Journal of Medical Council of Iran
Year:2006 | Volume:23 | Issue:4|Papers Count:20

In our country, frozen section (FS) is common because of lack of experienced cytopathologists in many centers in Iran in contrast to developed countries. The aim of this paper is evaluation of the accuracy of FS in thyroid nodules in Tehran university hospitals. Frozen section cases were determined in four hospitals (Sina, Amir Aalam, Imam and Cancer Institute) between 1991-1999. We gathered all information about patients, FS results and Permanent pathology from patient's records. Results of FS and their characteristics (Sen., Spec., P.P.V., N.P.V and Accuracy) were determined with respect to the pathological results.Total number of patients was 237. Cancer rate was %18.6 Results of FS was classified in two groups, benign and malignant.(Deferred cases were classified as benign). The results obtained showed: Sen. =63.1%, Spec. =%100, PPV=%100, NPV=%92.3 Accuracy= %93.2In cases with definite benign diagnosis, the nodule was benign in 96% of cases and in cases with malignancy result, malignancy was seen in all cases and there were no false positive cases. In cases where FS was deferred, the nodule was benign in 81% of cases. Results are the same with reports from other countries and prove that the efficacy of FS in our country is acceptable, especially that false positive cases were absent. With respect to deferred cases, it seems that our pathologists are conservative and report some benign results as doubtful.

Medical society potentially has a great influence on tobacco control and prevention. With respect to studies conducted in most countries, cigarette smoking had existed among medical personnel and had a significant correlation among physicians sate of smoking with that of the general population. In Iran we have not had a similar study and we decided to perform this project at the national level.This study evaluated the smoking behavior and its related diseases among all members of IMC who are 80,000. It is a descriptive cross-sectional study conducted by means of a questionnaire based on WHO which was matched with IUATLD questionnaire guidelines The project has been carried out in autumn 2003 by sending the questionnaires through the IMC journals for the members.3270 returned questionnaires show that 13.1% of IMC members are smokers. Among IMC members, 19.6% are male and 5.5% of female are smokers. According to the job, 16.6% of general physicians, 12.5% of dentists, 12.5% of pharmacologists, 10.6% of specialists, 1.4% of midwives, 18.2% of nurses and 4.7% of other professions are smokers. The most common age of starting smoking is 18 years (31%).Among whole population, 39.6% have diseases which are respectively 37.2%, 46.4% and 45% in non smokers, ex-smokers and smokers.28.2% of smokers who smoke less than 10 cigarettes a day and 44.6% of smokers who smoke more than 20 cigarettes a day have diseases.The smoking rates in IMC members are close to the general population rates and are higher in comparison to women. Tobacco use and its diseases have a dose related response.These results are profitable in educating the medical society about smoking control across the country and health priority strategies at the national level.

Patients requiring prolonged mechanical ventilation are not uncommon in a cardio surgical intensive care unit and many of them require tracheostomy. Studies demonstrate that prolonged mechanical ventilation with tracheostomy is associated with increased hospital mortality especially in cardiac surgical patients.This study was designated to predict the risk factors for tracheostomy in open heart surgery patients.We retrospectively investigated 27 patients who had undergone conventional open tracheostomy and compared them with a matched group (93 patients), without tracheostomy but with prolonged ventilation and reintubation. Pre, intra and postoperative variables were compared with X2 or student t-test and important variables with (P<0.1) included in Multivariate logistic regression.Statistics are expressed as mean±SD and a P-value < 0.05 was considered to be important.Of 120 the patients with respiratory failure, successful weaning from mechanical ventilation was achieved in 93 patients, while 27 patients underwent tracheostomy due to unsuccessful weaning from mechanical ventilation and out of this, 27 patients procedures were unsuccessful in 6 patients. Statistically significant difference was observed between the groups in regard to preoperative variables such as P2O2 and P2CO2 (P<0.05). But no difference was observed in regard to the variables such as ejection fraction, diabetes, post operative bleeding, hypercholesterolemia, smoking and opium abuse. But CPB time, congestive heart failure, inotrope usage, using, hypertension, COPD, respiratory complication, infection, TNG and nitroprusside use showed a significant difference (P<0.05).Patients who require prolonged mechanical ventilation are susceptible to many complications such as infection, ulcer and prolonged weaning from respirator. Therefore early detection of risk factors for prolonged mechanical lead to early tracheostomy avoiding the disadvantages of long- term endotracheal intubation.

Renal transplantation is the treatment of choice for most patients with end-stage renal disease which has resulted in improving the quality of life of these patients. Despite all improvements in the field of renal transplantation, mortality after renal transplantation remains a serious problem. Regarding survival and mortality of these patients, several studies rove been conducted which have produced varied results. This study was undertaken to examine survival and cause of death after renal transplantation in 207 patients who received a renal transplant between March 1993 and Jun 1996 at the Shariati Hospital.Eighteen patients died after renal transplantation in 4 (22-2%) of cases Where the cause was infection in 5 cases (27.8%), CNS problems in 5 cases (27.8%) and cardiovascular problems. The survival of patients was 94% at 1 year, 93% at 2 years and around 91% at 3 years.In the present study contrarily to other studies, cardiovascular problems were not the leading cause of death which could be due to the lower age of patients in this study. Malignancy was not found as a cause of death in this study although it has been reported as the frequent cause of death in other parts of the world. Perhaps low dosage of immunosuppressive drugs, less number of patients and limited follow up could be the reasons for this difference.

There are little data regarding the frequency of maternal, fetal and neonatal complications related to gestational diabetes mellitus (GDM) in Asian countries. Complications are thought to be higher than western countries, because of the poorer medical and obstetric facilities and lack of awareness. In an universal screening From 1310 pregnant women who were referred from private clinics and 8 health care centers to Fatemiyeh clinic, 63 women had GDM. All GDM women were controlled by researcher in Fatemiyeh clinic, also they were referred to the Sadri clinic (a specialized clinic) which was attended by a specialist team comprising obstetricians, an internal medicine physician, a dietitian and a nurse. Fasting and 2h post-prandial glucose values were evaluated weekly by formal laboratory method. All measurements of serum glucose were performed by the glucose oxidase method at the Fatemiyeh Hospital Laboratory. If the glucose level was not controlled the woman would be hospitalized and insulin prescribed by a physician.Of the 63 pregnant women with GDM, 50 (79%) were treated by diet alone and 13 (21%) had diet and insulin. Women with Insulin therapy were significantly older, obese and more parous. Delivery was earlier and had high blood glucose level during their pregnancy. The rate of glycosuria, age>30yr, obesity (BMI≥30Kg/m2), previous macrosomia, also elevated fasting blood glucose (FBG) in glucose tolerance test (GTT), GDM diagnosed before 12 weeks gestation, the rate of hydramnious (P<0.001, 33.3%), stillbirth (P<0.001, 33.3%), pre-eclampsia (P<0.05, 25%) and neonatal hypoglycemia (P<0.001, 58.3%) in women with insulin therapy had meaningful statistical differences with diet therapy group. Patients with GDM were scheduled for a 2-hour 75-gr oral glucose tolerance test at least 6-8 wks after delivery. All 8 women with overt diabetes were treated by insulin during pregnancy.The high level of pregnancy complications in the group with insulin therapy was due to the high level of blood glucose during pregnancy thus awareness among these patients, strict dietary control.regulation in insulin injection, also use of glycometer set in order to daily control blood glucose is emphasized. Furthermore, the risk factors of glycosuria, age>30, obesity and previous macrosomia also GDM diagnosed in early pregnancy and elevated FBG in GTT must be noticed as predictor factors for the need for insulin therapy during pregnancy in GDM women.

Thyroid cancer is the most common endocrine malignancy in the world. The incidence of this malignancy is related to the amount of iodine intake absorption. Iran is considered as an area with scarcity of iodine intake. To review epidemiological data about this cancer in Iran, we used thyroid cancer data from Tehran Metropolitan Area Population Based Cancer Registry.All cases of thyroid cancer registered since 1998 in Tehran Metropolitan Area Population Based Cancer Registry were used for this study. The incidence of thyroid cancer was estimated in the area covered by the cancer registry. Survival of patients was determined using two attempt calls to the patients and linkage of registry data to mortality data from the Bureau of Vital Statistics. Patient's survival was described based on sex, age and morphological type of the tumour.During 1998 through 2001, 429 cases of primary thyroid cancer were registered in the Tehran Metropolitan Area Cancer Registry.The incidence of thyroid cancer was 3.5 and 1.0 in 100,000 population for females and males, respectively. Seventy percent of the tumours were papillary, 11% follicular, 6.2% medullary and the rest were other subtypes. Five-year survival rate was similar in both the gender and was about 82.2% (median survival of 66 months and 95% confidence interval of 63 and 69 months).While the incidence of- thyroid cancer was slightly high, the descriptive epidemiology of thyroid cancer in Iran did not manifest a unique feature. Iranian patients experienced a high rate of survival, and this survival rate did not exhibit a significant difference between the male and female population.

1798 pregnant women with their neonate off springs were evaluated in to two high and low risk grpups.Maternal data consisting of level of education, socioeconomic status, gestational age, duration of rupture of membrane at delivery, history of infections or meconium staining, leukocyte count> 18000, demographic and other data about the neonates were entered into the data sheets.Mean maternal age was 26.72±5.7 years (15-48), comprising of 8.7% illiterate, 50% having primary, 36.9% secondary and 4.5% >12 years of education. Monthly income in 47.4% women was more than 1500,000 Rials. Comparisons of literacy and socioeconomic status in high and low risk mothers were not significant (p> 0.05).Mean gestational age and birth weight of infants were 37.9±2.7 weeks (25-43), and 3043±665.9 g (700-5000) respectively. Neonates with positive blood cultures had mean gestational age and birth weight of 35±3 (28-40) weeks and 2367±878g respectively, out of whom 60% were less than 2500g and 70% were premature. 45.6% of infants were male and the most prevalent organisms in blood cultures were Staphylococcus Epidermidis 25 (43%) and Acinetobacter 17(29.3%).Prematurity was the most common (70%) and in 10 patients this factor was the only one observed. Comparison of prevalence of neonatal infection in high risk and low risk groups showed a significant statistical difference (P< 0.000) with a risk ratio of 22.5 (CI 95%: 8.97-56.8). In logistic regression analysis, prematurity, maternal fever & infection showed significant statistical difference and prematurity was the most important risk factor with an odds ratio of 12.5.

Myelogenous leukemia is the most important hematopoietic system disease in today's world. Previous studies have indicated that Immunogenetic factors play important role in the production of myelogenous leukemia. This study has attempted to recognize the immunogenetical factors in predisposition or prevention of acute myelogenous leukemia.In the present case-control analytic study. Sixty (60) acute myelogenous leukemia patient's HLA class II alleles (DRB, DQA1 and DQB1) are detected and compared with eighty (80) healthy subjects by PCR-ssp method for the first time in Iran. In acute myelogenous leukemia patients, the frequencies of alle1es DRB1 *16 and DQB1 *03011 were significantly higher than in healthy subjects. In contrast, frequencies of alleles DRB1*07, DRB4*01 (DR53), DQB1*0604, DQB1*05031, DQB1*03032 and DQA1*0201 were significantly lower. And frequencies of haplotypes HLA-DRB1*11, DQB1 *03011, DQA1 *0505 and HLADRB1*16, DQB1 *0505, DQA1 *01021 were significantly higher, by contrast, frequency of haplotype HLA-DRB1*07, DQB1*0201, DQA1 *0201 was significantly lower in these patients in comparison with healthy subjects.The HLA system appears to have an important genetic influence in predisposition or prevention of acute myelogenous leukemia.

Ice-creams comprise the most widely consumed dairy products especially among children during warmer seasons. Ice-cream should contain extremely low bacterial load, but higher bacterial counts have been reported. This could be due to improper pasteurization process or post-process contamination. One hundred unpasteurized ice-cream samples and thirty pasteurized ice-cream samples, collected between June to September 2003, from various locations in Tehran, were processed by culture. They were examined in a specialized food microbiology laboratory and many different enrichment as well as selective media, such as BRI containing 7% NaCl, DNase agar, SS agar, CIN agar, PALCAM agar,... were employed for the isolation of coli form bacteria as well as Listeria, Yersinia and Staphylococcus aureus. Fifty ice-cream consuming disposable spoons and dishes were also examined.Eighty seven percent unpasteurized ice-cream samples had unacceptable high quantities of contaminating bacteria. Those included Staphylococcus aureus (74%), Klebsiella spp. (40%), Enterobacter spp. (37%), E.coli (24%), Pseudomonas spp.(19%), Proteus spp.(13%), Acinetobacter spp.(11 %), Rafnia(6%), Alcaligenes spp.(4%), Citrobacter spp.(3%), Edwardsiella spp.(2%) and Providensia spp.(1 %).Thirty percent pasteurized ice-cream samples had unacceptable high quantities of contaminating bacteria. Those included E.coli (13/4%), Staphylococcus aureus (6/7%), Klebsiella pneumoniae (6/7%), Pseudomonas aeruginosa (3/3%), Proteus vulgaris (3/3%), Enterobacter cloacae (3/3%) and Acintobacter baumanii (3/3%). No significant bacterial contamination was detected in the disposable spoons and ice-cream dishes.Isolation of Staphylococcus aureus, and Enterobacteriacea such as E.coli, which were the most prevalent contamination bacteria, must be due to improper processing, storage and handling. The other was environmental bacteria. The relatively high contamination of ice-creams with these pathogenic bacteria highlight the potential health hazard involved in ice-cream consumption. It also emphasizes of these dairy products the necessity of routine and periodic monitoring.

This was a 24 year old woman who had an ectopic pregnancy implanted over the left iliac artery. She had a normal vaginal delivery 7 years back following which had an intra - uterine device for the same period. 3 months prior to death, the IUD was removed. Initially she had irregular periods followed by amenorrhea for 2 months, a positive BHCG with no evidence of pregnancy two weeks prior to death. Trans vaginal sonography had also reported similar findings. One week prior to death, she developed abdominal cramps, irregular bleeding and vaginal spotting. On her last might, she developed syncopal attacks followed by coma, irreversible drop in heart rate, blood pressure and respirations and eventually died without a concrete cause of death. Post mortem forensic report confirmed rupture of the iliac artery (1-1.5 cm) that had been the seat of ectopic pregnancy and had caused severe bleeding and death. The uterus and adnexa were however normal.

The number of elderly patients reporting at private clinics, as outdoor patients and at both general and specialized hospitals is on the rise. One of the most important causes of visiting these patients in these centers is infectious diseases. Infections of the urinary tract, respiratory system, skin and soft tissues are most commonly encountered infectious disorders.An awareness and know ledge of physicians in the field of prevalent infections in this age group of patients can be of tremendous help in the diagnosis, early treatment and prevention of morbidity and mortality. These days prevention of infectious diseases or else reducing their complications is considered as the principle in geriatric medicine.