Journal of Medical Council of Iran
Year:2011 | Volume:28 | Issue:4|Papers Count:15

Background: Two factors alleged to cause thrombophilia in women with unexplained recurrent spontaneous abortion (RSA) are the MTHFR polymorphisms including C677T and A1298C. This case-control study was aimed to determine the association between RSA and two polymorphisms of MTHFR in Iranian patients.Methods: 30 patients with the background of two or more consecutive unexplained abortions and 10 women with at least two live births without a miscarriage who referred to Baqiyatallah Hospital and Avicenna Infertility Clinic were analyzed for MTHFR C677T and A1298C polymorphisms by the PCR-RFLP method. Results achieved from estimating the genotype of each polymorphism were analyzed by the SPSS program via the 2c method. The Sperman method was also used to evaluate the correlation between the two polymorphisms.Results: The data presented in this study have shown a significant correlation between MTHFR C677T and MTHFR A1298C polymorphisms. 17 women (56.6%) with recurrent spontaneous abortions and 5 women (50%) among the controls were heterozygote for MTHFR C677T polymorphism. T allele frequency in the patient group was more than the control group (28.4% for patients and 25% for controls). Frequency of the MTHFR A1298C polymorphism was 63.3% in patient and 50% in controls. For A1298C polymorphism, 43.3% of patients and 20% of controls were heterozygote. Furthermore, 20% of patients and 30% of controls were homozygote for this polymorphism.Conclusion: The prevalence of MTHFR C677T and MTHFR A1298C polymorphisms were slightly, but not significantly, higher in RSA patients compared to controls. These findings failed to support the relationship between thrombophilia polymorphisms and the increasing risk of RSA in evaluated Iranian women.

Background: Polycystic ovarian disease is one of the most common causes of hirsutism, irregular menstruation, obesity, anovulation or infertility in women. More than 50% of these women become obese and 1/3 of them diabetic at a time throughout the life.Metformin is useful to improve the insulin resistance, hirsutism and oligomenorrhea of PCOS patients. Administrating spirinolactone as an androgen antagonist in conjunction with a contraceptive pill such as Cyproterone compound (Dian) may also be effective to treat the sings and complaints of the patients.Target: To compare the efficacy of spirinolactone with cyproterone compound vs. metformin on PCOS.Methods: This study was performed on 113 women, 20 to 30 years old, diagnosed to have PCOS, visited in Imam Hosein and Loghman outpatient clinics during three years. They came with complaints such as obesity hirsutism oligomenorrhea or amenorrhea.Results: Metformin is effective in improving obesity, hirsutism and oligomenorrhea of obese PCOS patient (regardless of their insulin resistance) (P<0.005). Metormin is more effective to reduce the body weight in obese women than those two (P<0.05), on the other hand it has a limited effect on the hirsutism and oligomenorrhea of non-obese PCOS patients. Spirinolactone in conjunction with Dian is effective in improving the hirsutism, obesity and oligomenorrhea of the obese (regardless of their insulin resistance) (p<0.05) and non-obese patients (p<0.005). Metformin is more effective than Spirinolactone together with Dian on weight reduction in obese PCOS (p<0.005), and Spirinolactone together with Dian is more effective on hirsutism and oligomenorrhea of non-obese patients than Metformin alone (p<0.05).Conclusion: Metoformin is effective to treat the obesity, hirsutism, and oligomenorrhea of the obese women and the combination of spirinolacton and cyproterone compound is more effective to treat hirsutism and oligomenorrhea in non-obese women with PCOS.

Background: Serum lipid level may change due to acute febrile illness. This study was designed to evaluate serum lipid level changes in acute infectious diseases and emphasis on importance of serum lipid level measurement in infectious disease. This study also compares diagnostic value of serum lipids and acute phase reactant markers.Methods: This study was performed on 100 critically ill patients in 3 tertiary care hospitals in Tehran, Iran. 50 patients with infectious diseases were selected as case group and 50 patients without infectious diseases as control group. Serum level of total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride (TG) were compared in case and control groups.Results: Patients with critical illness and infection had lower level of HDL than patients with critical illness without infection. Mean and standard deviation of HDL was 40±19 in case and 53±14 in control groups. HDL value as a guide to diagnosis infection is equal to erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Conclusion: Serum lipid level change in acute febrile illness. Serum level of high density lipoprotein decreases in infectious diseases and diagnostic value of high density lipoprotein is equal to erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in our study.

Background: Chronic suppurative otitis media is still highly prevalent in our country. The most common symptoms are otorrhea and hearing loss. Result of common microorganisms are with a amount of variation within different countries The present study was conducted to find out common various microorganisms associated with SCOM patients and current antimicrobial susceptibility pattern as a guide to therapy. This study was done at Booali and Milad Hospital in Tehran between 2001-2003.Methods: This descriptive study was done on ear secretions of 940 patients (1000 discharging ears). All atients were evaluated through detailed history, clinical examination, schuller’s view and P.T.A. Secretion samples were collected from discharging ear (s) and cultured in blood agar, MC conkey and SOA. Drug sensitivity test of isolated bacteries was done.Results: Pseudomonas aeruginosa and staphylococcus aureus were commonest in the same of 17% in secretions. Aspergilus niger (12%), proteous mirabilis (8%), klebsiella pneumoniea (8%) were in text steps. Tubramycin (100%). Ceftizidim (98%), cyprofluxacin (93%), Gentamycin (75%) were effective against pseudomonas aeruginosa. Amikasin, gentamycin, Vancomycin, chloramphenicol, cephalothin, Erythromycin and cotrimoxazol were 100% effective against staph aureous. Cyprofluxacin was 97% effective against staph aureous.Conclusion: We suggest culture and antibiogram for draining ear and if not possible, its better to use antibiotices that are effective for commonest patogens (Pseudomonas aeruginosa and staphylococcus aureus). Ciprofluxacin is a good antibiotic for management of SCOM. It is effective and more safe than other effective antibiotics like aminoglycosides.

Background: The clinical effectiveness of heart valve replacement surgery has been well documented. Mechanical and homograft valves are used routinely for replacement of damaged heart valves. Homograft valves are produced in our country but we import the mechanical valves. To our knowledge the cost-effectiveness of homograft valve has not been assessed. The objective of the present study was to compare the cost-effectiveness of homograft valve replacement with mechanical valve replacement surgery.Methods: Samples were selected from 200 patients that underwent homograft and mechanical heart valve replacement surgery in Imam-Khomeini hospital (2000-2005). In each group we enrolled 30 patients. Quality of life was measured using the SF-36 health survey and efficacy was measured in QALYs. For each group we calculated the price of heart valve and hospitalization charges. Finally the cost-effectiveness of each treatment modalities were summarized as costs per QALYs gained.Results: Forty males and 20 females participated in the study. The mean score of quality of life was 66.06 (SD=9.22) in homograft group and 57.85 (SD=11.30) in mechanical group (P<0.05). The mean QALYs gained in homograft group was 0.67 more than mechanical group. The incremental cost-effectiveness ratio (ICER) revealed a cost savings of 9,604,440 IRRials for each quality-adjusted life year gained in homograft group.Conclusion: Despite limitation of this introductory study, we concluded that homograft valve replacement was more effective and less expensive than mechanical valve. These findings can encourage healthcare managers and policy makers to support the production of homograft valves and allocate more recourse for developing such activities.

Background: In recent decades, I.R. of Iran experienced remarkable growth in the number of health workforces; however, balanced distribution of them among provinces is a matter of concern. In this study, we investigate the geographical distribution of health personnel in provincial level using the medical registry of national medical council.Methods: the number of working general practitioners, physicians, specialist physicians, pharmacists, dentists, specialist dentists and midwives in each province were recruit form I.R. Iran Medical Council. The number per capita and geographical distribution were investigated and were illustrated using geographical information system (GIS).Results: in 2008, Iran had 1.02 general practitioners, 0.21 pharmacists and 0.29 dentists per 1000 population. In terms of physicians, Iran had 0.44 physicians, 0.02 specialist physicians and dentists per 1000 population. The number of midwives per 1000 fertile females was 0.38. The coefficient of variation for the number of health workers per capita was 252.3% for general practitioners, 144.7% for physicians, 65.3% for specialist physicians, 190.3% for pharmacists, 168.8% for dentists and 72.8% for specialist dentists. Central provinces have higher density of professional health personnel while other provinces still need more medical labor forces.Conclusion: Although the ratio of medical workforces to population is more or less acceptable in national level, the distribution around the country is not yet equal. It seems that still the provinces with lower socioeconomic status need more attention in this regard.

In childhood the most common reason for referring to clinics is coughing. As a protective mechanism the normal child has some cough during the day especially in polluted urban areas (expected cough); therefore previous history of cough, time of severity and its quality is important in diagnosis of pathologic cough.Chronic cough in children is a 3 weeks duration one. It is divided to specific and non specific cough. After ruling out possible exposure to allergens we take chest x-ray as the first step and then if x-ray or history and physical exam were abnormal we evaluate it as a specific cough.If we didn’t find any specific etiology for chronic cough, follow up and observation is recommended, and it should be told to parents there is no harm for their child and usage of drugs is not necessary. Usage of symptomatic anti cough drugs has the same effects as placebo. Paying attention to this symptom and appropriate approach for diagnosis and treatment of each type of chronic cough will help physician to do their best in the management of this symptom.

Researches within health domain apply different methods of investigations to study various aspects of the individuals and communities’ health. For example, in the bedside, clinicians might face with rare cases side-effects of a disease, a drug or a medical device. Under such circumstances, writing, publication and dissemination of the given case might extent the knowledge of the other clinical experts. The aim of the present article is to provide a definite and standard guideline for writing such case reports in order to help Iranian clinicians to prepare publishable case reports for Persian journals.