Journal of Medical Council of Iran
Year:2010 | Volume:28 | Issue:1|Papers Count:14

Background: Stroke, despite recent advances in medical technology is a problem of public health systems. Stroke is a neurological dysfunction by vascular origin and its signs and symptoms corresponding to the damaged areas of the brain. Prevalence of spasticity after stroke has been reported in 39% of patients. The upper limb of 50% of patients with stroke remains without function due to spasticity. The purpose of this study was to determine the effects of volar static splint on function and spasticity of upper extremity in hemiplegic adults.Methods: The design of this study was experimental and repeated measurement. Fifteen patients with stroke aging 41-85 years old of both sexes were no randomly selected from rehabilitation clinics and hospitals of Tehran. The patients used a volar static splint (10 degree of wrist extension, full extension of fingers and abduction and opposition of thumb) two mounts (2 hours at day and 4 hours at night). In this study Modified Ashworth Scale was used to evaluate spasticity. A Goniometre was used to measure passive range of motion. Upper extremity function was evaluated by Fugl-Meyer Test.Results: The results of this study showed significant reduction in wrist and elbow spasticity (p<0.0001), significant increase in wrist and elbow passive range of motion (p<0.0001 and p<0.002, respectively) and upper limb function (p<0.0001).Conclusion: This study shows that 2 months using of volar static splint in patients with chronic stroke has significant effects on reduction of wrist and elbow spasticity, increasing passive range of motion of these joints and upper limb function. It seems that application of this splint is useful for improvement of upper limb function in chronic hstroke patients.

Background: One of the asymptomatic lesions associated with an impacted mandibular third molar is localized periodontal pocket on the distal surface of mandibular second molar. In this study, relationship between periodontal pocket on the distal surface of mandibular second molars and pattern and depth of impaction is evaluated.Methods: The study was performed experimentally. A group of 100 patients, referring to surgical department of shahed dental school and shahid montazeri clinic (1386-87), were selected sequentially for the purpose. Pattern and depth of mandibular third molar impaction were recorded in studying form according to O.P.G radiograph. The impacted third molars were extracted by means of a clinical indication and depth of periodontal pocket was measured 4-24 months after surgical extraction. Statistical software of SPSS for windows was used for data analysis, using Kruskal-Wallis and Mann-Whitney tests for assessing relationship between periodontal pocket depth and pattern and depth of mandibular third molar impaction.Results: The age of the patients was 24.3+-7, 55 individuals (55%) were females while the next 45 individuals (45%) were males. There was statistically significant difference between periodontal pocket depth and pattern and depth of mandibular third molar impaction. (p<0.001)Conclusion: Based on the findings of this study, deep periodontal pockets on the distal surface of a mandibular second molar, is mostly associated with horizontal, mesioangular and class C impacted third molar. So, more attention should be given to the detection of signs of periodontal pockets on the distal aspects of mandibular second molars when assessing the clinical state of the adjacent impacted third molars, because pattern and depth of impaction could be very determinative.

Background: Restless legs syndrome (RLS) is a neurologic movement disorder that is often associated with a sleep complain patients with RLS have an irresistible urge to move their legs, which is usually due to disagreeable sensations that are worse during period s of inactivity and often interfere with sleep it is estimated that between 2 and 15 percent of the population may experience symptoms of RLS.Primary RLS likely has a genetic origin. secondary causes of RLS include iron deficiency, neurologic lesions, pregnancy and uremia .RLS also may occure secondary to the use of certain medications.The aims of this study was to determine incidens restless legs syndrome in hemodialysis patients.Methods: This was a descriptive analytical study in dialysis sectore of Nohom - day hospital (Torbat Heidrieh,Iran)a total 41 patients were enrolled in this study. The data (including demographic data, sign, symtom, clinical and para clinical finding,hemodialysis adequacy, hemodialysis periodicity, hemodialysis duration )were collected through questionare, intrview, physical examination and paraclinical studies. Data were analysed,using SPSS software and statistical descriptive indices.FINDING: A total of 41 patients were enrolled into our study.The prevalence of RLS in this study was 17.1% with male predominance (57.1% versus 42.9%).Anemia was found in 71.4% of patient. The most underlying medical problem was hypertension (42.9%).A direct relation ship was found between RLS and blood group.These was no association between RLS and iron deficiency, serum ferritin, HCT, dialysis adequacy in this study.Results: Contrary to the normal population in patients with hemodialysis, was no relation between RLS and iron deficiency.Conclusion: More attention to this disease might aid its detection and reduce patient discomfort. Further studies are needed to disclose its detailed risk factors and the pathophysiological role of the BUN level in RLS.

Background: Jaundice in neonatal period is a common disorder's that increase bilirubin deposision in tissues such as skin occurs.excessive bilirubin deposision in the brain increase the risk encephalopathy and kernicterus . there are several therapeutic procedures to reduce bilirubin level. One of the most important method especially in emergency situation is exchang transfusion (ET). This study was performed to find the causes of sever hyper bilirubinemia which required ET.Methods: This study was an analytical descriptive retrospective and prospective study which was performed in 48 cases in milad hospital (Tehran-iran ) from 1381-1386 . the data were collected by pediatrician in a detailed questionnaire. This data were fully analyzed by SPSS 16 software.Results: In this study 48 neonates age 1-32 days were enrolled . 24 patients (50%)were male and 50% were female. 34 patient (77%) were term and 14 patient (23%) were preterm. retic count in most patient were low (less than 2%).There was no specific cause for jaundice in 12 (24%) cases.ABO incompatibility was the most common cause of jaundice.Conclusion: ABO incompatibility was the most common cause ET which can be prevented by in paying attention to postnatal visit. there was no specific cause of jaundice 12 (24%) cases which required further investigation.In this study no positive coomb's test was seen. coomb's test under this situation little value.

Background: Although resection and anastomosis (RA) is known as most efficient method for treatment of post-intubation airway stenoses, non-resectional methods are being developed and suggested as substitutes for RA. Presenting our experience with sufficient number of patients who underwent resection might be helpful in comparison and selection of various treatment methods.Methods: All patients who had been referred to us (Feb 1994 to Jan 2007) underwent bronchoscopy and evaluation of the stricture and function of the larynx. Patients in good general condition whose strictures were operable by RA underwent this operation. Other patients underwent non-resectional treatments. Three types of operations were performed 1) tracheal resection 2) resection of trachea and anterior arch of cricoid 3) resection of trachea and anterior arch of cricoid associated with posterior cricoidotomy and autologous cartilage grafting at the site of cricoidotomy. Surgical results were categorized into good, acceptable and failure. Results were analyzed using SPSS software with Chi-square and Fisher’s exact tests.Results: Nine hundred one patients underwent treatment during 13 years out of which, 571 underwent RA (420 men, 151 women, mean age 25.6 yrs). Types 1, 2 & 3 operations were performed on 451, 88 and 32 patients, respectively. Results were good in 434 (76.10%), acceptable in 79 (13.84%) and failure in 53 (9.29%) patients. Thirteen deaths occurred after resectional treatment and 25 deaths after non-resectional treatments.Conclusion: Single-stage resection and anastomosis is an appropriate treatment for most cases of post-intubation tracheal and laryngotracheal stenoses.

Background: Every Year approximately 6 millions perinatal death instances occur worldwide, which 98% of these instances are in developing countries (1,2). One third of these death instances occur during delivery, whereas there are effective preventive measures to reduce these instances.Methods: During this case-control study, 1800 pregnant women,with gestational age above 28 week, admitted in hospital, were selected randomly to participate in this study. Data about risk factors were collected and samples were followed up to one week after the delivery in order to register early neonatal death cases .Then risk factors in cases (perinatal death) were compared with control group.Risk Factors consist of: demographic characters, medical history, obstetric history, pregnancy & parturition complication, newborn risk factors.Results: The most important risk factors of perinatal death consist of: mother age (P=000), prenatal care (P=0.000), medical history (P<0.03), anemia (P=000), abortion history (P<0.05), complication during pregnancy & delivery (P=000). Neonatal risk factors consisting of weight, gestational age and gender are the most effective risk factors in this study.Conclusion: It seems that in order to reduce perinatal mortality, measures such as developing delivery & NICU centers, available expert manpower for minimizing antepartum dangers, promotion of prenatal care & family spacing services can be effectively used.

Clostridium difficile is the causative organism of antibiotic associated colitis. Colonization of the intestinal tract occurs via the fecal-oral route and is facilitated by disruption of normal intestinal flora due to antimicrobial therapy. The organism is capable of elaborating exotoxins that bind to receptors on intestinal epithelial cells, leading to inflammation and diarrhea.Our understanding of C. difficile microbiology and epidemiology is changing rapidly.In this review article we discuss microbiology, epidemiology, clinical manifestations, diagnosis, and prevention and treatment of C. difficile.

Appropriate approach of the lymphadenopathy in children as a common finding is necessary .The proper time for following and checking up the palpable lymph node and its biopsy are significant considerations of approaching lymphadenopathy in children that are described in this review study.The lymphadenopathy could be properly studied using the correct patient history, physical examination and the characteristics of lymph nodes including: generalized or localized and associated signs & symptoms such as organomegaly, skin and mucosal lesions, fever, weight lose and sweating.The lymphadenopathy in children could be resulted from a common and insignificant finding following upper respiratory tract infections to a serious malignant etiology. The correct evaluation of unimportant and serious forms of lymphadenopathy can inhibits the wasting in money and refers on time.

Celiac sprue or Celiac disease is an autoimmune enteropathy often seen in patients are sensitive to gluten. Usually due to impaired absorption of iron and folic acid at the proximal of small intestine, iron deficiency anemia and megaloblastic anemia is common, but vitamin B12 deficiency is rarely reported. We will describe the case that in addition to have celiac disease ,without deficiency of iron and folic acid has deficient vitamin B12 due to severe pernicious anemia and improved dramatically to treatment with injection of vitamin B12.38-years-old male patient with complaints of weakness and malaise and abdominal pain is referred. Initial tests indicated patient have megaloblastic anemia caused by vitamin B12 deficiency. With stomach and deuodenal biopsy and serological antibody titration studies including anti-parietal cell antibody, anti-endomysial antibody and tissue transglutaminase, accompanied with pernicious anemia and celiac disease was proved. After diagnosis, patients treated with intramuscular vitamin B12 and regimen without gluten, after one month significant improvements in clinical symptoms and laboratory found.

Background: This study was conducted to clarify the expectations of the health care professionals (professors, residents, interns, nurses & head nurses) in Dr. shariati Hospital regarding the services of the Drug & Poison Information Center in this Hospital.Methods: Data was collected from a questionnaire which was distributed among 400 people in April 2009. Only 157 respondents fulfilled the questionnaire. So a return rate of 39% was achieved.Results: According to the results, medical reference books and drug information textbooks (36.7%) and expert colleagues (29.7%) were the "most commonly" used drug information resources. 77.8% of respondents "almost never" use DPICs. According to the results, 77.5% of respondents were non- acquainted with these centers' activities. 44.4% of respondents included "adverse drug reactions" and 33.3% included "availability of drugs in pharmacy" in the blank space considered for them to mention any expectation(s) they rank as the most important. In addition, 74% of them rank "incompatibility of injectable drugs" and" 70.1% rank "drug interactions" as the "extremely important" issues.Conclusion: Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Even after 13 years of opening of the first DPIC in IRAN, the health care professionals are not familiar with these centers' services and activities yet. It shows an urgent need for culture building activities to introduce them these centers services.