Journal of Medical Council of Iran
Year:2002 | Volume:20 | Issue:2|Papers Count:14

This study has been performed on 42 patients with digoxin intoxication during ten years. The patients had arrhythmia in ECG and on clinical examination. Tne digoxin level in these patients were higher than 2ng/ml with radioimmunoassay method. The results were compared with Chung's study that was carried out on 180 patients intoxicated with digitalis.The commonest arrhythmia in our and Chung's studies were ventricular arrhythmias(50% VS 57.75% P<0.05) and the most rare one was nodal arrhythmia (7% VS 4.76%). Atrioventricular(AV) blocks frequency was 16.66% VS 51.66% (P<0.05) and atrial arrhythmias 19.04% VS 20% (P<0.04) and sinus arrhythmias were 9.52% VS 15.55% (P<0.7) in comparision with Chung's studies.Digoxin intoxication was three times more frequent in females than males. The highest frequency was obseved in 60 and over 60 years old (73.8%) and the commonest coexisting disease was corpulmonale.

Low birth weight (LWB) is defined by WHO as infants who weigh less than 2500 gm at birth. ln the world 20 million (16% of an births) LWB babies born each year, and accounts for up to 70% of neonatal deaths in some countries. An estimate of 5% LBW was announced for Iran by WHO in 1995. We sought to determined the frequency of LWB and some related factors in a group of lranain patiant, therefore a cross sectional study was conducted, intering 4000 delivery records of liveborn in the hospitals of Tehran University, in 1999.The frequency rate of LBW was 9.2% (369 cases), in univariate analysis, there was significant association between LBW and: preterm labor, premature rupture of membranes (PROM), oligohydraminus, placental abruption, preeclampsia, primigravidity, twines or more fetuses and femal infants, (p<0/05). In our study 75.1% of LBW of infant was born preterm, compare to 24% full term infants (P=0.0001).In multivariate analysis based on logistic regression, preterm labor was the most important risk factor for LBW (OR =9.39 P=0.00001) Other significant risk factors included: premature rupture of membranes (OR = 2.29 P= 0.00001), Oligohydraminus (OR = 1.9 P = 0.0396), Placental abruption (OR =2.01 P=0.0048), Primigravidity(OR = 2.05 P=0.00001) and twines or more fetuses (OR = 1.66, P= 0.0035).The maternal high risk ages (<20 and ≥35 years) was not a risk factor for LBW (OR =0.66 P =0.0145). According to our findings, it seems that the frequecy of LBW in Iran is nearly at an acceptable level, since the population or the study was selected from referral hospitals of Tehran, and preterm later seems to be the most important risk factor, though other factors are involve.

Death certificates provide the essential data regarding morbidity and mortality, Inadequacies in filling out the death certificates raises a question over the validity of most health programmes. An endeavour is made in this study to evaluate the inadequacies of death certificates issued at Shariati Hospital in the year 1998 and their deviations from the standard forms, and furthermore assess the effective factors leading to such inaccuracies in issuing such death certificates. In this cross sectional study, the files of the deceased and their certifiers were utilized to gather The data. Results of this study showed that out of 642 files of the decease 328 (51.09%) of cases matched with the National Standards as regards completion of the death certificates. Out of this number, 198 (30.84%) of cases had problem in reporting the cause of death, 67(10.44%) cases had failed to report the complete identity of the deceased or date or timing of death, and 49(7.63%) case had problems in both. Significant correlations were found to exist between standardization of the death certificates and the underlying factors:Ward, duration of hospitalization of the deceased, pathological diagnosis, field speciality, gender, the grade of knowlege and attitudes of the certifiers, out of 67 certifiers 45 (67.16%), had not had formal training course for standard death certification. Based upon these data, it is suggested to improve knowledge of the certifiers in issuing death certificates are made for improving of death certification training of certifiers.

Trauma is the leading cause of death and disabilities especially among youth and in a country like the U.S, it causes economic harms forseveral billion dollars. In this study we decided to evaluate some direct and indirect economic consequences of trauma morbidity and mortality in Tehran. In this study, all information of trauma patients who were admitted in 6 large hospitals during 13 months for data gathering process, were gathered by trained physicians according to International Classification of Disease 10th revision (lCD-10). For this article we have focused on information of working population older than 18years old and we will discuss job-related problems in children and teenagers in another article.From 8000 trauma patients, 3509 cases were entered the analysis for this article. Three forth of them were men and mean age of the patients was 32 years old. Simple/construction workers had the highest rate of job-related injuries (35.3%) and vehicle related injuries (54.4%) and fall (22.1 %) were the most common mechanism of injury in this group. Approximately 65% of the patients in this study had no insurance coverage. Mean hospitalization cost for nearly 1 week of admission was 100,000 Tomans and patients had suffered from temporary disability for nearly 40 days. Unfortunately 115 deaths occurred among the patients. Estimation of some portion of direct and indirect health showed that community suffered nearly 3 Milliard Tomans only costs in these 115 cases. Similar estimate of health costs for live trauma patients resulted in more than 24 billions Tomans.Huge harmful effects of trauma on economy of the community have made implementation of comprehensive injury prevention protocols inevitable.

This study was conducted on 48 patients suffering from Thalassemic major Ali Asghar hospital.Out of the total 39 patients (81.3 %) had delayed bone age (Mean 15.8 m 42 Patients (87.5 %) had delayed hight age (Mean 19 mo). There was significent relationship between delayed bone age and delayed height age.On the other hand, 32 patients (66.7 %) were short statured, and 29 patient of those (90.6 %) had delayed bone age, there was significant relationship between short stature and delayed bone age. This research shows that in the delayed growth of thalassemic patients, beside innumerable factors such as chronic illness, endocrine disturbances and know ledged psychological problems, delayed bone age as another factor is being forwarded.

Data from 3148 participants ages 3-19 yrs(1447 males and 1701 females) in the cross-sectional phase study of Tehran Lipid and Glucose Study (February 1999 to May 2000) were used to determine serum lipid levels [total cholesterol (TC), triglycerides(TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol(LDL-C)] after 12-14hrs overnight fast. The values were analyzed by sex and age. Mean serum TC concentration was 170 mg/dl. TC was significantly greater in females than males (173 vs 167 mg/dl, P< 0.05). There was a significant decrease in mean TC in males during puberty. Thirty_one percent of population had TC values between 170 and 199 mg/dl and 16% had values of 200 mg/dl or greater. The mean TGs values were 103 for males and 108 mg/dl for females (NS). The prevalence of high-risk values of TGs increased with age in males, reaching a peak at 17-19 years. The mean HDL-C level was 45 mg/dl. Mean HDL-C was highest at 7-10 years of age and decreased thereafter. The mean LDL-C was 102 in males and 107 mg/dl in females (NS). Twenty-two percent had LDL-C values between 110-129 mg/dl and 17% had values 130 mg/dl or greater. The results showed higher levels of TC, LDL-C and TGs and lower HDL-C in Tehranian children and adolescents than in other studies. Because of a high prevalence of lipoproteinemia in children and adolescents in Tehran , a design and execution of a comprehensive public health programe is needed to reduce serum lipid levels and coexisting factors.

The aim of this study is to compare the symptomatic versus endoscopy – based treatment of dyspeptic patients without testing serology of H.pylori infecion Iranian patients.Tow hundred sixty six patients with symptoms of dyspepsia (DYS) (7 items at least 1month duration and no alarming symptoms were randomly divide, two groups( Gr A and Gr B ).Pt of Gr A (n=135) underwent endoscopy were treated for presence of ulcer and + HP histology with classic triple them (CTT), for NUD symptomatically with acid suppressive drugs (AS Metoclopramide (MET) or both.Pt of Gr B (n=132)were treated for ulcer - DYS with CTT and for dysmotility- like or reflux - like DYS with ASD, MET both for at least 1 month. The severity of symptoms were scored. In G endoscopy was performed only, when no response to therapy occurred. All patitent were followed up to 4,8 weeks, 4,8 and 12 response to therapy occurred. Patients were followed up to 4,8 weeks,4,8 and 12 month later. Patients older t?? 40 yrs with empiric treatment underwent endoscopy after 1 year.The data of patients were mostly comparable in both groups .In Gr A, l4 with DU disease and one with gastric cancer were found. Eradication therapy performed in 12 DU pt.of Gr B and IN 14 pt. of Gr A with ulcer - like D Thirteen pt. in Gr B did not respond to therapy and underwent endoscopy whit diagnosis of GU in 2 and GU in 4 and gastric cancer in one pt. Total symptoms score decreased markedly and comparably in both groups at 4 weeks. To symptom score was not different between two goup at 2.8 and 12 months. Patient of group B older than 40 years had cancer lesion at 1 year endoscopy examination.Symptomatic therapy of dyspeptic patients without any diagnostic procedure by lack of alarming signs is a successful and economic strategy, which can recommendes to all physicians, provided that a careful control examination of each patient is performed.

Breastfeeding is the best and complete food for babies, and protects them against many illnesses. Thus promotion of breastfeeding should be the main health task of health programmes concerning mothers and children health.Assessment of Ten Tasks For Breastfeeding promotion in Baby- friendly Hospitals in Guilan province was carried out. Using a Questionnaire prepared by UNICEF with the subject of self- Assessment of hospitals for evaluating of policies and the methods of promotion studied in which 10 points are considered useful, we finished a study among all 14 baby friendly hospitals in Guilan Province.The seventh, eighth and nineth tasks are done fully (100%) in hospitals, but the tenth task has got the least scores (79/03). Two hospitals on third task, one in fifth task and three hospital on tenth task gained middle quality, two hospitals on third task and one on fifth task got bad quality and the rest cases got good quality.Breastfeeding promotion activities in Amini hospital (Langroud), Shahid Ansary (Roudsar) and Vali- Asre (Roudbar) Hospitals have got the most rates, but Shahid Beheshti hospital (Anzali) has got the least rate. However all hospitals were in good quality in these regards. Totally ten tasks about breastfeeding promotion in baby friendly hospital board got good evaluation but in some tasks should be taken more efforts should be undertaken.

Rickets associated with tumor or oncogenic rickets is a rare form of rickets and comes under the class of hypophosphatemic rickets. In this disease probably factors are released from the turmor which suppresses the renal 25- OHD-1 -Hydroxylase system and thus causes a reduction in serum phosphorous levels leading to the clinical signs of rickets. In this study conducted during an 11year period, an interesting point of this disease had been recurrence of clinical signs of rickets along with recurrence of mandibular giant cell granuloma.As we shall see in this case after surgical extermination of the pathological lesion, the clinical and laboratory signs showed a significant improvement shortly after the procedure and medical treatment despite employing high dose had no effect.

Injection of narcotics has become widespread and its prevalence along with the use of heroin and cocaine has been on the rise. Consumers of narcotics in injectable form are people who are engaged in unlawful activities which the society disapproves. Their exact number and determination of incidence of infectious complication in these persons is not available.The infectious complications in a drug addict are mostly related to the environment and the life style of the addict rathe than per se the type of the drug itself.The characteristics that increase the risk of infection in drug abusers include increased rate of skin, mucous membrane and nasopharyngeal carriage of pathogenic organisms, unsterile injection techniques, contamination of injection equipments or drugs with organisms poor oral hygeinc, poor and low socioeconomic status, other behaviors such as cigarette smoking and alcohol consumption along with injection of drugs and the absence of primary health care services.