Journal of Medical Council of Iran
Year:2003 | Volume:21 | Issue:2|Papers Count:15

Glucose-6-phosphate Dehydrogenase (G6PD) is one of the vital enzymes involved in the metabolism of red blood cells. The deficiency of this enzyme is one of the most common enzymatic deficiencies in human being. More than 400 variants of G6PD have been identified and 400 million people are suffering in the world. This condition can cause acute hemolysis during oxidative stress and also severe neonatal hyperbilirubinemia in some population. The objective of our study was to determine the prevalence of G6PD deficiency and its relation to neonatal jaundice. Two thousand consecutively born babies at Najmieh and Baghiyatollah (a.s) hospitals (Tehran) from August 1999 up to February 2000 , were screened for G6PD deficiency. Blood samples were obtained from umbilical cord and tested by fluorescent sport test. These infants were observed for 10 days for development of jaundice.The results of the study are as follows: frequency of G6PD deficiency was 2.1% being 3.6% in males and 0.6% in females. Significant jaundice (Abdomen and soles) developed in 51.4% of infants having G6PD deficiency. versus 16.6% in normal infants (P= 0.000) . Mean +/-SD of bilirubin level in G6PD deficient and normal infant were, 18.76+/-56mg I dl and 15.5+/-4.2 mg/dl , respectively (P=0.000).Phototherapy was required in 48.6% of G6PD deficient infants and in 11.9% among normal infants (P=0.000) 11.4% of deficient, compared with 0.9% of normal infants, required exchange blood transfusion (P=0.000). Hemoglobin and reticulocyte values and hospitalization days in deficient and normal infants were not statistically different. Owing to the relatively high prevalence of G6PD deficiency and its relation to neonatal jaundice and side effects related to it , a wide scale country wide population screening is strongly needed, so that on the one hand, neonates that are highly risk prone be taken care of under intensive 'coverage and their jaundice timely and speedily treated. On the other hand because of probable attacks of hemolysis due to fava bean consumption during childhood, and above that age, necessary warnings and adequate health education are imported.

There exists controversies in the classification of uterine smooth muscle tumors (SMTS). The number of mitotic figures in 10 hpf in the most active areas (mitotic index) was used as the most common diagnostic criterion to evaluate malignancy (Taylor &Norris classification, 1966), mitotic index and cellular atypia (Zalondek & Norris ,1981). Accordingly when there were more than 10 mitosis per 10 hpf, it was classified as malignant lesion but experiences have shown that not all SMTS with more than 10 mitoses per 10 hpf are malignant, so it nesseciates reevaluation and using other differentiating criteria. Bell and Colleagues (1995) have used coagulative tumor cell Necrosis (CTCN) and degree of cellular Atypia to classify SMTS into five groups.In this article, we reevaluated SMTS in Mirza Kouchak Khan hospital which were previously diagnosed based on Taylor and Norris classification) between 1994-1998, using mitotic index, degree of cellular atypia and CTCN (Bell classification) as three defining criteria. Overall 612 SMTS were reevaluated and subclassified as:Group I: 603 cases, Group II:2 cases, Group III: 6 cases, Group IV: No case and Group V: 1 case.In this study diagnosis was changed in three cases, with the new classification muscle tumor of uncertain malignant potential (STUMP), and one case of leiomyosarcoma were changed to the leiomyoma. The third case of leiomyoma was changed to the atypical leiomyoma with limited experience.

Bacterial meningitis is an important disease world wide and if remains undiagnosed and not treated in time is associated with irreversible and serious complications and a high morbidity and mortality. This retrospective study was conducted on 90 patients who met the criteria of acute bacterial meningitis and who were admitted at the pediatric Medical center and lmam khomeini Hospitals between 1999-2000 . According to this survey, the important factors affecting the prognosis at discharge included age less than 12 weeks, no response to antibiotics 72 years after initiation of treatment, altered consciousness at the time of admission, focal neurological symptoms and a change in antibiotic regimen. No correlation was found between prognosis and other variables such as sex, antibiotic consumption before admission, duration of symptoms from their onset till the time of admission and the presence of other indices such as fever, seizures, meningism and use of corticosteroids in the treatment regimen.The overall mortality rate in our study was 10% and the incidence of complications on discharge as 13.3%. In conclusion, on the basis of the results obtained, despite the use of advanced supportive systems for these patients and also modern broad spectrum antibiotics and appropriate diagnostic methods, no obvious change in factors affecting prognosis compared to two decades back has been seen. Likewise because of the absence of follow up of patients following discharge, it appears that further teaching is needed about this disease among students and residents besides creating specific centers to prevent this disease.

Gastroesophageal reflux disease (GERD) is a very common disease caused by a dysfunction of the lower esophageal sphincter and esophageal dysmotility . The main signs of GERD include heartburn, regurgitation and dysphagia. Endoscopic findings of reflux include mucosal breaking in the lower esophagus (reflux induced esophagitis). Proton pump inhibitors are the drugs of choice in this disease. This study aims to assess the efficacy and side effects of omeprazole capsules manufactured in Iran compared with that manufactured abroad.A total of 64 patients (37 male, 27 female, age range, 15- 72 years) who were endoscopically diagnosed as grade A or B esophagitis (according to the Los Angeles Classification) were enrolled. The patients were randomly divided into 2 groups; patients in the first group received omeprazole and those in the second group received Prilosec 20 mg twice a day orally for 8 weeks. The patients were assessed for signs of disease and probable side effects in the initial visit and subsequently after 2,4,6 and 8 weeks and according to intensity, a score was given to the cardinal signs of disease. prior to treatment and at the end of the 8th week, Upper GI endoscopy was performed for all patients.Both drugs had similar effects in improving the signs of disease; mean total symptom score decreased from 6.8+1.7 to 0.4+0.9 in group which had been treated with drug manufactured abroad and from 6.5+ 1.9 to 0.3+ 0.8 in group which had been treated with drug manufactured in Iran (p>0.05). Endoscopic signs and adverse effects did not vary in two groups.It seems that Omeprazole manufactured in Iran with its low cost, has the same clinical utilization and side effects as that of its foreign counterpart. Therefore it is rationale to treat patients with the much cheaper drug manufactured in Iran without fear of severe side effects and in case of teatment failure it is necessary to revise the initial diagnosis and emphasize on life style modification.

Bacterial keratitis is the most serious complication after wearing of contact lens which despite appropriate therapy may produce corneal opacity and later ending in decreased vision.Seventy three patients admitted for bacterial keratitis due to wearing of contact lens were evaluated. Age, sex, type of contact lens, microbial pathogen, refractive error of patient, clarity of cornea after treatment and type of treatment were reviewed. Patients included 48 female (66%) and 25 male (34%) . Highest incidence was in age group 15-30years (89%) . The type of contact lens was soft in 84% , hard in 11% and cosmetic in 5% of patients. The most offending organism was pseudomonas in 79.5% of culture positive pecimens. Medical therapy was successful in 89% of patients but in II% surgery was needed. Refractive error of patients was less than 6 diopter in 80% and greater than 6 diopter in 15% of patients. Five percent of our patients had not refractive error and wore contact lens for cosmetic purposes.Using of contact lens for correction of refractory error or for cosmesis increase in Iran and it is mandatory to increase our knowledge about prevention and treatment of the complications. Because of an increased use of contact lens in Iran , a knowledge of one of the most serious complications is essential.Selection of the appropriate patient, advise of contact lens by a specialist and not by non specialists, and likewise proper education to the patient at the time of lens selection can prevent the occurrence of the serious complications.

In recent years, several studies have been carried out in developing countries to assess the prevalence of vitamin D deficiency. Majority of these studies were limited to specific age groups and were not population based. Results of these studies point to the high prevalence of vitamin D deficiency in these. countries. This report assesses the pervalence of vitamin D deficiency and its associated factors.This study was carried out on 1210, 20-69 year old residents of the city of Tehran who were randomly chosen. Serum level of 25(OH) D was assessed and a questioner was used to evaluate the time of sun exposure, the clothes, calcium intake and BMI.Vitamin D deficiency was detected in 79.6% of the studied population. Prevalence of severe, moderate and mild vitamin D deficiency was found to be 14.2%, 57.6% and %9.5, respectively in this population. Serum level of vitamin D had no significant correlation with sun exposure, calcium intake and BMI. The mean serum level of vitamin D in young females was significantly lower than older ones.Because of high prevalence of vitamin D deficiency in Tehran population, application of different methods such as food fortfication seems to be necessary to improve this condition and to prevent the side effects of vitamin D deficiency.

Pulmonary aspergilloma generally arises from colonization of aspergillus in pre-existing lung cavities. Among the predisposing factors, pulmonary tuberculosis, bronchiectasis, sarcoidosis and lung tumors are of high prevalence. Symptomatic patients especially with hemoptysis need treatment. Emergent surgery is the method of choice.This retrospective study was conducted between 1999-2000 at Masih Daneshvari hospital. All the patients were operated. The definite results after evalualting the pathological specimens along with all the data obtained and needed from the patients were recorded and classified in a form. 13 patients, 7 male (54%) and 6 female (46%) with definite pathological diagnosis of aspergillosis were evaluated.The age ranged from 22-60 years with a mean age of 43 years (ranging from 22 to 60 years) were examined. Hemoptysis (92%) was the most common clinical finding. All the patients were operated, among which the most frequent symptoms indicating surgery was hemoptysis (77%). Left upper lobe (62%) was the most frequent anatomic site of disease. Among the study population, no preoperative or postoperative deaths occurred.Our results confirm that aspergilloma has a high prevalence in Iran. Clinical presentations, epidemiological factors, etiology, radiological and pathologic findings must be considered to make accurate diagnosis and prompt treatment.

According to reports, Mycobacterium tuberculosis infects 8-10 millions people worldwide annually and causes 2-3 millions deaths each year. This study compares the awareness, attitude and performance (AAP) of general population of Ardabil district and patients suffering from smear positive lung tuberculosis. 500 inhabitants of Ardabil district and 34 smear positive patients were selected and studied by using q uestionaire. The degree of awareness of the participants the nature of the disease and ways of prevention and controlling it were determined.By doing Hoteling T2 test a statistically significant difference was seen between the above variables among healthy individuals and patients (p<0.05). The attitudes of people, both healthy and patients, about the nature of the disease and its prevention and control was positive and declared that tuberculosis was preventable. Only a few percent of individuals considered that the disease was dangerous and incurable. T test did not show difference between the attitudes of healthy and ill individuals (p<0.05). The degree of the practice of the individuals in prevention and controlling the disease was good and moderate and none of the samples had poor practice about the disease control (5.8% of healthy and zero percent of patients had poor performance.) T2 Hoteling test indicated a significant difference between the healthy and patients about the nature of the disease and prevention and control. This study did not show any meaningful relationship between variables such as age, gender and job, and the knowledge and practice of the samples about the tuberculosis prevention and control among healthy and unhealthy individuals (Doing X2 test with a p value of more than 0.05). Performing a X2 test showed a meaningful statistical relationship between the level of education of the healthy individuals, and their AAP (p<0.05). Among the patients, however, there was no meaningful statistical relationship in this regard.This study only shows the poor performance of the healthy individuals in tuberculosis control and therefore besides putting emphasis on the improvement of performances of people through education, it is also necessary to seek the causes of the disease's high prevalance in relation to others, such as poverty malnutrition population density, etc., and take the necessary actions in this regard.

We report a case of neonatal purpura fulminans due to homozygous protein C deficiency which presented itself in the first day of life. The level of protein C was low in both the parents. Homozygous protein C deficiency is a rare genetic disease with catastrophic and fatal purpura fulminans presentation or thrombotic complications occuring during the early neonatal period. In this disease, the level or function of protein C is very low. Early diagnosis and adequate replacement therapy with purified protein C concentrate or FFP can be life saving.Newborn infants with congenital homozygous protein C deficiency will not survive beyond the neonatal period without protein C replacement therapy. Protein C deficiency should be considered in any infant with necrotic skin lesions, purpura fulminans and or systemic thrombosis.

The rate of neonatal mortality and morbidity in Japan and Sweden 2.2, but in Iran it is 18 per thousand live births. In the industrialized countries, continuation of life in newborns weighing 500 gr or less is a normal occurance , but in Iran, you cannot always be sure of full term newborns to remain alive. in order to reduce the neonatal mortality and morbidity, attempts should be made to improve the nutrition, health and the social status of the girls and women. The quality of care during pregnancy, delivery and postpartum period should improve and the high risk pregnancies, deliveries and newborns be identified, cared for and if necessary transferred promptly.The committees for reducing perinatal mortalities and morbidities should be established in all maternity hospitals and universities of medical sciences as well as in the ministry of Health and Medical Education. These committees should look into every factor contributing to the morbidity or mortality of the newborns and try to rectify the situation.In the area of newborn care, research should be expanded and medical education improved. A close cooperation and coordination among the obstetricians and pediatricians should be established, and the knowledge and practice of perinatology should be expanded and promoted. A variety of scientifically sound guidelines in the areas of diagnosis and management should be prepared, and their practice implemented. The quality of neonatal care particularly during the first minutes, hours and days of life should change drastically and when needed, neonatal resuscitation should be initiated promptly and performed skillfully. The mother - infant contact and breastfeeding should start within minutes after birth. Regionalization should be implemented and for those mothers and newborns who need to be transferred after stabilizing their conditions, proper means of transportation should be available which should be well equipped and run by well trained teams of transportation.