Journal of Medical Council of Iran
Year:2007 | Volume:25 | Issue:1|Papers Count:16

Background: Gamma irradiation has been widely used for secondary sterilization of bone allograft before clinical use to reduce the risk of infection and associated complications. The current study evaluated the effect of gamma irradiation sterilization on the osteoinductive capability of human demineralized bone matrix using a rat model.Methods: Eighteen euthymic rats received two separate implants consisting of 30 mg sterile-harvest demineralized bone matrix and 30 mg gamma irradiation-sterilized demineralized bone matrix. The demineralized bone matrix from each group was placed into two separate muscle pouches created in the paravertebral muscles of each rat. All 18 rats were euthanized after 4 weeks and each implantation site was removed with 0.5 cm normal tissue around the implant. Histological examination was performed to determine the presence or absence of new bone, cartilage and bone marrow elements.Findings: All except one of 18 (94.4%) sterile-harvest demineralized bone matrix sites histologically contained new bone elements and five of 18 (27.7%) ethylene oxide sterilized demineralized bone matrix sites showed evidence of new bone elements, which was statistically significant (p<0.05).Conclusion: The results of this study indicate that demineralized bone matrix sterilized with gamma irradiation loses its osteoinductive capacity in a manner similar to that of steamsterilized demineralized bone matrix, making it unsuitable as a method of secondary sterilization of demineralized bone matrix.

Background: There are different opinions about the relationship between spontaneous abortion and women’s occupational exposure to anesthetic gases. This study and other similar studies about women’s occupational exposure seems necessary as more than 50 percent of women experience pregnancy during their working life.The aim of our study was to determine the association between rate of spontaneous abortion and maternal occupational exposure to anesthetic gases.Methods: Our study was a historical cohort. Two groups of married women were studied: exposed group (women who worked in operating rooms) and unexposed group (women who worked in emergency department, ICU or CCU). Data was collected through questionnaire and interview, and exclusion and inclusion criteria were applied. Pregnant personnel were followed till the end of 20th week of pregnancy. Data was analyzed using SPSS 11.5 software with frequency distribution tables, cross-tabulation tables, chi squared test, and t-test, and p<0.05 was set as significance.Findings: Spontaneous abortion rate in the exposed group was 15.7% and in the unexposed group was 13.4%. Chi-squared test showed no significant difference (p=0.529). Odds ratio was 1.196 with a confidence interval of 0.685-2.090.Conclusion: Our study did not find a significant relationship between spontaneous abortion and occupational exposure to anesthetic gases, but avoidance of unreasonable exposure is rational using scavenging systems.

Background: Pseudomonas aeruginosa is one of the most important pathogens, particularly in immunocompromised hosts, and remains a prominent gram-negative bacterium that causes hospital-associated infections. The aim of this study was to evaluate the susceptibility of 110 clinical isolates of Pseudomonas aeruginosa to routine antibiotics and antibiotyping of these strains.Methods: One hundred and ten bacterial isolates of Pseudomonas aeruginosa were isolated from 99 burned patients (Shahid Motahary Burn Hospital, Tehran, Iran, during March to April 2006) with different types of infections. Antibiotic susceptibility test was performed by disc diffusion method and clones of bacteria were determined by antibiotyping. Demographic data of patients were recorded too. Finding: The frequency of Pseudomonas aeruginosa resistant to imipenem, amikacin, gentamicin, trimethoprim, tetracycline, carbenicillin, piperacillin, ceftazidime , ceftriaxone and ciprofloxacin were 32.1%, 47.2%, 89%, 100%, 70%, 90%, 88.1%, 91.8%, 93.6% and 77.2%, respectively. Antibiotyping showed that 110 isolates were distributed in 33 patterns, but 19 isolates were resistant to all antibiotics and 65 isolates belonged to 7 patterns of antibiotyping. Other isolates (45 isolates) created 26 patterns.Conclusion: The results showed that most of isolates were resistant to routine antibiotics and it is necessary to introduce urgent measures for restriction of the spread of Pseudomonas aeruginosa infection in Shahid Motahary Burn Hospital. It is possible that most infections were carried by special clones and it is probable that the source of these clones is environmental.

Background: Hepatitis A and E are among the most important etiological factors of acute hepatitis, which can lead to fulminant liver disease and death. The aim of this study was to determine the prevalence of hepatitis A and E in the east of Golestan Province, Iran.Methods: Eight hundred inhabitants of Gonbad City and Ghamar-Ghozi Village from Kalale district were randomly selected for the study. Hepatitis A virus Antibody (Anti HAV) and Hepatitis E virus Antibody (Anti HEV) were checked by ELISA method.Findings: A total of 697 subjects (441 females) with a mean age of 43±15.1 years participated in this study. A total of 687 (98.6%) and 82 (11.8%) persons had positive Anti HAV and Anti HEV, respectively.Conclusion: This research is the first study on the prevalence of hepatitis A and E in the general population of Iran, which shows that HAV infection is pandemic and hepatitis E is common in the area.

Background: Congenital and valvular heart diseases are still major health problems in developing nations and have high prevalence rates in our country. Thus, detecting these diseases which mostly need heart surgery is very important. In this survey, we aimed to show the importance and necessity of angiography in valvular and congenital heart diseases.Methods: This was a cross sectional study and l96 patients with congenital and valvular heart diseases enrolled in this survey. Study population was patients who had been admitted to Baqiyatallah Hospital for catheterization and coronary artery angiography. Data was collected using a questionnaire, physical examination and paraclinical studies.Findings: The study subjects comprised 89 (45.4%) males and 107 (54.6%) females, with a mean age of 49.8±16 years. The most common diagnoses were 25.5% with combined mitral and aortic stenosis, 24% with mitral stenosis alone, and 10.7% with aortic insufficiency. Coronary artery angiography was abnormal in 13.3%. 3.8% of those  £40 years, 14.3% of those between 41 and 60 years, and 20.3% of patients ³61 years, suffered from CAD.Conclusion: These findings suggest that we should reconsider the necessity of angiography for patients with congenital and valvular diseases without CAD symptoms and reassess indications more carefully. Considering the low prevalence of combined CAD and valvular and congenital heart disorders in patients younger than 40 years of age, as well as patients between 41 and 60 years, it appears that performing angiography for all patients is not necessary. We suggest coronary angiography be performed in patients with clinical suspicion of CAD or multiple risk factors, and in patients older than 60 years old.

Background: To determine the registration status of patients with tuberculosis (TB) detected by private laboratories. Study design: a cross sectional study.Method: Out of all TB suspected subjects referred to four private labs for acid-fast bacilli (AFB) examination during 2002-3, those with confirmed TB were enrolled in this study. All AFB positive cases were then followed for registration by National Tuberculosis Program (NTP) of the Ministry of Health of Iran.Findings: Of all the cases referred to the private laboratories, 646 subjects were reported as AFB positive and followed. Of these, 317 (49.1%) were female and 328 (50.8%) male, with a mean age of 52.2 years (95% CI, 21.7). Using telephone and dwelling addresses to contact patients, 82 (12.7%) patients were found to be registered by NTP and 564 (87.3%) were not registered. Registration status was independent of age and sex (p=0.122, p=0.178). However, a positive association was detected between physician referral of patients and registration (Fisher's exact test, p<0.001). Conclusion: The cases detected and treated by private sector are far beyond our expectation, which indicates the valuable role of this sector in tuberculosis detection. Nevertheless, what needs to be improved is the management of relations between private and public sectors. On the other hand, physicians play an essential role in referring patients to NTP for registration, but it seems that they have not been performing well enough given the small proportion of patients referred.

Background: One of the great problems in education is reduction of educational motive among students. Therefore, factors that reduce students' educational motive must be recognized and removed for promotion of educational quality in universities.This survey was performed to evaluate factors effective in the reduction of educational motive of students studying in Ardebil University of Medical Sciences.Methods: This was a descriptive analytical study. The studied population was 240 students of Ardebil University of Medical Sciences (120 motivated students and 120 unmotivated students).The students were selected through scholastic motivation test. Tools of data collection were: Mcinerney standardized of scholastic motivation, Coopersmith self respect, Pons self-regulation learning and researcher-edited questionnaire. Reliability rate of these standardized tests has been reported at 0.73, 0.90 and 0.88, respectively. Also, reliability rate of researcher-edited questionnaire was estimated about 0.85. This questionnaire included questions that evaluated students regarding hope to future, and individual, social, familial and educational characteristics. Considering the type of variables, non-parametric chi-squared test and discrimination analysis statistical method were used to analyze data.Findings: Five of 11 studied variables, including hope to future (with 0.9 coefficients), self-respect (0.12), quality of educational factors (0.11), marital status (0.40), and family income (0.70) could explain the causes of students' motive reduction.Conclusion: In this study, the basic behaviors of students were explained and the results showed that the reduction in hope to the future, self-respect, quality of educational factors, family income, and being married were of the major factors underlying educational motive reduction. Therefore, it is necessary that persons in charge of Ardebil University of Medical Sciences take an action for the prevention of educational motive reduction among students, with designing appropriate methods.

Background: The objective of the present study was to investigate the hypothesis that levels of maternal androgens, including testosterone and dehydroepiandrosterone sulfate (DHEAS), were associated with nausea and vomiting in normal pregnancies.Methods: A prospective study was performed. One hundred and forty pregnant women in their 12th week of pregnancy entered the study. One hundred and twenty one women were visited for a second time at follow-up, 61 had nausea and vomiting of pregnancy and 60 without nausea and vomiting. Maternal levels of testosterone and DHEAS were measured at both visits. Statistical analyses were performed utilizing t-test and correlation.Findings: Mean levels of testosterone and DHEAS were significantly higher in women with nausea and vomiting of pregnancy than women without nausea and vomiting at the 12th week of pregnancy (p<0.001, p<0.05, respectively). Also, in the 28th week of pregnancy, mean testosterone and DHEAS levels were significantly higher in women with nausea and vomiting of pregnancy than women without nausea and vomiting (p<0.001, p< 0.05, respectively). There was no relationship between the severity of emesis and levels of testosterone or DHEAS at 12th or 28th week of pregnancy.Conclusion: Nausea and vomiting of pregnancy are associated with increasing levels of maternal androgens, including testosterone and DHEAS, during the 12th and 28th week of pregnancy.

Background: A surgically correctable form of jaundice is its obstructive type that if its cause is correctly defined, it will be a great help to the surgeon. The first imaging step to assess an icteric patient is ultrasonography, which if results in accurate diagnosis, will lead to a reduction in expenses and time spent, in addition to avoidance of unnecessary exposure to irradiation.Methods: This is a cross-sectional study. In this study, 65 patients with cholestatic jaundice underwent pre-operative ultrasound and their images in Razi Hospital (Rasht, Iran) Ultrasonography Unit during 6 months were compared with intra-operative clinical findings during surgery. Then, consistency rates between sonographic findings and intraoperative findings were calculated.Findings: Sonographic results showed that 30 cases had Stones (46.2%), 19 cases neoplasm (29.2%), including pancreatic cancer (10 cases), carcinoma of the Vater's ampulla (3 cases), Klatskin tumors (2 cases) and cholangiocarcinoma of the distal portion of common bile duct (4 cases). Consistency rates between surgical and sonographic findings on stones were reported as 93.3% (28 cases) and the remaining 6.7% (2 cases) had stenosis due to cholangitis without stones. Consistency rate between surgical and sonographic findings on neoplasms was reported as 78.9% (15 of 19).Ultrasonographic diagnosis was completely accurate regarding pancreatic cancer and Klatskin tumors, but not regarding carcinoma of Vater's ampulla and cholangiocarcinoma of the distal portion of common bile duct.Conclusion: Ultrasound is a valuable and noninvasive diagnostic modality in the evaluation of biliary stone in patients with obstructive cholestatic jaundice. However, it appears that for assessing other causes of cholestatic jaundice, other diagnostic modalities are necessary.

Background: In spite of many advantages in Lenke classification of adolescent idiopathic scoliosis, the latest study of Richards et al showed that the King classification is better than had been reported recently and the Lenke classification system of adolescent idiopathic scoliosis is less reliable than previously reported.Methods: In this study, we performed a multi-surgeon comparison of these two classification systems. After teaching and discussing all available data of these classification systems with four spine surgeons, a pilot classification was performed. Then, they independently evaluated preoperative radiographs (standing posteroanterior, lateral, and two supine side-bending views) of 99 patients with adolescent idiopathic scoliosis. The results were determined by calculating the average percentage of intraobserver and interobserver agreement. Reliability was quantified using kappa statistics.Findings: The King classification demonstrated good intraobserver and interobserver reliability, with an intraobserver agreement of 85.8% (kappa coefficient, 0.80). Interobserver percentage of agreement averaged 80.8% (kappa coefficient, 0.74). The complete Lenke classification, combining curve type, lumbar modifier, and sagittal thoracic modifier, demonstrated good reliability for both intraobserver and interobserver measurements. The intraobserver percentage of agreement averaged 85.8% (kappa coefficient, 0.82). The interobserver percentage of agreement averaged 80.8% (kappa coefficient, 0.77).Conclusion: In this study, with each investigator performing the radiographic measurements, the King and Lenke classifications were almost similar (the Lenke classification had slightly better results). Such better results might be due to more training of this complex classification system. So, because of greater coverage of idiopathic scoliosis curve and usefulness of Lenke classification system, we prefer using this classification system in our center.

Considering the rising prevalence of HIV infection, hepatitis B and hepatitis C epidemics in our country and other developing countries, and given that these blood-borne pathogens could be acquired through occupational exposure as a major professional hazard among healthcare workers, such as physicians, nurses, dentists, laboratory workers, and cleaning service employees by needle stick injury or splashing of infected fluid to mucosal surfaces, doctors, nurses and other health-care providers are worried about HIV, HBV and HCV exposure and, after such accidents, they ask "is this disease transmitted to me?". So, all of healthcare workers should be educated for post-exposure prophylaxis of blood-borne pathogens.This review is based on the last recommendations and current protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposure to blood-borne pathogens.

Background: Histiocytic necrotizing lymphadenitis or Kikuchi Disease (KD), first described in Japanese medical literature by Kikuchi-Fujimoto in 1972, is a rare, benign entity which predominantly affects young women. KD usually presents with painful or painless enlarged cervical lymph nodes. The diagnosis of KD can precede, postdate or coincide with the diagnosis of systemic lupus erythematosus (SLE).Case: A 29-year-old woman presented with right cervical and supraclavicular lymphadenopathy and gradually developed bilateral axillary, para-aortic and inguinal (generalized) lymphadenopathy.Biopsy of a lymph node showed necrotizing lymphadenopathy without hematoxylin bodies and thus diagnosis of KD was established. One year later, she developed constitutional symptoms like fever, sweating, weight loss, fatigue, loss of appetite, and arthritis of small joints of hands and feet, and paraclinical studies revealed anemia, mild leucopenia, increased ESR, positive ANA and anti-dsDNA. Clinical diagnosis was therefore revised to SLE and patient was treated with corticosteroid and anti-malarial drugs.Conclusion: This is a rare case of SLE that presented with KD. Previous similar cases of SLE preceded by KD have also been described in literature. We suggest that subjects with KD be followed for a few years for the development of SLE.