Journal of Medical Council of Iran
Year:2005 | Volume:23 | Issue:3|Papers Count:18

Performance assessment of intensive care units may not be possible unless there are objective criteria. This performance eventually determines patients' outcome and is the most reliable outcome measure for intensive care in hospital mortality. Scoring systems have been proposed for individual patient outcome prediction, for evaluating the performance of ICUs and for therapeutic trials. Despite a reasonable accuracy of scoring systems for predicting mortality, probability of defined ICU populations in developed countries, the healthcare delivery systems and patient characteristics in developing countries might influence the correlation between a given scoring instrument and the probability of death. Accordingly, intensive care physicians in developing countries should verify the accuracy of the available severity scoring systems in their specific settings by an objective validation process. This study tries to evaluate validity of APACHE III model in patients admitted to ICUs of Tehran University Medical Sciences intensive care units based on assessing calibration and discrimination.In the study; 1312 patients were analyzed. The mean age was 48.7 and median of length of stay at ICU and hospital was 4 and 9 days, respectively. Mean APACHE III score was 60 at first day of admission. Customized APACHE III (APACHE IIIc) model had poor calibration (P<0.0001), but good discrimination (area under ROC curve =0.88).In comparison, Sina-designed APACHE III (APACHE IIIs) model had appropriate calibration (P value =0.4) and good discrimination (area under ROC curve =0.87).Although APACHE IIIs model sensitivity was about 70%, acceptable specificity (86.1%) plus corrected classification percent as %79, it is being introduced as an acceptable model in intensive care units of Tehran University of Medical Sciences; however extended use of this model needs more comprehensive studies.

To determine common systemic, local and laboratory side effects of Avonex therapy in Iranian multiple sclerosis patients.50 confirmed MS patients (according to McDonald 2001 criteria)treated with 30mcg weekly bifla, Avonex, were studied and questioned for presence of common known adverse effects of the drug and probable depression induced or aggravated by it.The study was following up regularly at the onset of Avonex therapy and after!,3 and 6 months. At the end of 6 months follow up study the data was analyzed.70% of the patients were between 20 to 30 years. 78% were female. The patients had a duration of MS of 0-12 years.The most common side effects were systemic type out of which flu like syndrome was predominant (90%). Local (injection site) side effects were seen in 42% and anemia was seen in 8% as a predominant laboratory side effect.Reduction of the frequency of all of the side effects except local one was seen in the follow up duration.No correlations were found between side effects and sex and age of the patients.Avonex therapy had no effect in inducing induction or aggravating depression in our patients.Discontinuation of Avonex therapy was not seen among these patients because of the side effects. It seems that Avonex therapy in Iranian MS patients has more and relatively prolonged adverse effects but mainly these side effects fade away with continuation of therapy.The side effects do not lead to discontinuation of therapy. In spite of frequent complaints of the patients, all of the adverse effects are well tolerated.

Fine needle aspiration (FNA) as a cytological method for the evaluation of breast masses was first performed in 1930, and of present is used as a routine method for the evaluation of breast masses. Aspiration via fine needle as a diagnostic tool is easy, accessible and relatively non - invasive. The purpose of this study was to determine the diagnostic value of this method and its comparison with open biopsy in determining the nature of breast masses.This prospective study included 62 females with palpable breast masses who were candidates for breast biopsy. Mean age was 43.7±14.3 years (16-68 years). All patients had palpable breast masses and underwent FNA prior to conventional open breast biopsy Excised tissues and FNA samples were studied by a pathologist who was blinded to the patient's name and her medical history. According to histopathological exam, there were 40 (64.5 %) benign and 22(35.5 %) malignant. Incidence of malignancy was higher in the larger masses. When FNA reports were compared with final histopathology reports, there was one false negative and one false positive report. Positive predictive value (PPV) and negative predictive value (NPV) were 95.5% and 96.7% respectively. This study demonstrates that FNA is safe and accurate diagnostic procedure in evaluation and diagnosis of breast masses. We recommend it to be used as the initial diagnostic test for all palpable breast masses. To avoid any misdiagnosis, open biopsy should be performed when needle aspiration is negative or the masses are clinically suspicious for malignancy.

Painless labor provides conditions for mother during painful contractions of uterus and dilatations of cervix. In addition to providing smooth progression of the process, the mother remains calm and pain free.Painlessness is produced by 3 methods: A -By systemic drugs, B - By regional methods, C- By non - pharmacologic methods. Some of the complications of painless labor are:1- sympathic block and hypotension, 2-motor nerve block, 3-nausea and vomiting, 4- urinary retention, 5-respiratory depression, 6- pruritis, 7- meningitis, 8-headache.This study was a cross - sectional descriptive study in which the complications of painless labor were assessed in 200 mothers during a 6 months period in Najmieh hospital.* 200 mothers with painless labor were included in this study and 2 women (1%)were hospitalized. one woman was hospitalized for severe headache because of spinal anesthesia and another because of sympathic block, hypotension and headache probably because of drugs side effects. 2 women (1%) had respiratory depression. 5 women (2/5%) had nausea and vomiting, 3 of them had G.A and 2 women had regional anesthesia (1 spinal & 1 epidural). 7 women (3.5%) had headache. 2 of them G.A and 5 women had regional methods. 3 women (1/5%) had pruritis and all of them had G.A anesthesia. 2 women (1%) had sympathic block and hypotension. One of them had G.A and another had regional anesthesia (spinal). And in 1 case, Ketamine had been administered. 2 women (1%) had urinary retention. None of the patients had convulsion, meningitis and motor nerve block.

This study was designed to determine the effect of garlic tablet (Garlet) on plasma 1ipids, and platelet aggregation levels and the efficacy of this treatment in the prevention of preeclampsia in four government hospitals in Tehran.Study design: in a randomized, single - blind, placebo – controlled study, 100 primigravidas with positive roll-over test were treated with daily doses of 800 mg/day Garlet (n=50) or 800 mg/day placebo (n=50) during the third trimester of pregnancy. In this study serum total cholesterol, LDL- an HDL - cholesterol, triglyceride, and platelet aggregation were measured before and after the treatment. Blood pressure, weight, and edema were also examined during the entire study period. Results: in the case group, there was no significant difference in the means of total cholesterol, HDL, LDL, and triglyceride before and after the experiment. Furthermore, the inhibition of platelet aggregation did not show any significant difference before and after the treatment. There were not significant differences in the means of HDL, LDL, triglyceride, inhibition of platelet aggregation, the means of systolic and diastolic blood pressure and the mean arterial blood pressure (MAR), between the two groups, but there was a significant difference in the means of total cholesterol (p=0.038) and hypertension alone (p=0.043). conclusion: the administration of 800 mg/day of garlet during the third trimester of pregnancy was effective in reducing the occurrence of hypertention alone, but it was no effective in preventing preeclampsia.

An assessment of neonates in order to pinpoint early recognition of circulatory failure, institution of appropriate treatment, and in assessing response in sick neonates in intensive care units and their outcome is one of the major concerns of the neonatologists. None of the routine assessments such as ABG, and scoring systems (SNAP II PE, CRIB) are highly sensitive in this regard.Tissue hypoperfusion, resulting from any threatening illnesses, leads the neonate to anaerobic metabolism and lactate generation. Blood lactate concentration has been used widely as reliable indicator of tissue hypoxia in this regard.We evaluated the possible relationship between arterial blood lactate level at time of admission and the outcome of 50 neonates who were admitted in neonatal intensive care unit (NICU) of Children's Medical Center in 2004.0ther parameters such as clinical findings, SNAP II PE and CRIB scores, ABG indices, a possible need for mechanical ventilation and the duration of assisted ventilation were also considered along with the predictive value of blood lactate concentration. In alive neonates, lactate levels (21.3±10.6mg/dl) were significant, comparing to those who died (42.0±26.5 mg/dl) (p=0.037). The significant correlation between blood lactate concentrations and O2 saturation in ABG (p=0.02), and lactate levels and respiratory system involvement were relatively correlated (p=0.049). Blood lactate concentrations could be a useful tool in the prognosis of outcome in sick neonates in the intensive care units.

In an evaluation, cyclical prevalence of active pulmonary tuberculosis was determined in prisoners in Lakan prison in the city of Rasht from September 2001- March 2002.According to the guidelines laid down by the who to control tuberculosis, out of 1933 prisoners, 816 had one or more of the symptoms as under: 1; cough with sputum of more than 3 weeks duration, 2; hemoptysis, 3; precordial pain, 4; significant loss of weight, 5; loss of appetite, 6; night sweats. Early morning specimens (3 direct smear of the sputum for acid fast bacilli from 456 of them) were obtained and 1-2 or none from the remaining, who were released during our investigation. Of these, 4 were sputum smear positive for AFB for 3 times, and who were in different wards. 6 inmates had been on treatment for TB. Thus the period prevalence of pulmonary smear positive TB at the time of the survey was 517/33 per 100000.

Urinary tract infections (UTIs) remain a worldwide infection problem. Geographic variations in pathogen frequency and susceptibility profiles require monitoring to provide information to guide new therapeutic options.The aims of this study were to assess the changes of the prevalence and susceptibility patterns of UTI bacterial pathogens, over a 6-years period.Retrospective study of prevalence of bacterial pathogens and their susceptibility patterns by the disc diffusion technique was done as defined by the National Committee for Clinical laboratory Standards (NCCLS) which were isolated in cultures of urine of adult patients of Firouzgar Hospital, in 1997-1998 and 2003-2004. Out of 2914 and 3895 urine specimens, 309 (10.6%) and 853 (21.9%) were culture positive in 1997-1998 and 2003-2004, respectively. E coli were the most common urinary isolate (42.1% and 46.9%) in these years. The antibiotic susceptibility rates for all gram negative bacilli in 1997-98 and 2003- 2004 were: Amikacin (87.7%, 94.7%), Ciprofloxacin (91.4%, 87.1%), Nitrofurantoine (66.8, 52.9%), Nalidixic Acid(73.1%, 62.6%), Co-trimoxazole (37.5%,30.6%), Tetracyclin (27.9%,6.2%), Ampicillin (4%,1.1%), Gentamicin (72.1%, -), Ceftizoxime (-,72.5%) Also the antibiotic susceptibility rates, commonly in community acquired UTIs, were higher than nosocomial UTIs. Overal susceptibility testing demonstrated decreased usefulness of common antibiotics which indicate need to monitoring antibiotics susceptibility and re-evaluation of antibiotics used in the therapy of UTIs. Also strict control on the use of antibiotics and appropriate measures against over the counter availability and self – medication is recommended.

Composite Resin is a kind of polymer that has been recently substituted for Amalgam; therefore biocompatibility of Composite with periodontal tissue should be acceptable and also should not clinically induce inflammation and irritation symptoms in gingival tissue over a long time.The objective of this research is to investigate biocompatibility of posterior composite with periodontal tissue by means of PPD and Bap indices in teeth which have been filled with Composite and intact ones.This is a clinical trial research and a kind of case control in which 40 teeth of 20 patients-15 men and 5 women- were selected from students of Dentistry Faculty of Tehran Medical Science University as the case group with cl II caries in posterior teeth (4, 5, 6, 7) and the outline of preparation was near or 0.5 coronal to gingival which were filled with posterior composite Resin (P60).PPD indices - based on ranking of 1 to 4 - and Bap - based on Muhlemann category were measured and recorded exactly before operation and 3 and 6 months after in 40 restored case groups and 40 control group (intact teeth in opposite quadrant). Then the results were analyzed by means of SPSS software and tested by Friedman and Wilcoxon Tests.There was no significant difference between Bap Indices in T0-T1 and T2 in case group and also in control group. Further more there was no significant difference in PPD Indices in T0-T1and T2in case and control groups.There was no significant difference between Bap indices in case and control teeth groups in T0 (exactly before operation). Also there was no significant difference between mentioned teeth groups in T1 (3 months after operation). But a significant difference was found between them in T2 (6months after operation) (P=0.035) Furthermore there was no difference between PPD indices in case and control teeth groups in proximal side of buccal surface in T0,T1 and T2 and also no significant difference on the proximal side of lingual surface in T0,T1 and T2. Regarding biocompatibility of new generation posterior Composite Resin (like P60) with periodontal tissue, they have not been able to compete with the intact surface of tooth.  

Romberg disease is a rare progressive disease with hemifacial atrophy of skin, soft tissue and bone. It was first described by parry in 1825 and later in 1846 by Romberg and in 1871 named as progressive hemifacial atrophy by Eulenbery.First signs of this rare disease usually appear before the age of 20 and initially skin and subcutaneous parts are involved and later, there is muscle and bone involvement.In 95% of cases there is unilateral atrophy. Different theories are mentioned about the exact cause of this rare disease such as Rubeolla infection, trigeminal neuralgia, sclerodermia, cervical sympathetic anomaly, but the exact cause is not known yet.Progression of disease usually lasts between 2 to 10 years, but in some cases it takes longer. Treatment includes skeletal and soft tissue reconstruction, although in most of cases soft tissue rehabilitation is enough. The patient is a 20 year old woman who was suffering from atrophy of soft tissue and skull in the right frontal and parietal areas plus loss of eyebrow for the past 9 years. In biopsy skin and adnexal atrophyed was identified. The progression of disease ceased after 2 years and reached a steady state. The patient was a scheduled for tissue expander insertion in scalp area (left side) to expand hair full area and flap rotation and covering hairless area of scalp (right side). In 2 steps operation minimal surgical scar with satisfaction of patient was achieved and this way may be an effective way for limited form of this disease.

Fluidity of blood inside the vessels on one hand, and formation of thrombus just at the site of vessel injury on the other hand, is the result of an exact interactive equilibrium of multiple procoagulant and anticoagulant factors, and their activators and inhibitors.Destruction or stimulation of endothelial cells and platelets, and contact of blood and platelets with subendothelial tissues are among the main procoagulant factors. Integrity and function of endothelial cells, washing property of blood stream, fibrinolysis system (plasminogen) and thrombomodulin system, protein C and antithrombin are the most important anticoagulant factors. Dysfunction of procoagulant factors leads to bleeding tendency, whereas dysfunction of anticoagulant factors causes predisposition to the thrombosis (thrombophilia).Despite recent progresses, we can only diagnose half of hereditary thrombophilias, among these, the factor V Leiden, antithrombin deficiency; protein C deficiency and protein S deficiency are more common. Elevation of plasma factor VIII levels has been considered as a common but weak risk factor for hereditary thrombophilia. Mutation of prothrombin G20210A which leads to elevation of prothrombin levels has the same importance as the factor VIII elevation.Presence of hereditary thrombophilia in an individual does not inevitably end up in the formation of pathologic thrombosis, for clinical presentation of thromboembolic syndromes, coincidence of one (or more) hereditary thrombophilia along with one (or more) acquired thrombophilia (such as pregnancy, immobility, surgery, OCP use) are usually evident. Individuals with hereditary thrombophilia are more prone to the recurrence of thrombosis than normal individuals, so long term use of anticoagulant drugs in such patients is recommended.Screening for hereditary thrombophilia must be considered when (I) there is not an acceptable acquired risk factor for thrombosis in history and physical examination; (2)venous thrombosis before age 40, (3) recurrent thrombosis, (4)arterial thrombosis before age 30, (5) family history of thrombosis, (6) thrombosis in unusual sites such as mesenteric or cerebral veins.