Tehran University Medical Journal
Year:2007 | Volume:65 | Issue:6|Papers Count:18

Background: Some pregnant women are exposed to occupational noise, a risk factor for the development of the auditory system. The auditory system is one of the areas in embryonic development in which noise might induce aberrant development. Noise can change the gene expression pattern of an embryo and thereby modify the physiology of the auditory system. Therefore, noise can change the molecular structure of the developing ear. One of the critical molecules involved in development of auditory system is glycoconjugate. The aim of this study was to investigate the molecular changes of the developing spiral ganglion after exposure to industrial levels of noise.Methods: A total of 42 pregnant mice were divided into control and experimental groups. Each group was further divided into three subgroups. The three experimental subgroups were exposed to daily noise with an intensity of 100 db for 2.5 hours until sacrifice (for the first group to be sacrificed) or day seven of postnatal life (for the other two groups). The mice offspring were sacrificed at the first, seventh and 14th days of postnatal life. The inner ears were prepared histologically. The specimens were stained with the lectins wheat germ antigen (WGA), peanut agglutinin (PNA), Dolichos biflorus agglutinin (DBA) and BSAI-B4.Results: The results indicated that, although there were no histological changes at the light-microscopic level in the ear development, statistical analysis showed that there was a significant decrease in the uptake of the BSA1-B4 lectin by neurons of spiral ganglion in 14th day of postnatal life in the experimental group compared to that of the control group (p<0.05).Conclusions: After noise exposure, in spite of normal neuronal structure, these cells were modified at the molecular level, especially in glycoconjugate expression, influencing the normal physiology of neurons and causing auditory disorders.

Background: Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. Central lung distance (CLD), the distance from the chest wall to the edge of the field at the central axis, is an indicator of lung volume within the radiotherapy fields. In this study, we aim to detect the relationship between CLD and pulmonary function tests.Methods: In this study we included 50 patients with breast cancer receiving postoperative adjuvant radiotherapy at Imam Hossein Hospital, Tehran, Iran. The patients received radiotherapy with a total dose of 4800-5000 cGy. For all patients, the central lung distances were measured using simulation of tangential fields, in addition to determination of pulmonary function, including force vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) determined before radiotherapy, one month and three months after radiotherapy.Results: There is no significant statistical difference between the FEV1 and FVC values before radiotherapy and those measured one month after radiotherapy; however there was a significant statistical decrease in the FEV1 and FVC before radiotherapy and those measured three months after radiotherapy (P<0.001 and P<0.006, respectively). There is a positive statistical correlation between the change in the FEV1 three months after therapy and the CLD (r=0.71, p<0.01) and that of the FVC three months after therapy and the CLD (r=0.59, p<0.01). Linear regression for the prediction of FEV1 and FVC three months after radiotherapy was designed according to the CLD, FEV1 and FVC values before radiotherapy.Conclusions: Three months after breast radiotherapy, the FEV1 and FVC values decrease, and the CLD is a proper predictor of these changes.

Background: Frozen shoulder is a debilitating disease characterized by pain and progressive loss of motion in shoulder secondary to fibrotic inflammation of the joint capsule. The incidence is 2% in the general population, mostly affecting women 40 to 70 years of age. Therapeutic measures include physiotherapy, shoulder manipulation, corticosteroid injection and arthroscopic release. The purpose of this study was to compare the results of manipulation under anesthesia with or without concomitant intra-articular injection of corticosteroid.Methods: Twenty-six patients (21 females, 5 males) with the clinical diagnosis of idiopathic frozen shoulder were evaluated in a randomized clinical trial. The average age of the patients was 55.7 years. Twelve cases had diabetes mellitus, which is considered a strong predisposing factor and has a poor prognosis. Thirteen patients received intra-articular corticosteroid injection just before manipulation. The outcome was assessed by evaluating functional score (Constant scoring system) at the six-month follow-up.Results: The average score before manipulation was 28.7 out of 100, which significantly improved to 84.8 at six months after the procedure (p<0.05). The results were slightly better in the group who received corticosteroid injection, but the difference was not statistically significant (p=0.1). The outcome in the diabetic group was less favorable than in the non-diabetic patients (p<0.05).Conclusions: Manipulation under anesthesia is a very effective method of treatment for idiopathic frozen shoulder. Concomitant intra-articular injection of corticosteroid does not seem to improve significantly the final outcome. Diabetes mellitus can negatively affect the results of this treatment method.

Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharrnacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.Methods: Fifty children with oncologic malignancies whose ages ranged between 2- 12 years were emolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001).fter Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.

Background: Despite the overwhelming progress that has been accomplished in the prevention of mortality due to cardiovascular disease, coronary artery disease (CAD) is the leading cause of death in the world.The aim of this study was to compare of the effects of enoxaparin versus unfractionated heparin (UFH) on major clinical events, including mortality, myocardial infarction (MI), and recurrent angina, as well as bleeding in patients with non ST elevation acute coronary syndrome (NSTEACS). We also studied the need for coronary angiography and revascularization (PCI or CABG) in these patients.Method: Two-hundred patients were enrolled in this study, 100 of whom received intravenous UFH (an initial bolus of 5000 U followed by continuous infusion of 1000 U/h) and 100 received enoxaparin subcutaneous injections of 1mg/kg twice daily for a minimum of 72 h. During their admission we recorded data regarding death, MI, recurrent angina, need for angiography and revascularization, and major and minor bleeding.Results: The incidence of recurrent angina, total mortality and the need for revascularization were significantly lower in patients receiving enoxaparin compared to those receiving UFH, at 17% vs. 39% (p=0.002), 0% vs. 3% (p=0.035), 14% vs. 33% (p=0.001), respectively. However, there was no significant difference regarding the incidence of MI, major bleeding and cardiac death between the two groups.Conclusions: This study showed that, in patients with NSTEACS, enoxaparin was superior to UFH regarding the prevention of major in-hospital clinical events, especially recurrent angina and the need for revascularization. We therefore recommend enoxaparin as an alternative antithrombotic agent to UFH in patients with NSTEACS.

Background: The common cold is the most prevalent sickness and an important cause of absence from job. Furthermore, it often disturbs travel, including the practice of hajj, causing the use of many inappropriate drugs by these travelers. The health belief model is a psychological model that attempts to explain and predict health behaviors. The purpose of this study was to determine the effects of zinc and health belief model based educational intervention on the behavior of hajj travelers with regard to viral upper respiratory tract infections (URTI).Methods: This double–blinded randomized controlled trial was performed among hajj travelers in 2005. Preventive measures were randomly allocated to four groups: 1- education + zinc sulfate. 2- education + placebo. 3- zinc sulfate only 4- placebo only.Data regarding incidence and duration of URTIs, background disorders, vaccination and health behaviors for cold were gathered by questionnaire by physicians and finally analyzed by SPSS 11.5 software using chi-square, t-test and independent samples t-test.Results: A total of 646 travelers were studied. The incidences of common cold in groups receiving zinc were significantly less than that for those receiving the placebo. (P=0.05).However, incidence was statistically the same for those who received education versus those who did not. Use of handkerchief was the most prevalent behavior and use of mask was the least prevalent behavior. Mean duration of symptoms was less in those receiving zinc and education (3.7 days) comparing to those who received placebo and education (5.6 days).Conclusions: This study showed that zinc consumption can decrease the incidence and duration of the common cold. Health belief model based education could promote some preventive behaviors although most people do not take advantage of them. We recommend the use of zinc by those attending hajj.

Background: Burns are a major cause of death and disability worldwide. Today biological dressings have become an integral part of modern burn care. Using this method, in otherwise healthy young adults, the size of burn relative to the total body surface area (TBSA) correlating with a 50% mortality rate has increased from 30% to 80%. Due to a lack of experience and an interest in using biological dressings in Iran, as a developing country, the aim of this study was to compare patient outcome using the biological dressing vs. conventional treatment in patients with massive burns.Methods: In this clinical trial study, 118 burn patients (30 to 75% TBSA) were enrolled. The patients were divided in two groups. Those in the conventional treatment group had not accepted treatment with a biological dressing. The second group agreed to treatment with biological dressing, a pig skin xenograft known as Xenoderm.Significant differences were evaluated using the unpaired Student’s t test, the Mann-Whitney U test and the c2 test.Results: Mortality rates in the conventional treatment group (n=53) and biological dressing group (n=65) were 35% (19) and 10.8% (7), respectively (p=0.001). Excluding those patients who died, the mean hospital stay was 31.3 days in the conventional treatment group versus 18.2 days in the biological dressing group (p=0.0005), and number of dressings was 22.1 versus 9.9 (p=0.0005), respectively. Three patients in the conventional treatment group were transferred to a tertiary-care hospital after three weeks of treatment. The most commonly burned areas were the upper limb, lower limb and trunk.Conclusions: The results of this study indicate that biological dressings give a better outcome and decrease the hospital stay and the number of dressings. A randomized clinical trial is warranted.

Background: Spinal anesthesia can be associated with hemodynamic changes and some other complications. The aim of this study was to evaluate the effect of adding fentanyl to lidocaine on the spinal anesthesia time and its complications for cesarean section.Methods: Sixty pregnant women with gestational age of 37- 42 weeks and ASA physical status I and II undergoing elective cesarean section under spinal anesthesia were enrolled in a randomized double blinded clinical trial. They were randomly allocated to receive spinal anesthesia with lidocaine-normal saline (LS: 75 mg lidocaine 5% with 0.3 ml normal saline) lidocaine-fentanyl (LF) group (75 mg lidocaine 5% with 50 mg fentanyl). The duration of initiation of sensory block to achieve T4 level, time to return of sensory level to T12, time to first analgesic request, ephedrine requirement, nausea and vomiting during and after the surgery, pruritus, respirator depression, headache and apgar score of the new born at 1st and 5th minutes were assessed.Results: There was no significant difference between time to achieve T4 level, ephedrine dose, post operative nausea and vomiting (PONV), pruritus and headache in study groups. Time to return of sensory level to T12 was significantly longer in LF group (152.6±14.7 vs. 66.2±11.2 min, P=0.0009). Time to first analgesic request was also longer in LF group (164.2±20.8 vs. 68.1±11.3 min, P=0.0009). The incidence of nausea and vomiting during surgery was significantly more in LF group (20% vs. 0%, P=0.023).No case of respiratory depression was observed in groups. The 1st and 5th minute’s apgar score were comparable between groups and were between 7 and 10.Conclusions: Addition of fentanyl to intrathecal lidocaine in patients undergoing elective cesarean section results in increasing of the block duration and time to first analgesic request without significant maternal or neonatal side-effects, without effect on 1st and 5th minutes apgar score with increasing the incidence of during surgery nausea and vomiting.

Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children.The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05).Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.

Background: Jaundice is one of the most frequent problems observed in newborns.Our purpose was to investigate the incidence and the risk factors on jaundice noted in the first 24 hours after birth.Methods: All newborns observed to have jaundice within the first 24 hours after birth were enrolled prospectively in this study. Laboratory evaluations included blood group typing of mother and newborn, hemoglobin and hematocrit, complete blood count, peripheral blood smear, reticulocyte count, G6PD activity, maternal indirect and neonatal direct Coombs test, and serum total, conjugated, and unconjugated bilirubin.In all cases, gender, birth weight, Apgar scores, gestational age, mode of delivery, birth trauma, cephalhematoma, maternal age, parity, or any siblings with neonatal jaundice were recorded. Data were analyzed using one-way ANOVA, Student’s t-, and chisquare tests.Results: Of a total of 2096 newborns delivered in one year, 122 (5.8%) developed jaundice within the first 24 hours after birth. Risk factors for hyperbilirubinemia were ABO incompatibility, prematurity, infection, G6PD deficiency, cephalhematoma, asphyxia, and Rh disease. There were no statistically significant relationships between jaundice and maternal age, parity, mode of delivery, neonatal gender or previous siblings with jaundice (p>0.05).Conclusions: Jaundice observed in the initial 24 hours after birth was infrequent, but clinically significant. All newborns should be followed by repeated exams within the first 24 hours after birth and before discharge, especially if the maternal blood group is O.

Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.Methods: All infants with cleft lip and palate referred to the Children’s Medical Center and Bahramy; the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain; a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. Non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements, consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5.Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. The most common type of these congenital heart defects (28.3%) was atrial septal defect.Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.

Background: Burnout is one of the most important factors in reduced productivity in organizations and involves physical and mental signs, especially in the human service professions. The role of nurses in the healthcare system is vital and motivation to ensure health security is extremely important. We carried out this research to examine the relationship between burnout and mental health in the nursing staff of educational hospitals of Tehran University of Medical Sciences.Methods: A descriptive cross-sectional survey was conducted among 200 nurses selected via probable multistage sampling. We used three instruments in this study:1) demographic questionnaire 2) General Health Questionnaire-28 (GHQ-28) and 3) Maslach Burnout Inventory (MBI).Results: On the whole, using the MBI subscale, we found low levels of emotional exhaustion and depersonalization and high levels of reduced sense of personal accomplishment, both in frequency and intensity. The prevalence of symptomatic samples in the GHQ-28 was 43%, and two variables, burnout and poor mental health, were related (p<0.001). Burnout was to be related to gender, age and years of work.The correlation between poor mental health and years of work as well as hours of work in a week were significant.Conclusions: Our results suggest that there is a strong correlation between poor mental health and burnout. Furthermore, the prevalence of symptomatic samples detected in our study using the GHQ-28 was much higher than that reported in studies of the general population. The high prevalence of symptomatic samples and high prevalence of burnout in the dimension of self accomplishment, especially in younger nurses, combined with the strong correlation between poor mental health and burnout all show that care should be taken to improve the stressful conditions that nurses face.

Background: ABO incompatibility hemolytic disease of the newborn is a common cause of clinical jaundice and causes two-thirds of the hemolytic disease in newborns.This study was undertaken to determine the frequency of ABO incompatibility hemolytic disease and its complications in newborns undergoing exchange transfusion.Methods: This prospective_and descriptive study was performed in jaundiced newborn infants during a three-year period. Inclusion criteria were: maternal blood type O, newborn blood type A or B, rising indirect hyperbilirubinemia in the first two days of life, positive immunohematologic test for newborns and exchange transfusion.Exclusion criteria were: incomplete information, other accompanying diseases that induce hyperbilirubinemia. All newborn infants received phototherapy before and after exchange transfusion. We did not use intravenous immunoglobulin, hemoxygenase inhibitor drugs and blood products before exchange transfusion.Results: Double-volume exchange transfusion via umbilical cord catheter was performed in 96 patients, 19 (20%) of whom suffered from ABO incompatibility. Of these 19 newborns, two-thirds (13) were preterm infants. The minimum level of serum bilirubin was 10 mg/dl and the maximum serum bilirubin level was 35 mg/dl. In six patients (32%) serum bilirubin levels were >25mg/dl. The most common blood group was type A for newborns. Immunohematologic tests were positive in 84% of the mothers. ABO incompatibility hemolytic disease was the fourth and second most common reasons for blood exchange transfusion in preterm and term infants, respectively. Laboratory complications were more common than clinical complications. The etiology of 48% of the alloimmunization and 42% of the hemolytic disease in these newborns was ABO incompatibility.Conclusions: Mothers with blood group O and newborns with blood group A or B with positive immunohematologic tests in first hours of life are at high risk for hemolytic disease. Therefore, in this high-risk group, further therapy including prophylactic phototherapy, intravenous immunoglobulin and intramuscular protoporphyrins are necessary to prevent severe jaundice and decrease the need for exchange transfusion.

Background: Sexual function in women may be affected by their menstrual cycle. Lack of sexual drive is a deficiency or absence of sexual fantasies and desire for sexual activity. This study aims at determining the changes in sexual desire during the menstrual cycle and those associated with premenstrual syndrome (PMS) and evaluate sexual desire during the menstrual cycle and the associated changes with PMS.Methods: The sample for this cross-sectional study includes 150 women employed in factories in Tehran. The instruments for data collection were questionnaires and journals of premenstrual experiences.Results: Analysis of the data showed that the mean age of the subjects was 31 years (standard deviation = 8.46). The most frequent decrease in sexual desire was during the week prior to the start of menstrual bleeding (27.3%) and the least frequent was from the end of bleeding to one week before the next period of menstrual bleeding (5.3%). In 24.7% of the cases, an increase in sexual desire occurred during the middle of the menstrual cycle and 27.3% during the course of menstrual bleeding. Moreover, 10.7% of the subjects had an increase in sexual desire during the week before bleeding.Furthermore, a positive correlation was found between changes in sexual desire and PMS (p<0.001). In addition, a positive correlation was found between changes in sexual desire and breast tenderness, joint and muscle pain.Conclusions: The sexual desire of women, with or without PMS, changes during the menstrual cycle. The greatest decrease in sexual desire occurs during the first week before menstrual bleeding in women with PMS. Such information can greatly help toward understanding and treatment in sexual therapy for couples.