Journal of Medical Council of Iran
Year:2006 | Volume:24 | Issue:2|Papers Count:15

Background: Febrile convulsion is one of the most common CNS disorders of children for which several predisposing factors have been mentioned.The objective of this study was to determine predisposing factors and analysis of the demographic characteristics of children with febrile seizures.Methods: Patients group consisted of 115 children aged 5-60 months. Control group was 345 healthy children with the same age and sex.Findings: According to demographic charactristics, positive correlation between mean weight and family history for febrile seizure; were statistically significant. Where as differences between head circumference, height, breast feeding, birth APGAR score and multi vitamins & Iran supplement in patients and control group were not statistically significant.Conclusion: We concluded that febrile convulsion was more common among children with higher weight and family history of febrile seizures.

Background: Allergic rhinitis is a chronic disease of upper respiratory tract which can be presented as asthma. Some investigators have reported a significant relationship between the disease and the number of eosinophils in nasal secretion of the patients. This study aims to evaluate the serum IgE and it, s relation with nasal secretion eosinophils count in patients with allergic rhinitis.Methods: In this study, setum IgE of 92 patients with non anatomical nasal complication were investigated using ELISA method (IEMA WELL Q-D). Nasal secretion smears of the patients were also evaluated for eosinophils count. Age, sex, profession and past history of allergic reactions in patients and their families were also investigated.Findings: 48. 9% of the patients had high titers of serum IgE (>100 IU/ml). Also, eosinophils over 5/HPF were seen in 15. 6% of patients, nasal secretion smears. There was no significant relationship between eosinophils count and presence of allergic rhinitis in the patients. Otherwise, there was a significant correlation between rhinitis and patients, profession and their locality of living (P<0.05).Conclusion: Detection of serum IgE is mandatory for diagnosis of allergic rhinitis. Besides, it seems that nasal secretion eosinophils count alone is not a reliable finding for diagnosis of the disease.

Background: Central nervous system tumors are the most common soild tumors in children, which are very important because of non-specific clinical manifestation, delayed diagnosis, complication and relatively high mortality. The aim of this study from different angles and different aspects is to arrive at workable solutions towards appropriate management of these cases.Methods: An "existing data" study was carried out by using data of 120 patients (age<14years) with brain tumors operated in Mophid hospital during 8 years (1996-2002). Variables included age, gender, tumor site, pathology of tumor, symptoms, signs, time period of first clinical manifestation till the definite diagnosis.Findings: Results showed that female to male ratio was 3: 2. The most common tumor was astrocytoma (50%). The most frequent location of tumor was posterior fossa (52%). The major peak in the incidence of tumors was observed between 5 and 9 years. The longest period between disease onsets till final diagnosis was related to astrocytoma (180days). Vomiting (63%) and headache (56%) were the commonest complaints of patients referring to the hospital. DTR changes (39%) and cerebellar signs were reported as most common neurologic findings.Conclusion: Clinical findings of these tumors are usually non-specific therefore physician should recognize the clinical presentations and put them in their differential diagnosis which would reduce time period of disease onset until final diagnosis and thus decrease mortality and morbidity due to this tumors. A comprehensive study is recommended in order to estimate survival, response to treatment and complications resulting from it.

Background: Few studies related to the importance of inpatient phase of cardiac rehabilitation and the percentage and full execution of phase I during admission have focused on its importance. The main goal of this study is evaluation and discussion about the importance and correct execution of phase I cardiac rehabilitation in Tehran city hospitals. Methods: Eleven hospitals among the governmental and non-governmental ones which have cardiac surgery sections were chosen randomly. To gain the main purpose of study, we used a questionnaire that was prepared according to American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) guideline. The questionnaires were sent to the heads of the cardiac rehabilitation departments by educated personnel in a two weeks period. These forms contained ten specialized questions with different scores about evaluation of the quality of phase I cardiac rehabilitation performance and attention to it. The scores were used in SPSS software to analysis the data.Findings: The results showed that only 10٪ of the hospitals with cardiac surgery section, had a relatively complete plan of phase I cardiac rehabilitation according to AACVPR guideline (P=0. 07). These results were lower than the international standards, where as in some of them, the scores were about zero. Conclusion: Due to the importance of phase I as a main goal in cardiac rehabilitation program and its direct effect on participation of the patients in the last phases of cardiac rehabilitation, it is suggested to pay more attention in planning, processing and performing this phase.

Background: Mental retardation (MR) is a common problem in the world especially in the developing countries. Nearly 2-3% of total population have IQ below 70 but only 0. 3% of them have severe mental retardation.The purpose of this study is to evaluate the etiologic factors of mental retardation.Methods: In a retrospective study, we collected 160 cases referring to the pediatric neurologic out patient of Imam Khomeini Hospital with the chief complaint of mental retardation between 1996–2000 and documented their IQ with the help of Ravon test.The causes of MR were divided into pre/ peri / postnatal and unknown ones.Findings: The causes were prenatal in 24(15%), preinatal in 82(51. 3%), postnatal in 31(19. 4%) and unknown in 23(14/4%) of the cases.In the first group (prenatal causes) fragile X syndrome was the most frequent one 5 cases (3/1%). But hypoxic- ischemic encephalopathy 31 cases (19. 37%), neonatal infection 25 cases (15. 61%), hyperbilirubinemia 16 cases (10%) and RDS 12 cases (7. 5%) were the most frequent causes in the perinatal group, and epilepsy 16 cases (10%), C. N. S infection 5 cases (3. 1%), trauma 5 (3. 1%) were the most frequent causes among the postnatal groups.Conclusion: As the result, we conclude that in the majority of our patients, the cause of MR were perinatal accidents. Secondly perinatal causes were the most important and common causes (51. 2%). Moreover, it appears that these factors were preventable and preventive medicine could be an effective measure in the reducing the incidence of MR.

Background: to study the role of the private sector in detection and diagnosis of tuberculosis suspected cases by referring to the private labs.Methods: this cross sectional study was performed to evaluate all cases referring to 4 private labs for afb examination during 2002-3. The total number of referred cases and the positivity ratio were calculated.Findings: a total of 9037 were enrolled into our study, 44.9% being female and 55.1% being male. The two peak ages of patients were 15-25 yrs and >65 yrs and the majority of the patients were iranians (98.6%).As a whole, 637 cases had positive examination results (7.1%), among which 531(5.9%) cases were direct smear positive and 489(5.4%) culture positive. This is comparable to data given by moh, where the total number of cases referred to governmental labs in the tehran urban area, during the period of study was 9479, including 7850 (82.8%) iranians and 208 (2.2%) being positive.Conclusion: a larger than expected proportion of tb patients are detected and (managed) by the private sector which indicates that a much more intimate cooperation should develop between the public and private sectors.

Background: considering the massive number of patients referring to the emergency department of 15 khordad hospital with finger tip injuries, we decided to statistically survey the treatment modality practiced and also the most prevalent finger involved and compare the results with that of referenced books.Methods: in the study 288 patients with finger tip injuries who were referred to 15 khordad hospital in a period of 3 years were enrolled and treatment modality and the fingers involved were evaluated.Findings: 63% of the injuries due to trauma were treated conservatively, 21% by volar v-y advancement flap, 6% by kutler flaps, 6% by skin graft and the remining 9% with cross finger flap.The most common finger involved was the index finger.Conclusion: the selected treatment modality depended on the nature of injury and discretion of the surgeon, with due consideration to the published literature. The index finger however was the commonly involved finger, whereas the books refer to the middle finger as the common site of injury.

Background: meconium is the first defecation of fetus and neonate. Intrauterine passage of meconium may represent a normal physiologic or pathologic event. The presence of meconium stained amniotic fluid (msaf) is relatively common and occurs in 5 – 15% of births. Studies have showed that msaf may affect maternal and neonatal outcome, however the risks associated with meconium staining remains uncertain and controversial.Methods: a retrospective analytic descriptive study was done in alzahra & talegani educational centers in tabrize. We studied 8512 files of delivered women and selected 640 records which had criteria of investigation, in two groups of case and control (320 records with msaf as case group and 320 records with clear amniotic fluid as control group).Data were then gathered and analyzed using spss9 soft word, by t & x2 & fisher exact tests. Findings: the prevalence of msaf in this study was 9. 6% and the incidence of meconium aspiration syndrome were 3. 8%. Thich meconium was presented in 232 (72. 5%) infants. In addition there were statistically significant differences between maternal age (p=0.032), abnormal fetal heart rate (p=0.002), fetal sex (p=0.033), the 5 minute apgar score (p=0. 011), gestational age, mode of delivery, the first minute apgar score, respiratory distress, post partum care, resuscitation and length hospital stay in the two groups (p<0.001). But there were no statistically significant differences in parity, induction of labour, birth weight, and neonatal seizures during the first 24 h between two groups.Conclusion: according to this study meconium stained amniotic fluid is a predictor for some of the adverse maternal and neonatal outcomes.

Background: fatigue is one of the most common and important disabling symptoms in multiple sclerosis (ms) patients. Fatigue in patients could be due to neuroimmunology, disability secondary to the disease process, muscular fatigue due to spasticity, drugs and problems such as depression and sleep disorders. Methods: in order to evaluate the prevalence and degree of fatigue&nbsp; severity in ms patients and to determine some influencing factors, we studied sixty patients&nbsp; with definite ms&nbsp; in iran and assessed fatigue (according to fss score) and also some factors such as depression (according to bdi score), disability status (according to edss score) in them.Findings: in our 60 patients the range of age was 20-24 years. 73% of the patients were female. In 70% of the patients clinical course of ms was compatible with relapsing-remitting type and in 30% secondary progressive form.The prevalence of fatigue (according to fss) was very high; exactly 100% but only 10% of the patients had self-complaint of fatigue. There are some correlations between fatigue and presence of disability (according to edss), depression and age of the patients. Fatigue was more frequent in secondary progressive form of ms.We didn’t find any correlations between fatigue and sex, duration of the disease, the rate of attacks during the first year of the disease, using ms-specific drugs and fatigue modifying drugs in the patients.Conclusion: it seems that fatigue is more frequent in ms iranian patients than it has been thought. The correlation between fatigue and depression and degree of disability in patients should alert physicians in considering proper treatment of depression and prevent the progression of ms in the patients as much as possible.

Background: hepatitis b is the most common occupational hazard for health care workers. Midwives get infected with patient’s blood and discharges in 25% of vaginal deliveries. The purpose of this study was to identify knowledge and universal precautions and their performance about hepatitis b prevention among midwives and midwifery students in some medical science university hospitals in tehran, 2002.Methods: this study was based on survey questionnaires with a total of 120 midwives and midwifery’s students between june and october 2002. Hospitals were selected by cluster sampling and persons were selected by simple randomization. Data were analyzed with chi-square and fisher’s exact test.Findings:&nbsp; knowledge and universal precaution were moderate in majority of midwives and midwifery’s students. There was no significant deference between knowledge and universal precaution of midwives and midwifery students (pk=.784), (pp=.847).Conclusion: the study demonstrated that the level of knowledge and universal precaution of midwives and midwifery’s students were inadequate. The education about universal precaution is indispensable. It is desirable to raise the level of knowledge and include of in the curriculum. Further educational interventions for midwives are needed to increase their compliance about blood borne disease, particularly hepatitis b.

Kawasaki disease is an acute febrile vasculitis of childhood first described by Dr. Tomisaku Kawasaki in Japan in 1967. The disorder occurs worldwide, with Asians at highest risk. Approximately 20% of untreated patients develop coronary artery abnormalities including aneurysms, with the potential for the development of coronary artery thrombosis or stenosis, myocardial infarction, aneurysm rupture, and sudden death. Kawasaki disease has replaced acute rheumatic fever as the leading cause of acquired heart disease in children. The disease is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. The classic diagnosis of Kawasaki disease has been based on the presence of ≥5 days of fever and ≥4 of the 5 principle clinical features. During the past few years there have been several reports of patients with coronary aneurysms corresponding to changes in Kawasaki disease who did not exhibit the other required symptoms. The diagnosis of Atypical Kawasaki, in addition to coronary aneurysms, requires the presence of three to four of the major symptoms. Atypical Kawasaki is more common in infants than in older children, making accurate diagnosis and timely treatment especially important in these young patients who are at substantial risk of developing coronary abnormalities. Therefore, Kawasaki disease should be considered in an infant with prolonged, high fever in spite of atypical or incomplete presentation and echocardiography may help us to begin earlier treatment in these high risk patients.

Gastric cancer is a relatively common cancer that can metastasize to multiple organs such as liver and the biliary tract.The patient is a 60-year-old woman who was admitted for severe abdominal pain, icterus, rised liver enzymes and a mass at the bifurcation of the common bile duct in MRCP (Magnetic Resonance Cholangio pancreatography) and was diagnosed as a case of primary colangiocarcinoma (Klat skin).Patient was scheduled for stenting. Because of aggravation of abdominal pain upper GI endoscopy was performed and an extensive tumoral mass was found from body down to the pylorus of stomach. The pathology report of biopsies obtained from mass was Signet Ring cell adenocarcinoma of stomach which had metastasized to the biliary tract.