Tehran University Medical Journal
Year:2006 | Volume:64 | Issue:9|Papers Count:19

At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy “as is your pathology so is your medical practice”. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes ,clinicians’ and pathologist’ reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities.Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% (on average 23.5%) of clinically missed diagnoses and managements involving the principal or underlying cause of death.The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understanding of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals. We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities.

Background: The objective of this study was to investigate the relationship between glucose-6-phosphate dehydrogenase inhibition in macrophages treated with 6-Aminonicotinamide, the amount of nitric oxide (NO) production and the resistance of infected macrophages against Leishmania major infection.Methods: Peritoneal macrophages of BALB/c mice were isolated and treated with different concentrations (1.25, 2.5, 5, 10 mM) of 6-aminonicotinamide. After 24 hours, the viability of treated macrophages was measured by MTT assay at 540 nm. G6PD activity was measured in the cell extracts 24 hours later. Macrophages were then infected with leishmanial amastigotes and after 18 hours NO production was determined using Griess-reagent. In order to study the inhibition of macrophage activity, 5 mM concentration of 6-AN was used and number of leishmanial amastigotes was recorded in these cells from day 1 to7.Results: Different concentrations of 6-AN were shown to cause a significant increase in cell death and decrease in G6PD activity and NO production in macrophages. Also, the number of amastigotes in macrophages was increased significantly (p < 0.05).Conclusion: The concentration of 6-aminonicotinamide and G6PD activity affect the viability of BALB/c mice peritoneal macrophages through production of NO. Inhibition of G6PD activity leads to decreased leishmani-cidal activity of mouse peritoneal macrophages.

Background: Freezing and thawing induce a number of insults to the sperm cells, such as low motility and low fertilization capability. For evaluation of hyaluronan (HA) supplementation on sperm characteristics, we investigated the effect of hyaluronan (HA) on mouse sperm before freezing and after thawing.Methods: For this purpose we removed cauda epididimes from 24 male mice with aseptic method and freezed the semen in 1.8ml cryotubes with %18 raffinose and %3 skim milk cryoprotectant solution. We had 4 groups: group 1(fresh control) group 2(freeze control) group 3(supplemented 750 μg/ml HA to sperm before freezing) and group 4(supplemented 750 μg/ml HA to sperm after thawing). Fertility rate evaluated after routine IVF by counting two-cell stage embryos. Results: HA supplementation (750μg/ml) after thawing improved fertilization capability parameters but supplementation before freezing had no effect on mentioned characteristic.Conclusion: Acording to data of present study the hyaluronan supplementation (750μg/ml) after thawing has the greatest effect on the fertility rate of sperms.

Background: Staphylococcus aureus (SA) is an important ause of nosocomial and community-acquired infections. The emergence of antibiotic resistance, especially in methicillin-resistant SA (MRSA) strains, has caused difficulties in treatment of such infections. The determination of antibiotic resistance patterns, particularly domestic patterns of Iran, is essential for appropriate treatment of MRSA infections and proper infection control measures in our country.Methods: The antibiotic resistance of 338 SA isolates from various clinical specimens was determined by disk agar diffusion (DAD), minimum inhibitory concentration (MIC) and polymerase chain reaction (PCR) methods. Results: Using the DAD method, 47% (160/338) of the SA isolates were resistant to oxacillin, and only 6% (20/338) were resistant to vancomycin. By PCR, 48% (162/338) of the isolates had the mecA gene. The MIC of oxacillin in 93% of isolates was higher than 256μg/mL. The MRSA isolates, showed a high resistant to gentamicin (40.5%), erythromycin (40%), and ciprofloxacin (38%). However, only a few of the SA isolates showed a high resistance to vancomycin (5%) or erythromycin (3.5%). Conclusion: The results of this study can provide guidance for physicians toward a more appropriate treatment of SA infections in Iran, thereby preventing the emergence of further antibiotic resistance among SA. Our results also revealed the need for further investigations using a higher number of specimens representing a wider variety of locations to determine the antibiotic resistance patterns in our state more precisely.

Background: Performing traditional autopsy mostly seems to be unpleasant in dead persons' relatives' opinion. This study aimed to determine the accuracy of laparoscopic examination of intra abdominal organs in comparison to the traditional autopsy in trauma victims.Methods: From December 2004 to September 2005, 50 fresh cadavers of blunt trauma victims were studied in less than 24 hours from death time. Intraperitoneal and retroperitoneal organs were first evaluated by laparoscope and then the traditional autopsy was performed as gold standard. The organs were assessed regarding impairment and its grade in both ways. Diagnostic accuracy of laparoscope was determined for each case with 95% confidence interval using Fisher's exact test.Results: The values of overall and distinct accuracy of laparoscopic examination for intraperitoneal and retroperitoneal organs were significantly comparable with traditional autopsy. The accuracy of laparoscopic evaluation of intraperitoneal and retroperitoneal organs was 90% (95% CI of 81.7% to 94.8%) and 92% (95% CI of 84.7% to 96%) respectively in comparison to open autopsy. The overall accuracy of laparoscopic examination was 84% (95% CI of 74.3% to 90.5%).Conclusion: The sensitivity and specificity of laparoscopic examination for intraperitoneal but not retroperitoneal organs were acceptable in comparison to open autopsy. Laparoscopic examination seems to be an eligible substitute for the traditional autopsy in assessment of intraperitonel organs.

Background: Mechanical low back pain (L.B.P) is most common in middle-aged people especially in developing countries and the symptom compromises routine life activities of the patients. Disk herniation is the most frequent cause of LBP. The less costly way for diagnosing the cause of LBP is performing careful physical examinations. This study aimed to evaluate the sensitivity and specificity of clinical diagnosis of the cause of Discal Sciatic Neuralgia at Construction Labors in comparison to MRI as the gold standard. Methods: In a descriptive- analytic study 60 middle-aged professional construction workers were evaluated. Their age range was 25-45 years old and all of them had the complaint of mechanical LBP. Medical history was taken and all cases under went a cautious physical examination. The presence of disk herniation between L4-L5 orL5-S1 was recorded according to clinical signs and symptoms. Lumbosacral MRI was performed for all cases and the results were compared to clinical data. Results: The clinical diagnosis of presence and severity of pathology was confirmed by MRI in all stages of discopathy in L5-S1 and L4-L5 vertebrae (sensitivity= 100%).Conclusion: This study showed that careful physical examinations will be sufficient for the sciatic neuralgia diagnosis and even the staging of disk herniation can be performed clinically. Requesting MRI as an expensive procedure is not recommended for diagnosis of Discal sciatic neuralgia because of feasibility of the cost effective way of precise physical examination.

Background: The most frequently used test for evaluation of fetal health is the Non Stress Test (NST). Unfortunately it has a high incidence of false positive results. The combination of vibroacoustic stimulation with the NTS has been shown to reduce non reactive results.Methods: A tests assessment method was chosen with a simple randomized sampling. 40 pregnant women with non reactive NST in the first 20 minutes who received VAS in one of Tehran University's Hospitals were compared with BPP scores. A vibroacoustic stimulation was applied for a 3 seconds on the maternal abdomen and fallowed within 10 minutes. Data collection tools were NST, sonography instruments, NST result paper, tooth brusher, watch, demographic questioner and check list. Data analysis was made by descriptive static and by using the Fisher's Exact Test (with level of significant at p<0/05). All statistical analysis were performed using an spss/win.Results: After VAS, 70% of non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). False positivity of VAS was lower than NST.Conclusion: VAS offers benefits, by decreasing the incidence of non reactive test and reducing test time. VAS lowers the rate of false positive NST. VAS is safe and allows more efficient of prenatal services. This test could be used as a rapid antepartum test to predict fetal well-being.

Background: Many studies have shown the efficacy of cognitive – behavioral therapy and psychological debriefing in treatment of post traumatic stress disorder (PTSD) and a few evidences are available for using these techniques in large scale disasters. This study aimed to asses the effect of some psychological interventions in reducing PTSD symptoms after Bam earthquake in different age groups.Methods: In a before-after quasi experimental clinical trial, we compared the efficacy of one session of psychological debriefing and three sessions of group cognitive-behavioral therapy in bam earthquake PTSD symptoms in different age groups. We evaluated PTSD symptoms before and immediately and three months after interventions by CASP scaling system and analyzed data. Results: one hundred and thirty persons entered in the study and 51 persons excluded during interventions because of migration. Interventions were showed to be effective only in short term period. The means of PTSD symptoms frequency and severity of avoidance symptoms were reduced during three months period of study which were statistically significant P<0.05. Interventions showed no efficacy for recall symptoms in long term and hyper arousal symptoms in short term and long term periods. There was no statistically significant difference among age groups. Conclusion: Psychosocial supportive interventions may be effective on some of the PTSD symptoms but there is no difference in different age groups.

Background: Multiple drug use is frequently considered to be hazardous for the elderly because of their greater vulnerability to the complications. The purpose of this study was to determine the prevalence of polypharmacy in Tehran and to assess the relative demographic characteristics of patients. Methods: In a cross-sectional study 400 persons aging 55 years and older were interviewed in order to determine the presence of polypharmacy (daily intake of three or more drugs). The cases were randomly selected and asked to answer a questionnaire through interview at home. The questionnaire contained questions about all taking drugs, pattern of using each drug and also patients' personal, social and medical history. Chi-square and fisher exact tests and determination of odds ratios were used in order to data analysis. Results: Medium number of drugs used was 3.4 ± 1.9 in studied cases and %39.6 of cases were exposed to polypharmacy. The prevalence of physician prescribed drug usage was observed to be increased by increasing number of total used drugs in each case (P<0.002). The most commonly used drugs were A.S.A, Atenolol and propranolol and these drugs were prescribed by physician in over than %90 of cases. There was a positive correlations between polypharmacy with referring to multiple physicians (OR=1.96, CI 95%, 1.28- 2.98) (P<0.002) and adverse drug reactions (OR=2.44, CI 95%, 1.47-4.05) (P<0.001). Polypharmacy was more prevalent in the age group of 65-75 years (P<0.04) and lower levels of education (P<0.004) and less prevalent in the group with moderate income (P<0.001).Conclusion: Polypharmacy is common among adults aging 55 years and more in Tehran and is affected by age, education level and economic status.

Background: Long term use of immunosuppressive therapy in transplant recipients in order to prevent acute and chronic rejection increases the long term risk of cancer. This study evaluates the incidence of different organs’ cancer after renal transplantation and immunosuppressive therapy. Methods: This is a retrospective analysis of malignant tumors in renal graft recipients with more than one year graft survival. Patients were assessed according to their age, sex, diagnosis of cancer, immunosuppressive drugs, donors and period of dialysis before transplantation. Results: Evaluating all existing files in selected private clinics in Isfahan 350 patients were reviewed and 289 of them had entrance criteria. A total of 186 men and 103 women (mean age: 42.17±13.09 years) were included. They were followed up over a mean period of 52.46±33.24 months. A total of six cases (2.1%) of cancer were diagnosed in six recipients: All patients with cancer were male with a mean age of 51.17±14.7 years (range: 26-68 years). Tumor presented at a mean time of 51 months (rang: 15-82 months) after transplantation. There were two patients with BCC, two patients with SCC and two patients with lymphoma. Two patients died of progressive malignant disease. Age, period of dialysis before transplantation, and using immunosuppressive and anti-rejection drugs had no significant impact on development of post transplant malignancy. Conclusion: The frequency of tumors in these patients is lower than what reported by other centers, probably due to short period of follow up and low incidence of cancer in our general population. The risk of malignancy was 28 fold higher among transplant recipients than in general population. High risk of cancer in this group, confirms the necessity of routine examination for organ transplant recipients both before and after transplantation.

Background: The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. The objective of this study was to study prevalence of inflammatory factors particularly C-reactive protein (CRP) in hemodialysis patients.Methods: We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP (agglutination method), albumin (bromocresol green method) and ferritin (ELISA) were measured in all patients.Results: One hundred and twenty five patients including 53 (44.1%) men and 72 (55.9%) women were enrolled in this study. Fourteen patients (11.2%) had hypoalbuminemia, 81 (64.8%) had high serum ferritin, and 57 subjects (45.6%) were CRP positive.Conclusion: According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance.

Background: Alteration in pattern of sexuality is known to be impressed by couples’ believes about women’s physical and psychological changes during pregnancy. The objective of this study is to evaluate the knowledge and attitudes of couples about sexual relations during pregnancy.Methods: In a descriptive study from February to April 2005, two hundred sixty six consecutive pregnant women referring to a university hospital were asked to answer a questionnaire containing questions their sexual status and some demographic data. In 122 cases the answers of the spouses was collected also. The answers were compared in divided groups according to age range, duration of marriage, parity and educational status.Results: Fifty five percent of men and fifty eight percent of women had a negative attitude about sexual relations during pregnancy, and 60% of men and 75% of women presented incorrect knowledge about sexuality during pregnancy. Main reasons for decreased sexual relations in pregnancy were mentioned to be dysparaunia, and the fear of trauma to the baby, abortion, membrane rapture, preterm labor and infection. Conclusion: As couples’ knowledge and attitudes about sexuality affect their general sexual behavior during pregnancy it is crucial to provide proper consultation regarding sexual relations in prenatal care services.

Background: Cerebral metastases from choriocarcinoma are poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable gynecological malignancy, failure rate among “highrisk” patients is still high despite the use of aggressive multidrug regimens.case: A 27 year old woman (G4P2Ab1) presented with hemiplegia due to brain metastases of choriocarcinoma one year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin-etoposide and cisplatinum (EMA-EP) regimen combined with whole brain irradiation. She delivered a term healthy child two years after termination of treatment.Conclusion: Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis.