Feyz Medical Sciences Journal
Year:2000 | Volume:4 | Issue:14|Papers Count:20

History and Objectives: The ultimate objective of rehabilitation in sport injury is the rapid and safe return of the individual to his pre-injury status. If the therapeutic plan is oriented only to increase strength, tolerance, and range of motion, and such factors as balance, agility, deep sensation, and neuromuscular coordination are not stressed, the risk of repeated injury will increase. In this study the effect of walking and running as the main function of lower limbs are considered. Materials and methods: This study has been carried out as a clinical trial using six functional performance tests of single leg hop distance test, vertical jump, anaerobic power test, modified Romberg test, shuttle run, and single leg hop for time before and after exercise in two groups of 15 healthy girls matched for age. All the girls had three sessions of 15 minutes running forward and backward each week for six consecutive weeks. At the end of each week, some of the tests were performed and finally after eight weeks, all the tests were repeated again. Results: In the group walking or running forward, vertical test revealed 0.46% (p>0.003), single leg hop for time 10.52% (p>0.005), vertical jump 9.95% (p>0.005), anaerobic power 4.58% (p > 0.005), modified Romberg test 59.26% (p>0.003), and shuttle run test 2.19% (p>0.001). improvement, and for those with backward walking or running, single leg hop distance test revealed 4.5% (p>0.003), single leg hop for time 23.89% (p<0.005), vertical jump 2.98% (p>0.005), Anaerobic power test 0.53% (p>0.005), modified Romberg test 68.33% (p>0.003), and shuttle run test 6.88% (p<0.001) improvement. Conclusions: In rehabilitation planning, when improvement of strength, velocity, agility, static balance, and aerobic power is considered, walking and running backwards, and when increase in vertical jump, or aerobic power is the aim, walking and running forward is recommended.    

History and Objectives: Due to the prevalence of blunt abdominal trauma and availability, relative ease, economic consideration of sonographic applications, and current controversy regarding sonography on diagnosis of intraabdominal injury, the present study was carried on blunt abdominal traumatic patients at Rasul Hospital in 1997-98 in order to assess the diagnostic power of sonography on intraabdominal injury. Materials and Methods: A clinical diagnostic experimental study was performed and patient's information and characteristics of the injury was recorded. Definite diagnosis of injuries was based on CT scan and laparotomy findings. PPV and NPV of sonography were defined. Results: Study covered 94 patients (76.6% male and 23.4% female) with age of 26.9±14.8 years. Car accident was the major cause of trauma. PPV and NPV of sonography for diagnosis of intraabdominal organs injury were 76.5 and 84.8 respectively and for diagnosis of intraabdominal free fluid were 100 and 96.6 respectively. Conclusions: Sonography has sufficient power for diagnosis of intraperitoneal free fluid however it does not have sufficient power for diagnosis of intraabdominal organs injury. Further study regarding the cause of low power is recommended.      

History and Objectives: Due to complications of pregnancy and labor and several reports on the association of BMI with outcome of pregnancy, the present study is performed in order to determine relationship between maternal BMI with complication of pregnancy and labor on the pregnant women referred at the Shabikhani Hospital in Kashan between years of 1998-1999. Material and Methods: A cohort study was performed on 450 nulliparous pregnant women without previous systemic diseases. The individuals were referred to hospital for prenatal care in the first trimester and delivery. Women were divided into three groups (150 individuals); based on the body mass Indecies (BMI) as BMI < 19.8, BMI =19.8-26, and BMI> 26. Prenatal complication such as hypertension, hospitalization before delivery, weight gain in pregnancy, premature rupture of membrane, decreased fetal movement, preterm labor, post date pregnancy and labor pain was recorded. Intrapartum and postnatal complication was studied with the index of stimulation of labor with oxytocin, type of delivery, maternal hemorrhage during delivery, duration of hospitalization, apgarscore and weight of newborns. Statistical analysis was performed using Ki-square test and Fisher exact test. Results: Three groups were matached for age and porous. Hypertention was present in 10.7% of women with BMI<19.8 and 18.7% women with BMI=19.6-26 and 38.6% women with BMI>26 (p<0.0001). Oxytocin stimulation of labor above groups was 28.7%, 41.3% and 42.7% (p<0.02), and abdominal delivery was 22%, 18.6% and 51.4% (p<0.0001). Conclusions: Deviation of normal BMI in pregnancy causes increase in complication of pregnancy and delivery. Due to the importance of public health of pregnant women special attention must be paid to increase in maternal weight in reproductive age in order to lower these complication.  

History and Objectives: High blood pressure is fairly prevalent and due to its importance, side effect because of imprecision in its measurement, the present study was carried out in order to determine its precise value and its ability to measure the high blood pressure by a indirect method by the medical staff of Shahid Behesti Hospital in 1996-1997. Materials and Methods: A diagnostic clinical trial study on 157patients selected for cardiac catheter was carried. Aortic blood pressure was determined by the specialist during catheter operation and two minutes later arterial blood pressure by medical staff (one of nine groups of cardiology residents, internal medicine residents, CCU nurses, cardiology nurses, internal medicine nurses, intern students, nursing students and nursing technicians). The difference between direct and indirect measurements was the basis for correctness and statistical paired t-test was performed; and the ability of various medical staff in the determination of high blood pressure (higher than 139.89mmHg) was assessed. Results: From total of 157 patients (69.4% male, 30.6% female) examined, the mean age was 48 ±12.8 year. Most medical staff reported the systolic and diastolic pressures lower and higher than the actual value respectively. A variation of 13mmHg (10%) (P< 0.001) 10.7 mmHg (14%) (P < 0.001) for systolic and diastolic blood pressure was observed respectively. Highest and lowest absolute difference in the measurement of systolic blood pressure among various medical staff was 17.4 mmHg (13.2%) and 10.3 mmHg (8.3%) for Internal medicine residents and internal medicine nursing staff respectively and the highest and lowest diastolic blood pressure the absolute difference were 15.3 mmHg (20%) and 5.3 mmHg (7.2%) for cardiology nursing staff and nursing students respectively. Conclusions: Due to the sensitivity and specificity of indirect blood pressure determination, Similar study ought to carry out at other medical centers. The cause of differences and instruction as to the importance of accurate blood pressure measurements ought to be brought up the attention of medical staff.        

History and Objectives: Children's growth is important, and it has significant economical, social and health consequences. In our society, there is no social growth charts for children. This investigation is designed to prepare new growth charts for Iranian infants in Kashan. Materials and Methods: A longitudinal study was carried out on 400 newborn infants in Kashan. They were grouped on sexual basis and their weight and height were measured. On the basis of the data collected, statistical analysis was carried out and growth charts were drawn. Results: Weight for female and male newborn infants were 3.23 ±0.35Kgand 3.30 ±0.39Kg respectively. Height for female and male newborn infants were 50.53 ±1.86cm and 50. 92±1.98cm respectively. In comparison of 50th weight percentile for age and height for age growth charts with 50th percentile NCHS growth chart was shown that our infants growth till 3-4 months were almost the same as NCHS but then decrease rapidly (particularly weight) than standard growth charts. Conclusions: Weight and height for our newborn infants are the same as NCHS but our growth' charts from 6-7 months are slower than NCHS growth chart. So drawing of new charts for every country is recommended.    

History and Objectives: Growth and development of children has an important role in life and one of the basis of general health. The most important determinants of growth in children are weight, height and head circumference. Because the most rapid period of growth of brain is the first year and increase of head circumference indirectly indicates brain growth, so, regular measurement of head circumference and it's comparison with standard curves is important in health centers for monitoring of head circumference growth use from standard curves NCHS. Genetic, nutritional, and social status of infants will have direct effect on the body growth charts, and adjustment to a given population under study is essential. The present study is carried out to address such a purpose. Materials and Methods: In this longitudinal descriptive study, 200 girls and 200 boys with weight between 2.5-4Kg born at the Shabikhani Hospital were evaluated in first 6 months, monthly and in the second 6 months. Bimonthly head circumference was measured and statistical analysis is presented. Results: In this study average HC for boys and girls were 34.6 and 34.4cm respectively. The 50th percentile increment of HC in boys during the first year of life was 12.12cm and for girls was 11.56cm. Average growth of HC during the first 3 months of life in boys was 5.7cm, second 3 months 3.15cm and second 6 months of life was 3.25cm. Average growth of HC during the first 3 months of life among girls was 5.63cm and second 3 months was 3.02cm and in second 6 months of life was 3.91 cm. Conclusions: In this study, average rate of HC after birth in boys and girls was similar to reference tests. In addition, head circumference growth rate during the first year of life in comparison with NCHS charts did not show any significant difference. So we used NCHS charts for monitoring HC growth in the Kashan.      

History and Objectives: Light's criteria in which serum and pleural LDH activity and protein levies are the most common variables to differentiate exudative from transudative pleural effusion, for the past 3 decades. Several other biochemical parameters have been suggested, one of which is serum pleural effusion albumin gradient (> 1.2: transudate, < 1.2: exudate). The present study was performed to assess diagnostic value serum and pleural gradiant in the patient with pleural effusion. Materials and Methods: A descriptive study was carried out on 76patients. In a sitting position, pleural fluid aspiration was obtained and albumin, lactate dehydrogenase (LDH), protein levels and at the same time blood total protein, LDH and albumin was obtained, on the basis of Light's criteria, pleural fluid is categorized as exudate or transudate. 76 patients presented with pleural effusion referred to the Shahid Beheshti Hospital (Kashan) were studied according to the Light's critria and gradient method. Results: According to Light's criteria, 41 patients (54%) had transudateand 35 patients (46%). had exudate. These measures were 59% and 41% respectively in gradient method. Thus discrepancy was noted in 6 cases, labeled exudate according to Light's criteria however transudate according to gradient method. Sensitivity, specificity, positive and negative predictive value were 82.9%, 95% 93.5% and 86.6% respectively for gradient method. Conclusions: Sensitivity of Light criteria is higher than albumin gradient, but the gradient method has a higher specificity for patients who are clinically suspect of transudate but labeled exudate according to Light's criteria, albumin gradient is helpful.    

History and Objectives: Due to the increased frequency of tuberculosis for the past ten years, specially in developing countries(e.g. Southeast Asia) and importance of role of health care in prevention of the disease. BCG scar's and PPD response after BCG vaccination in neonatal period was determined. Their relationship in infants, who come to treatment to health centers of Kashan in the summer of 1998. Materials and Methods: This is a descriptive - analytical study. 400 infants (3 months old) who come to treatment and health centers of Kashan. Infants receiving BCG vaccination in neonatal period and PPD test were selected. Results: More than 93% of vaccinated neonates had BCG scar in 3 months old. 53.31% of infants 3 months after vaccination had positive Mathuex test. The bigger BCG scar had bigger Mantuex test induration size. Conclusions: Due to the importance of preventive measures in control of disease and efficacy of BCG vaccination in prevention of tuberculosis (specially in lethal forms) BCG vaccination is necessary in neonatal period in our country, and principle of storage and production of good vaccine solution and their usage by experienced staff should be taken into consideration.      

History and Objectives: Due to the prevalence of Berger disease and continuation of pain and its side effects among patients and probability of veinal- arterial fistula, the present study was carried out as a preliminary study on the effect of fistula on Berger patients referred to the Shohadaie Haft Tir Hospital in 1998. Materials and Methods: An experimental study on five patients suffering from Berger disease was performed. Pathologic findings were the basis of diagnosis of Berger disease. Veinal-arterial fistula was created on the ischemic and painful organs and its effect on the lowering of PV02 ischemic organ and lowering of the pain were assessed. Results were examined with paired t-test and significant difference (p<0.001) were observed. Results: PVO 2 before and after the operation was 44.4±6.28 and 69.6 ±4.2respecteively, with 25.2 ±3.11 and increase of 56.75% in arterial oxygen pressure was obtained. Pain was decreased (upto 75%) in all patients. Veinal-arterial fistula did not have any effect on prognosis and need of amputation in short run. Conclusions: The results of the present study are very promising. Further study in a larger scale and maintenance of pain free organ for the patients is recommended.      

History and Objectives: Due to scattered reports and collecting of bedbugs from Kashan villages in the past years and due to effect of this pest on health, the present study was done in the Western villages of Kashan in 1998. Materials and Methods: A descriptive study was conducted on houses to search for bedbug in 495 residential units in ten villages, that random samples were taken. The proof of infection were bedbug adult or nymphal instars in holes and cervices of wall and roof, under the signboard and pictures and paper hangings. The prevalence of infection were determined in the samples with 95% confidence of interval. Results: From 495 houses, 33 units (6.7%) were infected with bedbug. Infection was allocated in Azarm, Wadeghan and Meragh villages. In the present study, Azarm, wadeghan and Meragh infection were 20.4%, 13% and 11.6% respectively. Conclusions: Due to the presence of bedbug infection in a number of villages, the present study is suggested further research ought to carried out in order to understand the underlying causes of infection.      

History and Objectives: Due to different reports of prevalence of goiter in most parts of the Country and their consequences and lack of an exact and general statistics regarding spread of the disease in Kashan, the present study was carried out. Materials and Methods: A descriptive study was designed on 3130 male and female students. Individuals were selected from 30 schools from rural (10primary, 4 intermediate and 4 high schools) and urban (5 primary, 3 intermediate and 2 high schools) regions. Random samples were taken from classes and personal specificities such as age, sex, level of education, school performance, place of residence, parents' occupation and number of family members were recorded. Clinical examination of individuals were carried out by bimanual method according to the WHO guidelines. Based on the information recorded, the type of goiter was classified. The prevalence of goiter was extrapolated to the population. Results: From total of 3130 individuals studies 2548 (51.3%malesand 48.6%females) were from urban and 582 (58.7%malesand 41.3%females) were from rural regions and the prevalence of goiter was 47%. The prevalence among males and females were 59.1% and 40.9% respectively. The prevalence of goiter was 45.7% and 52% in urban and rural regions respectively. The prevalence of goiter among the students of elementary, intermediate and high school were 40.4%, 50.9% and 54.7% respectively. The age group of 16-17has the highest rate of goiter (62.2%) with type Ib with 28.4% rate of prevalence and the least type of goiter was type III with 0.3% rate of prevalence. The prevalence of goiter among students with good, fair and poor academic performance was 32.2%, 50%, and 70% respectively. The rate goiter prevalence was higher among males compare to females. Conclusions: In light of hyperendemicity of goiter in dessert area and inconsistency of prevalence with age and sex, further investigation on causes and underlying factors need to be carried out.      

History and Objectives: The inaccuracy of available diagnostic methods lead to an unacceptable high negative appendectomy and perforation rate. Our objective was to determine the value of clinical symptoms/signs and WBC differential count in the diagnosis of appendicitis in order to improve the accuracy of clinical diagnosis. Materials and Methods: In a clinical trial study, 914 consecutive patients with a clinical diagnosis of appendicitis, the value of abdominal pain and tenderness, pain shift, anorexia, vomiting, fever, tachycardia, leukocytosis and neutrophilly determined on the basis of P.P.V and N.P.V then analysed by Chi-square test. Results: From total of 914 patients evaluated, 61% were males and 39% females. The mean age was 24.7 ±12.4 years. Pathology revealed 700 positive appendicitis (cases) and 214 negative appendectomy (control). The most accurate diagnostic factors were neutrophilly leukocytosis and pain shift. Neutrophilly had a PPV=85 which means 15% diagnostic failure. It had N.P. V=38 which means 62% of patients who have not neutrophilly will have positive appendicitis (p < 0.0005), so this factor has a poor diagnostic value. Obviously other clinical and laboratory factors will have lower accuracy than neutrophilly, thus none will have any diagnostic value by themselves alone. For this reason, diagnostic value of more common symptoms was examined in combination for diagnosis of appendicitis. The most common and accurate factors were the combination of pain shift, anorexia, vomiting, leukocytosis and neutrophilly with P.P.V=92.4 and NP.V=36, which means only a 7.6% diagnostic failure. Conclusions: None of the clinical criteria and leukocytosis alone could have diagnostic power To predict appendicitis, however, the combination of several factors have more accurate predictive value and reduces the false appendectomy rate. The study revealed that with more attention to clinical symptoms, signs, leukocytosis and neutrophilly can improve clinical diagnosis and result in lower negative negative appendectomy and perforation rate significantly(p<0.0005).      

History and Objectives: Due to the importance of and different factors related to failure of pregnancy and since little is known about failure of pregnancy in Kashan, the present study was carried out in order to determine prevalence and factors related to failure of pregnancy in Dr. Shabikhani Hospital in Kashan in 1998. Materials and Methods: A descriptive study concerning 1077 pregnant women and failure Of pregnancy including abortion and fetal death and its relationship with maternal age, paternal age, parity and previous abortion was carried out. Results: The prevalence of failure of pregnancy, abortion and fetal death was 13.8%, 11.4% and 2.4% respectively. High maternal age was the most prevalent factor involved with abortion (21.8% with the age of 40 or older and 10% with age group of 20-30). The prevalence of abortion and fetal death was increased with maternal age, paternal age, previous history of pregnancies (> 6 time) and previous abortion. Conclusions: The parental age in the time of pregnancy, previous abortions and parity were significant factors in failure of pregnancy. Further studies on the factors related to failure of pregnancy is recommended.      

History and Objectives: Due to the importance of diagnosis of the abnormal epithelial cells of cervix and usual diagnostic method of Pap smear and various reports of ability of Pap smear in diagnosis of abnormal epithelial, in order to determine positive predictive value of Pap smear with abnormal epithelial cells comparing with the biopsy and patients characteristics this study was carried out among women referred to Shabihkhani Hospital of Kashan in 1996-1999. Materials and Methods: A clinical trial was performed on all women with abnormal Pap smear candidate to biopsy. Data were collected by interview and reports of Pap smear, type, results of biopsy were recorded. Analysis was performed and positive predictive value was determined. Results: From 65 patient analyzed, all samples had abnormal epithelial cell determined by Pap smear test. The positive predictive value of the detection of the disease was 78.5%. Conclusions: Considering the ease, relative inexpensiveness and availability of the Pap smear and relative low predictive value, further investigation in order to upgrade the quality of Pap smear test, and to increase the diagnostic power of abnormal epithelial cells is needed. In addition, a new clinical trial design is required.      

History and Objectives: Because leukemia is the most common disease and one of the cruable malignancies in children, the present study was performed for the determination of characteristics of children with leukemia in Kashan area. Materials and Methods: The present study was carried out on exsiting data of patients undergone diagnostic procedures and treatment in the ward of pediatric disease. Demographic, clinical, laboratory, cytogenetic and immunophenotype characteristics of patients were evaluated. Results: The study showed that frequency of leukemia in children before 1years old 5.5%. ALL, AML frequency were 89% and 11% respectively. The most common clinical symptoms were paleness (60.5%) hemorrhage (50%) and fever (44%). 17% of cases had WEC count more than 5000/mm3 and 27.5% of cases had platelet count less than 50,000. Relapse occurred in 22% of cases with the bone marrow the most common place (11%). Frequency of leukemia was 55.5% in boys and 44.5% in girls. 50% of patients had anemia. From cytogenetic point of view 44.5% were diploid and 5.5% aneuploid and evaluation was not performed for the rest. From immunophenotype point of view cases were divided to ALL with B cell origin (50%), ALL with T cell origin (11%), ALL with unknown origin (5.5%), AML (11%) and this evaluation wasn't performed for the 4 cases. Conclusions: Due to nonspecific clinical signs and symptoms of leukemia among children, for early diagnosis and treatment, more precise examination by physicians is emphasized. Also more extensive studies on the prognosis of patients is suggested.      

History and Objectives: To compare the values of some biochemical factors with the reference values, fasting blood sugar, urea, uric acid, creatinine, cholesterol and triglyceride were determined in clustered samples of the population of Kashan. Materials and Methods: Blood samples of 994apparentlyhealthypeople above 30years old were collected. All of them were asked to fast for about 12 hours. Blood sugar, urea, uric acid, creatinine, cholestrol and triglyceride were determined by RA -1000 autoanalyzer using Technician biochemical kits. Results: Mean blood sugar values in women and men were 83.9±25. 6mg/dl and 2.4±29.8mg/dl respectively, mean urea values in women and men were 13.1±9.0mg/dl and 14.9±mg/dl respectively, mean uric acid values in women and men were4.9±2.6mg/dl and 6.1±3.0 respectively, mean creatinine values in women and men 210.0 ± 92.6mg/dl and 195.0 ±84. 0mg/dl respectively and mean triglyceride values in women and men were 220.0mg/dl and 242.0 mg/dl respectively. Conclusions: The present reference ranges for fasting blood sugar, urea, uric acid and creatinine were similar to those appearing in the textbooks. The cholesterol values of 49% and triglyceride values of 55% of those people were above 200mg/dl which clearly shows higher values than reference values given by the World health organization. More research should be done to find the reason for these high values of lipids in the population.      

History and Objectives: Pancreatoblastomais a rare pancreatic disease. Due to discrepancies as to the origin, histogenesis and type of treatment of the disease, the present article presents a case of pancreatoblastoma of a 10year old boy admitted to the Shahid Beheshti Hospital and underwent surgical operation. Presentation of the Case: A 10 year old boy was presented with abdominal pain for 20 days prior to hospitalization. The pains were more pronounced at night and with ingestion of food. A mass of about 10cm was palpable at the epigaster region. The patient underwent the surgical operation and pathalogic findings indicated pancreatoblastoma. Results: Pancreatoblastoma, although is a malignant tumor, with early diagnosis and with prompt surgical operation, half of children recover fully.