with bismuth subcitrate ,amoxycillin and omprazole.Methods: In this study, a total of 177 patients were enrolled and randomized to two groups and received the following medications: Group I: omprazole 2×20mg + amoxycillin 2×1gr + bismuth subcitrate 4×120 mg for two weeks and furazolidone 2×200mg for 1 week; Group II: the same regimen as in group I except that one week furazolidone in group II patients followed by one week metronidazole 2×500 mg/day (one week furazolidone and one week metronidazole).patients were followed after 2 weeks for side effect of drugs and compliance and control endoscopy was performed after 6 weeks and three biopsies spicimens from the antrum and three from the corpus were taken for a urease test and histology. Eradication was concluded if all the tests were negative for H-pylori.Results: One hundred fifty seven patients completed the study. Mean age was 38.84+10.42 and 55.4% were male and 44.6% were female. Two patients from group I and three patients from group II did not tolerate the regimen and were excluded from the study. No serious complication was detected in two groups. The eradication rate per protocol analysis and intention to treat analysis were 89% and 79.3% in group 1 and 86.6% and 74.4% in group 2.No significant statistical differents between two groups (P=0.32 , P=0.33).Conclusion: One week furazolidone in combination with two weeks amoxicillin, omprazole and bismuth subcitrate is a good, safe and cost effective regimen for eradication of H-pylori. Addition of metronidazole in the second week of treatment period did not increase eradication rate.

Background: Adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass graft (CABG). This study was designed to evaluate the effect of ascorbic acid as an adjunct to beta-blockers in prevention of post-CABG atrial fibrillation.Methods: Patients who were more than 50 years old and scheduled to undergo CABG were included if they were treated with beta-blockers at least 1 week before surgery. Patients with previous history of atrial fibrillation, AV block, heart rate <50 /min, end-stage renal disease, severe pulmonary or liver disease and those who were taking digoxin or class I and III anti-arrhythmics or had pacemakers were not included. Ascorbic acid group were prescribed 2 gm of ascorbic acid, the night before the surgery, and 1 gm twice daily for 5 days after surgery. Beta blockers continued in both group after surgery. Telemetry monitoring was performed in ICU and Holter monitoring was performed for 4 days.Results: Fifty patients completed the study as ascorbic acid and 50 as control group. The population was 60.19 ± 7.14 years old and 67% were male. The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in control group (odds ratio=0.119, 95% confidence interval: 0.025 to 0.558, P=0.002).Conclusion: Ascorbic acid is well-tolerated, relatively safe and seems effective. Therefore it can be prescribed as an adjunct to beta-blockers for prophylaxis of post-CABG atrial fibrillation.

Background: Radiofrequency has recently been used in treating tonsilar hypertrophy in adults. We evaluated the results of partial resection (volume reduction) of tonsil using this method.Methods: Twenty patients with tonsilar hypertrophy were enrolled in a quasiexperimental before-after clinical trial. Local anesthesia was achieved by utilizing lidocain spray and then injection of lidocain and epinephrine, then radiofrequency was performed at power=7-8w. Bleeding, pain and need for analgesics were assessed during, immediately, 4, 6, and 8 weeks after operation.Results: The mean pain scale was 2.68±2.11 according to (VAS) and the mean bleeding amount was 1.16±0.24ml during operation. The mean operation time was 7.81±2.56min. Ten percent of our patients did not have pain immediately after surgery while 55% complained of pains that did not warrant using analgesics and the remaining 35% experienced pains that were alleviated by analgesics. During and immediately after operation 95% of the patients experienced mild bleeding and only one patient (5%) had moderate bleeding (2-5ml). Mild bleeding was only reported in 10% of patients during the first 4 weeks after operation and was not seen in patients in following weeks. The grade of tonsilar hypertrophy decreased in all patients and the mean time of symptom disappearance was 7.81±0.36 in 8 weeks. Finally the mean satisfaction rate of the patients was 66.92±12.5% (ranging from 50% to 80%). Mild complications were reported in 15% of patients.Conclusion: Radiofrequency is a safe procedure with minimum possible complication rate for tonsilotomy.

Background: Major thalassemia is relatively common in Iran and in looking of their need to recurrent transfusion; their high risk for acquisition of HCV is revealed. These patients also suffer form liver hemosiderosis that accelerate disease excursion to cirrhosis and hepatocellular carcinoma. In this study combined therapy with interferon and amantadin has been evaluated.Methods: This prospective clinical trail has been done on thalasemic patients that had been contaminated by HCV and had laboratory signs of hepatitis. During years of 81-82, 26 patients admitted at Children Mmedical Center with major thalassemia and HCV hepatitis. Inclusion criteria were positive HCVRNA, high ALT and histologic evidence of hepatitis in liver biopsy and exclusion criteria were history of incomplete treatment any contraindication of IFN or amantadin-emergence of drugs adverse reactions, to intending of these criteria 10 case of them had situation for treatment and follow-up.Results: In 10 cases, treatment with IFN α - 2b in doses 3 mu for every square meter of body surface three times in week subcutaneously and cap. Amantadin in doses 100 mg po B.d for 6 months was done and after it, 8 cases were negative for HCV-RNA (8%) and in 6 patients, ALT turned to normal (60%) and in 2 other case ALT decrease to lower than 50% of pretreatment value. None of them showed drug adverse reactions and response to therapy was better in lower ages. No relation between response to therapy and liver hemosiderosis, inflammation and sexuality was found.Conclusion: Combined therapy with IFN and Amantadin is effective in HCV treatment and for lower recurrence, treatment period longer than 24 wk, such as 48 wk is recommended.

Background: Both hypoxia and hypocapnia can cause broncho-constriction in humans, and this could have a bearing on performance at high altitude. The objective of this study was to examine how pulmonary ventilatory function during high-altitude trekking.Methods: This study was a before and after study on spirometric parameters at Base line (1150 m above sea level), and after ascending at 4150 m above sea level. This study was performed in summer 2004 at Cialan Mountain in Iran. Fifty six healthy male University student volunteers were enrolled in the study. Respiratory function was assessed in participants before ascending at baseline (1150 meter) and after ascending at 4150 meter in Cialan Mount with a Spirolab II. Spirometric parameters changes were compared using paired t-test statistical analysis computations were performed by spss 11.5 and p≤0.05 was considered significant.Results: The mean age and body mass lindex of our subjects were 22.9±5.3 years and 21.5±2.5, respectively. Forced vital capacity (FVC) was significantly decreased with increasing altitude from baseline level (P<0.01). Forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) and maximal midexpiratory flow rate (FEF 25-75%) were significantly increased with increasing altitude (P=0.001). There was no significant change in forced expiratory volume in 1 second and peak flow (P>0.05). FVC fell by the average of 7.1% at 4150m (2.4% per 1000m increased altitude) in comparison to 1150m.Conclusion: The changes in some pulmonary ventilatory parameters were proportional to the magnitude of change in altitude during a high-altitude trek.

Background: The objective of this study was to describe the audiologic and related characteristics of a group patient with speech perception affected out of proportion to pure tone hearing loss. A case series of patient were referred for evaluation and management to the Hearing Research Center.To describe the clinical picture of the patients with the key clinical feature of hearing loss for pure tones and reduction in speech discrimination out of proportion to the pure tone loss, having some of the criteria of auditory neuropathy (i.e. normal otoacoustic emissions, OAE, and abnormal auditory brainstem evoked potentials, ABR) and lacking others (e.g. present auditory reflexes).Methods: Hearing abilities were measured by Pure Tone Audiometry (PTA) and Speech Discrimination Scores (SDS)), measured in all patients using a standardized list of 25 monosyllabic Farsi words at MCL in quiet. Auditory pathway integrity was measured by using Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE) and anatomical lesions Computed Tomography Scan (CT) and Magnetic Resonance Image (MRI) of brain and retrocochlea. Patient included in the series were 35 patients who have SDS disproportionably low with regard to PTA, absent ABR waves and normal OAE.Results: All patients reported the beginning of their problem around adolescence. Neither of them had anatomical lesion in imaging studies and neither of them had any finding suggestive of conductive hearing lesion. Although in most of the cases the hearing loss had been more apparent in the lower frequencies (i.e. 1000 Hz and less), a stronger correlation was found between SDS and hearing threshold at higher frequencies. These patients may not benefit from hearing aids, as the outer hair cells are functional and amplification doesn’t seem to help; though, it was tried for all.Conclusion: These patients share a pattern of sensory –neural loss with no detectable lesion. The age of onset and the gradual deterioration are remarkable. It seems that this is a new category of sensory –neural haring loss which deserves more attention.

Background: According to some previous reports prevalence of addiction estimated to be 3 ٪in Iran. One of the most important key points about addiction is the identification of predisposing factors for starting substance use. False general believes can play important roles in this regard. This study evaluated the demographic characteristics of opioids addiction and the visions of them about the effect of opioids on their cardiac diseases.Methods: This cross-sectional analytical study intended to evaluate situation of opiate dependency among 1329 CABG patients in Yazd Afshar hospital based on criteria of the diagnostic and statistical manual of mental disorders, Fourth edition (DSM-IV).Data were collected from each subject by a self report questionnaire and structured interview and was analyzed using chisquare and ANOVA and MC nemar test. P<0.05 was determined significant.Results: The data were gathered from 1329 CABG patients (945 men and 384 women). In addition 131 patients (9.9%) containing 127 men (98.9%) and 4 women (1.1%) were opium dependent based on DSM-IV criteria. Mean age of opium dependent group was significantly higher than non-dependent patients (58.5 ± 10.08 VS 50.7 ± 10.15) (P= 0.000). Opium was the most common used substance (96.9%) and inhalation was the preferred pattern of use (52.7%). Majority of addicted patients were simple workers (44%). Based on educational levels, 57.2% of opium dependents have had primary education (under high school). Eighty two (62.5%) of addicted groups believed that after starting opium, their cardiovascular function and chest pain had been improved. Although before starting opium use 58 (44.6%) of them have had this belief.Conclusion: The prevalence of opium addiction in CABG patients is relatively high, and the majority of addicted patients are on this belief that opiates have positive effects on improvement of their chest pain and cardiovascular function. Because the effects of opioids on chest pain are palliative, the necessity of education for correction of this idea has been identified.

Background: Fibromyalgia has been defined as a constellation of complaints including diffuse chronic pain and the presence of tender points. Its frequency varies from 3% to 20%. This study was conducted to estimate the prevalence of fibromyalgia syndrome in patients who come to the general medical clinic of Dr. Shariati hospital.Methods: Using a standard questionnaire, all patients who came to the general medical clinic were asked about their ages, presence of diffuse chronic pain, marital status, educational level, living place, number of children and presence of fatigue or sleep disorder by a physician, without any gender or age restriction and without considering their main complaints or their underground diseases. The same physician did a thorough physical examination with special attention to the tender points in order to diagnose fibromyalgia according to the ACR criteria. To rule out other differential diagnosis relevant tests would be ordered for suspected patients.Results: Among 1004 patients who were assessed, the prevalence of diffuse chronic pain was 14.6% (95%CI: 12.4-16.8). Forty patients 4% (95%CI: 2.9- 5.2) suffered from fibromyalgia syndrome, their mean age (±SD) was (48.4±14.9) years.92.5% of these cases were female and 7.5% (3 patients) were male.The prevalence of fibromyalgia among women was 5.98% (95% CI: 4.31-8.06) and among men was 0.78% (95% CI: 0.20- 2.11) (OR=8.1,95%CI:2.48-26.44). There was a meaningful statistical relation between the prevalence of fibromyalgia and gender (P=0.001). There was also a direct statistical relation between the prevalence of fibromyalgia and low educational level (P=0.003). But there was not any relation between fibromyalgia and living place or marital status.Also, there was no relationship between the prevalence of fibromyalgia and having more children (Logestic analysis).82.5% of patients with fibromyalgia suffered from sleep disorders and 92.5% of them complained of fatigue. There was a remarkable statistical relation between fibromyalgia syndrome and sleep disorders or fatigue. (P<0.001) Conclusion: Fibromyalgia syndrome is relatively prevalent among Iranian and in some extents its epidemiological aspects are comparable to those in developed countries. More extensive epidemiologic studies on fibromyalgia is ecommended in general population.

Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

Background: The present study designed to assess the effect of Mg+Zn, vitamin C+E, and combination of these micronutrients on glycemic control and insulin resistance in type 2 diabetic patients.Methods: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group M: 200 mg and 30 mg Zn (n=16), group V: 200 mg vitamin C and 150 mg vitamin E (n=18), group MV: minerals plus vitamins (n=17), group P: placebo (n=18).Fasting blood glucose, fructosamine, HbA1c and serum insulin were measured at the beginning and at the end of 3 months supplementation. Insulin resistance was calculated by HOMA score. Treatment effects were analyzed by general linear modeling.Results: After 3 months of supplementation fasting blood glucose decreased in MV group (165±46 vs 177±41 mg/dl, p=0.035). There was no significant change in fructoseamin, HbA1c, serum insulin or insulin resistance in treatment groups.Conclusion: The results of the present study provide evidence for the effects of combination of Mg, Zn and vitamin C and E supplementations on improvement of fasting blood glucose but not fructosamine, HbA1c, serum insulin or insulin resistance in type 2 diabetic patients.

Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. Phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.

Background: Metabolic syndrome is a complex of metabolic disorders that contemporary occurrence in a person is more than the risk of occurrence of each one separately. This syndrome has gained researcher's attention because of its relationship with cardiovascular disease and diabetes type II and its high prevalence in populations.Methods: A cross-sectional study performed on 1110 participants, 20-74 years old with cluster sampling. All of them had interview and special questionnaire were filled. Epidemiologic and demographic data were about hypertention cardio vascular disease and related lab data.Results: The prevalence of metabolic syndrome was 32.1% that it was significantly more in women than men .this prevalence increased with age and BMI in both sexes .the most common metabolic disorder was TG>=150. 19.2% have none, 21.1% have one, 27.6% have two, 20.8% have three,9% have four and 2.3% have all criteria of metabolic syndrome.Conclusion: Approximately one third of population of Yazd have metabolic syndrome and according to other statistics of Iran, this prevalence is more than U.S and Europe. It seems there is an urgent need for a national multicenter program for determinding risk factors for metabolic syndrome.

Background: We report a case with apparent resistance to local anesthetics. While regional anesthetics failure is often attributed to technical failure, the clinical presentation and medical history of this patient suggests a true resistance to local anesthetics.Case report: A 28 years old man was scheduled for elective orthopedic surgery for right sided tibial bone fracture, and decision of spinal anesthesia was made. There was a questionable history of multiple prior episodes of local anesthetic unresponsiveness (Interscalan block, local infiltration for lipoma resection and dental surgery). Spinal anesthesia was performed and sensory or motor blockade was not obtained despite any evidence of technical problems. The surgical procedure performed under general anesthesia and skin analgesia (local infiltration of lidocaine 2% and bupivacaine 0.5% to forearm), did not achieve, the day after surgery.Conclusion: While the failure rate of spinal anesthesia has been shown range from 4 to 13% and is often attributed to technical failure, this particular case showed a true resistance to local anesthetics.