Journal of Medical Council of Iran
Year:2009 | Volume:27 | Issue:3|Papers Count:16

Background: Scorpion sting is a public health problem in various areas of the world. According to the climates, our country has a lot of scorpion species, especially dangerous kinds of them. South of Kerman province is one of the regions whit highest prevalence of Scorpion sting. So study of epidemiologic and predisposing factors study of scorpion sting in this region seems to be essential. Methods: This study was a prospective case series conducted from 2003-2006. All cases of Scorpion sting have been referred to hospital in Kahnuj city. After examination and treatment. There were entered to be study for evaluation of epidemiologic characteristics and predisposing factors. Statistically analysis performed using SPSS version 15 software. Chi-square test was used to compare categorical variables. Results: Totally 301 cases of scorpion stings referred to the hospital. Most scorpions bitinys happens between (24 to 6.00 hours) in early morning and mostly in hands and feet. 50% of victims slept outdoors and 20% had garbage around of their homes. There were only 2 deaths due to scorpion sting. Conclusion: It seems some that precationary measures, such as repair of buildings, self control and sleeping indoors, can decrease incidence of scorpion stings.

Background: The incidence of hearing loss in pediatric population is estimated to be 2-5%. Most of the causes for conductive hearing loss can be easily diagnosed and treated. Hence, majority of hearing loss cases can be prevented by taking appropriate measures. This study was performed to examine the incidence and common causes of hearing loss among school children in Tehran. Methods: This cross-sectional descriptive study was performed on 1000 primary school boys and girls (grade 1) in Tehran. Simple random sampling from those schools that were selected as population clusters was used. Hearing loss was defined as lack of voice perception with different frequencies of 500, 1000, 2000, and 4000 Hz and intensity of 25 dB in pure tone audiometry. Results: In this study, 433 cases had hearing disorder and were referred to the audiometric and tympanometric centers for further examinations. Eventually, 37 (3.7%) students were proven to suffer from hearing loss. There was a statistically significant association between hearing loss and previous history of neonatal jaundice, infamily marriage of parents, and congenital anomalies (P < 0.05). Conclusion: in the light of the rather high prevalence (3.7%) of hearing loss and the easily treatable nature of the most common causes, more extensive and interventional studies seem necessary to include hearing assessment among the routine screening programs in the nation.

Background: Color vision deficiency has a relatively high prevalence in working population and cause difficulties in everyday tasks. Occupational exposure to various neurotoxic chemicals has been shown to be associated with acquired color vision impairment. This study was undertaken to determine the effect of occupational exposure to mixed organic solvents at low levels on color perception. Methods: A cross sectional study was conducted in an automobile plant. Workers employed in painting saloon, were considered as cases and workers employed in assembly saloon were considered as controls, as well. We administered a questionnaire, containing age, years of employment, histories of congenital color vision impairment or eye injuries, alcohol consumption and.... for workers. After considering exclusion criteria, Color vision of 121 case workers compared with 157 controls. Results: The LD-15 test showed that 31.4% of case group had an acquired color vision defect .Most defects were of the blue-yellow type in the case group. Also the prevalence of acquired color vision defect was 3.8% in the control group. The prevalence of acquired color vision defect of exposed employees were statistically significantly higher than those of the control subjects (OR = 11.52, CI = 4.67- 28.38) (P<0.001). Besides mean of the color-confusion index (CCI) derived from the LD-15 test for exposed employees were statistically significantly higher than those of the control subjects (1.14 and 1.03 respectively and P<0.001).The logistic regression for color confusion index (CCI) showed that it was positively related to exposure to mixed organic solvents (P<0.001). Conclusion: The results of this study suggest that, chronic occupational exposure to mixed organic solvents even at lower concentrations than permissible levels can cause acquired color vision impairment. Also acquired color vision impairment seems to be a sensitive indicator which can detect solvent-induced neurotoxicity in car painters. Finally we propose that the color confusion index (CCI) may be used as an appropriate indicator of early neurotoxic effects in workers exposed to low concentrations of mixture of organic solvents.

Background: Unfortunately, many physicians and even dentists are unaware of existence of oral medicine practitioners. This fact leads to high incidence of medical malpractice in patients with oral mucosal lesions before visiting by the specialist of oral medicine. These malpractices might leadto not only imposing high expenses on the patients but also may waste the time and money which cause irreparable side effects. To our knowledge this is the first detailed Iranian study which its aim is to evaluate medical malpractice involving patients with oral mucosa lesions. Methods: In this descriptive cross-sectional study, clinical charts of patients attending in the oral medicine department complaining of oral mucosa disorders (during 1998-2005) were reviewed. Finally after collection of information from all charts through data forms, the diagrams were drawn with the use of SPSS.V.17 version. Results: Information of 753 charts were reviewed. 45% of patients first seen by physicians and 36/2% by dentists. Majority of patients were examined by otolaryngologists, dermatologists, maxillofacial surgeons and periodontists. The average period of time between the initiation of disease and professional examination of patients was 24/05±4/14 months. Malpractice seen in 37/6 % of patients, most commonly in the forms of avoiding of neglecting necessary referral and biopsy mostly performed for lichen planus and pemphigus vulgaris. Medical malpractice had the significant relationship with types and numbers of the lesions (P<0/05). Conclusion: In this study high percentage of medical malpractice and long period of time between initiation of symptoms and referring to the specialist in oral medicine shows that inevitable efforts is needed to change referral patterns and treatment procedures in oral dis. for medical malpractice prevention.

Background: Nowadays Breast cancer is one of the most common types of cancers among women along with high mortality and morbidity rates. The illness psychologically has negative effects on these patients. The prevalence of this illness has been increasing throughout the world including Iran. Lack of adjustment with the illness can have an adverse impact on patients' individual relationships, clinical treatment procedures and prognoses. Depression is considered as a major symptom of unadjusted psychological behaviors of patients with breast cancer. Having considered the role of woman in the society and family institution as a mother and/or a wife, this illness can be devastating which gives rise to instability of the family foundation, causes severe irremediable damages to other family members, and imposes considerable impacts revenues of government annual financial budgets. Therefore, identifying depression and its susceptible components can be of a great help curing the illness and promoting coping strategies against it in these patients. Methods: In this study 78 patients with no other prehistorically chronic diseases and/or psychiatric disorders were selected. They were given a questionnaire consisting of demographic information and Zung Self-Rating Depression scale. Results: By using SPSS the frequency distribution of depression was measured and depicted in bidementional tables. Results showed 42.3 percent of the patients suffered from depression. Conclusion: The findings indicate high prevalence of depression among the patients with breast cancer, and have implications for referring them to a mental health center as soon as the illness being diagnosed. A psychotherapeutic plan not only can help these patients to promote the quality of their lives but also to execute mental health programs. It is important to propose that a systematic treatment plan is required for this illness that accompanies with a psychotherapeutic plan.

Background: Preeclampsia occurs in approximately 17% of pregnancies, unknown etiology. The gold standard method for assessment of protein excreted in the urine to diagnose preeclampsia is a 24- h urine collection. However, this method is cumbersome and time consuming for the patient and laboratory. The aim of this study is to evaluate the use of protein to creatinin ratio in random urine sample for prediction of proteinuria in preeclampsia. Methods: This study is a cross-sectional descriptive study. This study was performed on 150pregnant women who were hospitalized as preeclampsia in Ghaem Hospital during early 2006. At first, a random urine sample was collected for each patient to determine protein/creatinine ratio. Then, 24-h urine collection was analyzed for the measurement of proteinuria. Statistical analysis was performed with SPSS software and Pearson correlation coefficient for evaluation of the results. Results: A total of 150patients were entered the study. There was a significant relation between the 24-h urine protein and protein to creatinine ratio (r=0.659, P<0.001). Conclusion: The use of e protein-to-creatinin ratio in random urine sample is a suitable replacement for the measurement of 24-h urine protein. This method is quick, reliable and cost effectiveness.

Background: Many studies have evaluated the effect of endometrial thickness on pregnancy rates (PRs) in Assisted Reproductive Technology (ART) patients. The results obtained were controversial. The aim of this study is to evaluate this effect in the ZIFT technology output. Methods: In this case-control study a total of 90 females who have been referred to the infertility center and treated using ZIFT with the long protocol, were entered into two groups: successfully fertilized and unsuccessfully fertalized women regarding to the treatment results, and evaluated retrospectively for their demographics and increase in their endometrial thickness in response to the treatment. Results: The endometrial thickness in response to the gonadotropin stimulation From the 7th to 12th day was greater than 2 mm in the successful group, whereas this increase was lesser than 0.3 th mm in unsuccessful group, although, there was no statistically significant difference between two groups in the case of this messures (P=0.178). Moreover, the endometrial thickness in 7th and 12th days of the Human Chorionic Gonadotropin (HCG) infusion, weren't significantly different between two groups (P=0.372 for 7th day, P=0.096 for 12th day). Conclusion: Our study declines the role of the endometrial thickness response to the gonadotropin stimulation in the prognosis of the ZIFT for a successful pregnancy. On the other hand, the thickness of the endometrium in the 7th day of Gonadotropin infusion and threshold value of 8 mm in the 12th day that has been emphasized in some references lacked their prominence in our study.

Background: Urinary tract infection (UTI) is one of the most common bacterial infection in childhood. It's incidence in neonates is 0.1 - 1%and it is more common in premature, low birth weight and uncircumcission male infants. More reports suggested association between hyperbilirubinemia with unknown etiology and bacterial infection including UTI, but AAP has not still recommended to evaluate such infections as routine. This study did to evaluate the incidence of UTI in icteric neonates without fever and other signs. Methods: This was a cross sectional study on 400 hospitalized icteric neonates without fever and other signs at Javaheri hospital in 2003-2006. In these neonates urinalysis was done by bag and if urinalysis or urine culture was positive, then the test repeated through suprapubic procedure. Evaluation of urinary tract anomalies and reflux were done in patients. The results analysis by frequency tables and T and chi quare tests. Results: The incidence of UTI in hospitalized icteric neonate was 1.8%. It was more common in males and the most common isolated organism was E coli. There was unilateral dilatation of pyelocaliceal system in one case (14.3%).Conclusion: In attention to low incidence of UTI in icteric neonates without other signs, it is recommended to perform urine test in prolonged jaundice with unknown etiology, direct hyperbilirubinemia or when hyperbilirubinemia decreases difficulty.

Infection is a serious complication of total hip arthroplasty (TRA). Although the prevalence of perioprosthetic infections is only 1 percent, the economic burden as well as the likelihood of significant morbidity and even mortality, make this complication potentially devasting. Risk factors of these complications are DM, RA, SCA, taking corticosteroid, prolonged surgery time, prolonged pre operation hospitalization and previous surgery on hip. Although the most frequent organism of TRA infections are gram positive bacterias, but gram negative microbes and uncommon organisms must also be considered. Fortunately, there are many ways to detect the infections before or after surgery.

Constipation is a common medical problem that imposes multiple clinical referrals in addition to familial and social impacts. The condition is functional in most cases, despite the presence of several etiologies, especially in severe cases and patients unresponsiveness to treatment. Assessments of secondary causes are important. A comprehensive and economic diagnostic and treatment approach for the large number of cases suffering from this medical problem is essential. In medical history and physical examination, the patient's aim regarding the word "constipation" should be considered, and symptoms and signs of secondary causes (such as weight loss, gastrointestinal bleeding, anemia, and ...) should be evaluated. In cases without these alarming clues, treatment with fibers, diet, liquids, physical activity and discontinuation of medications resulting in constipation can be recommended. Reevaluation of patients in order to find out other defecation problems, slow transit of colon, and secondary causes like malignant or metabolic etiologies should be considered. Defecation problems resisting medical treatment, are always responding to biofeedback treatment. Psychological support and consultation are also helpful in treatment. Long term consumption of medications affecting constipation should be considered with due regard to their side effects. Surgical operations might be performed in unresponsive patients. It should be mentioned that success of surgical methods are greatly dependent on concise selection of patients; lowest success are detected in cases with background psychological problems. Researches on new treatment options for constipation are continually conducted.

Penetrating cardiac trauma is a medical emergency and should be managed as soon as possible. There are some different causes of cardiothoracic injury, which gun and stab wounds are the most important direct cause of penetrating cardiac trauma. Pepending on the wound size, penetrating cardiac trauma causes different clinical manifestations. Small stab wounds lead to cardiac tamponade, meanwhile severe hemorrhage and shock are reported for gun wounds. A 45 years old man was admitted with complaints of dyspnea, weakness and severe hemorrhage during a dispute. There were two wounds on the thorax the first wound was in 5th intercostal space at left mid clavicle and the second was in 10th intercostal space at left mid axillary. Breath sounds were going to diminish in the left base. After performing CPR in emergency room, the patient was sent to operation room immediately. In operation room a left thoracotomy was performed. There was a bleeding area on apex. Apex rupture and pericardial rupture were repaired and bleeding was controlled. After 48 hours echocardiography and chest x-rays were normal and the patient was discharged in good conditions after 7 days.