Feyz Medical Sciences Journal
Year:2005 | Volume:9 | Issue:2 (Serial 34)|Papers Count:19

Background: Given the prevalence rate of missed abortion and the complications of its surgery and also the propounded controversies about medical treatments and in order to determine the efficacy of vaginal misoprostol in terminating missed abortion cases till 12th weeks of pregnancy, this study has been conducted between Dec. 2004 and Sep. 2004 in Kashan Shabihkhani Hospital. Materials and Methods: The study was a clinical trial in 80 pregnant women with missed abortion. The patients were categorized randomly in two groups (medical group, surgical group). The women in medical group were given an initial dose of 800 mgr. of vaginal misoprostol and if it was necessary more dose of 400 mgr would be repeated every four hours for maximum of three vaginal or oral dose in proportion of amount of bleeding. After 15 days if the ultrasound findings showed residual tissue, curettage would be performed. In the surgical group dilatation and sharp curettage was performed. Patient’s data such as age, gravidity, gestational age based on LMP and sonography, previous cesarean and previous abortion was recorded in a data chart. Statistical analysis was performed using X2 analysis, McNemar, Fisher exact test and T–Test. Results: In medical group 87.5% had complete abortion without any need of curettage. In 92.5% of cases in surgical group, gestation products were evacuated completely by curettage. Bleeding period in medical group was significantly more than surgical group but there was no significant difference in hemoglobin concentration level before and after abortion. The most common side effect in medical group was lower abdominal pain and fever.Conclusion: Misoprostol is an effective method with tolerable side effect for terminating missed abortion until 12 weeks, in the other words, it is recommended to use misoprostol as a medical method for terminating first trimester pregnancies in Iran.

Background: Prolonged labor is associated with known complications. There are different reports about initial dose and dosage interval in induction of labor. This study was conducted to compare the effectiveness and complications of two different oxytocin regimens for induction of labor. The differences between them include: starting dose (mu/min) incremental increase (mu/min) and dosage interval. Materials and Methods: A randomized clinical trial study was performed in Akbar Abadi Teaching Hospital between oct-march 2001 on 110 pregnant women with 41, completed weeks of pregnancy with bishop score ≤4 in protocol A (50 women) (Low-dose oxytocin), oxytocin was initiated at 2/5 mu/min, with 2/5 mu/min incremental increases every 15 minutes until maximum dose 40 mu/min. In protocol B (60 women) (high-dose oxytocin), oxytocin was initiated at 5 mu/min with incremental increases every 45 minutes until maximum dose 40 mu/ min. Then the effectiveness and complications of two protocols were compared. Results: the duration of induction- to- active phase of labor, was significantly shorter in high dose protocol B. (P<0.001). The duration of induction-to-delivery was significantly shorter in high dose regimen (Protocol B).(P<0.001). The duration of active phase of labor was significantly shorter in protocol B (High dose regimen) (P<0.01). Complications including, hyperstimulation, fetal distress and cesarean deliveries were the same in two groups. Conclusion: High dose oxytocin regimen is more effective than low dose oxytocin with no more complications and is suggested for induction of labor.

Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (GBS) , this study was carried out to assess autonomic dysfunction signs and symptoms and also heart rate variation (HRV) with respiration in the acute phase of GBS and it's prognostic value. Materials and Methods: Forty-three patients with GBS who referred for electrodiagnostic study in the first week of their disease were studied. Autonomic system involvement detected with careful clinical examination and heart rate variation with deep breathing were studied in all patients and Prognostic value of test was evaluated with proper analytical tests. Results: HRV was abnormal in five patients (11.6%) and expiratory to inspiratory ratio (E/I) was abnormal in eight patients (18.6%). In 9 Patients (20/9%) each of the tests were abnormal. There was no significant correlation between HRV and E/I Ratio between axonal and demyelinating types. (P=0.88) but there were significant correlation between abnormal results and respiratory failure (P<0.001), (P<0.011) and also severity of weakness (P<0.05). Conclusion: Autonomic dysfunction is common in acute phase of GBS (60%). Our results showed cardiovascular involvement with abnormal HRV and E/I Ratio tests could be alarming for sever respiratory involvement in the course of disease.

Background: Number of neurosurgery patients is increasingly high. With respect to controversies about morbidity and mortality in these patients and lack of any information about these cases in our university this study was carried out in Kashan Naghavi hospital during 1999-2001. Materials and Methods: This descriptive study was performed on medical files of all neurosurgery ICU cases during the study period. Demographic information, morbidity & mortality rates and their causes were assessed. Descriptive statistics was used for analysis. Results: Of 280 cases, 267 cases were enrolled the study. Rate of mortality in 1990 was 43. 1% that reduced during the years of study (P<0.02). With increase of duration of hospitalization, urinary tract infection rate increased. Conclusion: Low GCS and high mortality are matter of concerns. We suggest further studies on the causes. Preventive interventions are also recommended.

Background: Hypercalciuria is the most common cause of nephrolithiasis. Many hypercalciuric patients are visited in pediatricians’ offices. Various factors like solutes of water and diet affect the prevalence of hypercalciuria in different areas. So this study was carried out to evaluate the prevalence of hypercalciuria and its related factors in 6-12 years old children in Kashan. Materials and Methods: This descriptive study was done on 400 children aged 6-12 years old in kashan city and its villages. After determining the sample size and selecting the school that should be studied, investigating teams were instructed about sampling and collecting data. The questionnaire was completed for every child who had not signs of hyperparathyroidism, Cushing syndrome and history of excessive use of vitamin D. Urine samples were collected in plastic sealed labeled containers and were sent to central laboratory of university. Then sodium, creatinin and calcium of samples were tested by flame – Phothometer and RA 1000 apparatus. Children with urine calcium to creatinin ratio more than 0.2 and urine sodium more then 200 meq/lit were known respectively as hypercalcouria and hypernatriuria. Results: The study was done on 362 out of 400 cases. The prevalence of hypercalciuria was 34.2%, of them 58.1% was male while 47.9% of children without hypercalciuria was male (P<0.09). The prevalence of hypercalciuria at Kashan city and its villages were 33% and 39% respectively. The prevalence of hypernatriuria in children with hypercaliuria was 41.9% but in children without hypercalciuria was 20% (P<0.0001). Conclusion: The prevalence of hypercalciuria in Kashan city and its villages is high. This is even higher in rural than urban regions. Hypercaciuria prevalence in male is more than female. There is direct relation between prevalence of hypercalciuria and hypernatriuria hence it is recommended another study to compare solutes level of drinking water and excessive use of salt in rural and urban regions of Kashan

Background: The pathologic accumulation of fluid in the peritoneal cavity, which is named ascites, is observed in different diseases. Paracentesis is used to diagnose the causes.  The difference of albumin concentration between ascitic fluid and simultaneous blood serum less than 1.1 g/dl, indicated low gradient ascites. Regarding the importance of low gradient ascites causes, this study proposed to find causes of this type of ascites in Rasht in a 7 –year period.Materials and Methods: This cross sectional study was done according to the data, which were obtained from the recorded files of referral patients to two hospital of Rasht from 1993 to 2000. The type of ascites was determined by albumin concentration between ascitic fluid and simultaneous blood serum. Ascitic fluid Glucose and LDH were measured in the patients too. A data form including Patients’ demographic information and final diagnosis was prepared. Thereafter, the data were analyzed using SPSS 10 software. Results: Of 148 studied patients there were 72 (48.6%) males and 76 (51.4%) females with the mean age of 56.03 ±13.54. The most frequent causes of low gradient ascites were tuberculous peritonitis  (68, 45.9%) and cancers (62, 41.9%). Of cases, 12.2 % were associated with other causes. Type of low gradient ascites didn’t show any significant differences between male and female groups, but age groups had significant differences (p<0.0001). The mean Serum-Ascites Albumin Gradient (SAAG) and LDH were 0.68±0.19 and 342.38± 135.46, respectively. Mean ascitic fluid Glucose of peritoneal tuberculosis (TB), malignancies and others were 71±13.82, 101.4±17.21, 89.16±13.15 mg/dl respectively and these differences were significant  (P<0.001).Conclusion: In our area in patients with low gradient ascites, it is necessary to rule out TB, this treatable disease, at first. Afterwards we do other diagnostic tests such as ascitic fluid glucose and LDH, for diagnosis of malignancies and then other causes.

Background: Regarding to prevalence of otitis and different report of etiology and resistant drug and inaccessibility of accurate bacterial agents and the rate of antibiotic sensitivity, this study was performed in patients who referred to Matini Hospital of Kashan. Materials and Methods: A descriptive study was conducted on 50 patients with supperative otitis media that refereed to the Central Laboratory of Kashan University during 2002-2003. All of patients were examined by Otolaryngologist, then refereed to Centeral Laboratory, specimens were collected and cultured on media: eosin Methylen Blue (EMB), blood agar, Thioglycolate, isolated were identified by National Committee for Clinical laboratory Standard (NCCLS), antibiotic sensitivity was determined according to disc diffusion method (Kirby-Bauer). The results were presented by descriptive analysis. Results: Rate of infection in the 50 cases were determined 56%, the most common age of patients in the both sex were 25-35 year. Pseudomonas Aeroginosa and Staphylococcus Aureus were the most common pathogens (22%), Pseudomonas showed the most rate of antibiotic sensitivity to vancomycin Conclusion: P. aeroginosa was the major pathogen in patients with suppurative otitis media, gentamycin and ciprofloxacin were determined as effective drugs.

Background: Application of some materials, in order to increase raw water turbidity and to enhance the efficiency of coagulation process is usual. SFBW recycling due to its relatively high volume (4% of total water production) is usual too. In the USA usually in about 30% of water treatment plants SFBW is recycled directly to the inlet of treatment plant line. This study was achieved in order to determine the influence of SFBW recycling on coagulants reduction in Jalalieh   water treatment plant. Materials and Methods: In this study the samples were taken from raw water and filter wash water effluent. At the first step, the parameters of pH, turbidity, TDS, EC and temperature were examined for both raw water and SFBW. Then the optimum coagulant dosages for raw were determined by Jar test. The optimum coagulant dosages for raw water and the mixture of 4% SFBW and raw water were determined at the next stage. Finally the data was analyzed by SPSS software.  Results: The results of this study showed that the mean values of pH for raw water and SFBW were 8.1 and 7.73 respectively. The mean values of raw water and SFBW turbidity were 7.7 and 237 NTU respectively. The mean values of EC for these two conditions were 253.2 and 240.7 μs/cm respectively. Conclusion: Although it was observed that by recycling 4% of filter wash water there was a 0.72 mg/l reduction in ferric chloride, but the difference was not statistically significant in the range of analyzed turbidity (3.77 25 NTU…)

Background:  Patient seeking care behaviors are affected by many factors including socio-cultural and financial affaires, therapeutic costs, etc.  This study was conducted to investigate patient seeking care behavior in Kashan, in 2004. Materials and Methods: This was a descriptive study in which a random sample of 414 individuals was selected from people attending public outpatient health clinics. Multi stage sampling was used to select the subjects. For data collection a trained expert health worker interviewed the subjects individually in the health centre waiting room. Identity variables and study specific objectives (contact with GP or health clinics as optimistic behavior and direct contact with specialty or subspecialty as non relevance behavior) were assessed.  Then the data were analyzed using Chi-square statistical test. Results: Of participants, 49.3% were men and 51.7% were women. Rate of having a visit to a physician in four recent weeks were X= 0.96 ± 1.29 in women and X= 0.49 ±0.93 in men. Seeking care optimistic behavior were 21% and 15.7% respectively. There was a significant association between the sex and physician seeking care behavior (X2=18, P=0.5). Of subjects83.3% were covered by a health insurance plan and 16.6% were not covered by any insurance plan. Overall patient optimistic behavior in insured and uninsured subjects were 19.1% and 14.5% respectively. Conclusion: The findings of this study demonstrated the high degree of difference in patient seeking care behavior rates according to the healthcare delivery system structure (insurance type and care givers), patient characteristics and many influencing variables. We recommend findings of this study for reorganization of healthcare delivery systems. The findings may be regarded as preliminary to further research into this area of health system structure.

Background: Due to aged population and the high prevalence of chronic psychiatric disorders in our country and necessity of collecting information for therapeutic and rehabilitation programming especially in hospitalized patients, this study was done to evaluate and study demographic characteristics of hospitalized chronic psychiatric patients over age 55 in the largest psychiatric hospital of the country in second half of 2002. Materials and Methods: This was a descriptive study that was done by studying of current data. Data were gathered using medical records and interview. Then the data were extracted and classified. All data were compared in male & female groups and difference between them was calculated by statistical tests. Results: Of total number of 1025 hospitalized patients we evaluated 191 patients over age 55. There were 108 women and 83 men. The most common jobs of women and men were housewife and simple worker respectively. Many women were divorced and the men were unmarried. A large percent of both groups were illiterate and most common psychiatric diagnosis was schizophrenia in both groups. The disorder in two groups had gradual onset. Most patients were hospitalized more than 10 times and most of them did not have any visitors. Conclusion: Results indicate that these patients suffer from some psychological and somatic pains and they have poor social and family supporting. Thus we must try to program for de-institutionalization. More intention to rehabilitation and developing supporting systems are needed.

Background: Cryptorchidism is a defect in the time of fetus development, in which one or both of testes don’t reach to scrotum. This situation causes some important complication such as testis cancer, inguinal hernia, and infertility. The delay in treatment increases the risk of complications. The methods of treatment are hormone therapy and surgery, regarding to this fact that the first method is less successful; surgery in the first year of the life is considered the best. The purpose of this study is to evaluate the ages of cryptorchidism and the diagnosed complications at the time of surgery, in Kashan Naghavi Hospital.Materials and Methods:  A descriptive study was performed on 50 patients with cryptorchidism, referring to Kashan Naghavi hospital during March 2002 until March 2004. Age of patients, laterality, surgical finding and reason for delayed referring were recorded. Results:  Age of patients ranged 8 month to 27 years old. Mean age was 9 years old. Post-surgical diagnoses were 36 inguinal testes, 46 (92%) unilateral, 4 (8%) bilateral, 14 (28%) atrophic testes and 11 (22%) inguinal hernias. The most important reasons for postponed treatment were ignorance of the parents 28 (56%) and delayed diagnosis 14 (28%). Conclusion: Early detection of cryptorchidism is of high importance. Screening for this situation and referring the suspected cases for early treatment are recommended.

Background: Combined Oral Contraceptive Pills (COCPs) are widely used. This study was carried out to determine prevalence rate of twin delivery and to assess the effect of combined oral contraceptive pills on twin delivery in the next pregnancy. Materials and Methods: This was an epidemiological case control study. The study was under taken in Ahwaz in 1999-2001. Data was collected from both governmental and private hospitals. Cases were 156 pregnant women who attended to hospital for termination of twin pregnancy. Controls were also 156 women with singleton pregnancy who attended to hospital for delivery. Type of hospital, maternal age, gravida and history of twin pregnancy in the family were matched between cases and controls. Trained interviewers filled questionnaires. Other information such as weight of newborns was collected by observation.  Softwares such as Spss for windows, EPI and CIA (confidence interval analysis) were used for data analysis. Results: The prevalence rate of twin delivery was 153/10000 live births. There were significant difference between twin pregnancy and irregular menstrual cycle (p=0.04), problem in newborn (p<0.001), gestational age and husband’s job (p=0.006) Overall 29.8% of all cases had used oral contraceptive pills. The difference between two groups for use of contraceptives was significant (p=0.04). Conclusion: Consumption of COCP is not associated with twin delivery in next pregnancy. Evaluation of other factors is recommended.

Background: Due to controversies in etiology of malnutrition, mother’s BMI and child’s sex, the present study was conducted in order to determine the role of mother’s BMI and child’s sex on malnutrition of children younger than 5 years old that referred to health care centers in Kashan in 2002-2003. Materials and Methods: In a case-control study using cluster and random sampling,125 children with malnutrition based on weight for age using -2 standard deviations criteria NCHS (case group) and 125 children without malnutrition (control group), from 10 health centers in Kashan were enrolled during the study period. Mother’s BMI and child’s sex was compared in two groups. Case and control groups were matched in confounding variables. Information was obtained from medical records through interview. Results were judged with Chi- square, t-test and mantel haenszel. Also Odd's ratio and confidence interval were determined. Results: Results showed that matched factors such as maternal age, maternal employment, parity, birth weight and height, duration of breastfeeding and child age were similar in two groups. Mean mother’s BMI was significantly different in two groups (P<0.002). Also results demonstrated child’s sex was related to malnutrition, (P<0.02). Odd's ratio and confidence interval for effect of BMI<22 and female sex on malnutrition were) OR=2.1 CI=3.74-1.16 P<0.05, OR=1.81 CI=3.05 -1.07 P<0.05) respectively. Although malnutrition was showed to be related to each variable separately, mantel haenszel test demonstrated that two factors were not concurrently related to malnutrition. Conclusion: Low mother’s BMI and female sex, increased risk of malnutrition alone but not related with malnutrition together. Further studies are recommended to determine other risk factors.

Background: A great number of patients in our country have had valve replacement operation. Considering much problems and not being clear the rate of them in valve replaced patients in this area, this study was done in order to determine the difficulties of these people in Kashan in 2001. Materials and Methods: In a descriptive study patients with replaced heart valve were examined. For each patient a questionnaire was completed consisting variables such as: age, sex, occupation, valve type, place and duration of valve replacement, dyspnea, hemoptysis, continuous cough, wheezing, palpitation, edema, blood pressure under 95 mm Hg, diet and nutritional habits like salt consumption, abnormal hemorrhage, contraception status, altered daily activities, and sleep difficulties like difficulty in onset of sleep, frequently and unwanted waking up during the sleep and insomnia. Using descriptive statistics, data were classified and presented. Chi square and Fischer exact tests were used for analysis. Results: Of 140 patients with replaced heart valve, 20 cases had died and 20 people had migrated. The others were 60 women and 40 men. Seventy-five patients ranged 21 – 50 years old. Mean age was 36 years old. Two patients had biologic and 98 patients had mechanical valve. Of participants, 70 cases had at least one respiratory problem. Most common respiratory problems including dyspnea and hemoptysis were associated with Biork Shaily valve (46.6% and 36.7% respectively). Wheezing was mostly related to Sent Jude valve (28.5%). Highest rates of palpitation, edema and atrial fibrillation were observed in patients over 51(85.7, 14.3 and 90.4% respectively). Rates of sleep problems and altered daily activities were 60% and 70% respectively. Fifty-five percent of patients were not educated about care plan after surgery. Conclusion: dyspnea, hemorrhage, hemoptysis, decreased tolerance to activity, sleep disorders, atrial fibrillation and low blood pressure were the most common problems of patients with heart valve. On the other hand, rate of these problems were higher in uneducated patients than educated ones. Therefore, paying more attention to education of patients after cardiac valve surgery, and also more studies in this field are recommended.

Background: Hyperimmunoglobulinemia E syndrome (Hyper-IgE syndrome) is an idiopathic primary immunodeficiency disorder, that characterized with recurrent staphylococcal cutaneous and lung infections with abscess pneumatocele formation, which begins in infancy and is associated with extremely elevated levels of IgE in serum. Other findings that are associated with this disorder are: coarse facies, eosinophilia, and skeletal abnormalities. According to variability of findings in this disorder that easily may be mistaken with other rare immunodeficiency syndromes, in this article a case of Hyper-IgE syndrome that was referred to Kashan Shahid Beheshti Hospital in 2002 is presented. Case report:  A 30 years old man was admitted with history of fever, dyspnea and purulent cough. He had multiple episodes of pneumonia and pustular skin lesions since childhood. In physical examination multiple skin scars on the face, neck and the legs were observed. Chest radiography revealed multiple thin-walled pulmonary cysts suggestive of pneumatoceles. Computed tomography of the chest showed bilaterally pneumatocele with abscess formation. Considering systemic and recurrent infections, evaluation of immunodeficiency state in-patient was performed and according to extremely elevated levels of IgE in serum and eosinophilia, the diagnosis of Hyper-IgE syndrome was confirmed. Treatment with intravenous antistaphilococcal antibiotics was done and after treatment of acute stage, the patient underwent longterm oral prophylaxis with co-trimoxasole and cloxacillin. In follow- up he was doing well. Conclusion: It is necessary to consider the diagnosis of Hyper-IgE syndrome according to clinical findings and recurrent skin infections from infancy and pneumatoceles associated with extremely elevated levels of IgE in serum. It is recommended that after treatment of acute stage, prophylaxis with oral antistaphylococcal antibiotics is continued.