Journal of Medical Council of Iran
Year:2006 | Volume:24 | Issue:1|Papers Count:15

Carpal tunnel syndrome (CTS) with mild to moderate severity can often be effectively treated by Non- Surgical Measures in a primary care environment. In this study, we investigated the efficacy of nerve and tendon gliding exercises in the treatment of CTS. In a prospective randomized controlled trial. 38 hands with the diagnosis of CTS were randomly divided to two groups. Both groups were prescribed to wear a Custom molded wrist splint. The patients in group 2 were also instructed to perform nerve and tendon gliding exercises. Duration of treatment for both groups was 4 weeks. Patients were evaluated with clinical and electrophysiological parameters, symptom severity scale, and functional status scale. There was statistically significant improvement in all parameters in both groups, The Improvement in group 2 was slightly better, but the difference between the two groups was not significant (p<0.05). Patient’s satisfaction was investigated during the follow up period (5-8 months), A total of 11 (61.1%) of the patients in group 1and 13 (76.0%) of the patients in group 2 reported good or excellent results but the difference between the two groups was not statistically significant. Conservative treatment in both groups was effective but without significant difference between them. Further studies with more patients and longer duration of follow up with clinical and electrophysiological parameters are recommended.  

In hypothyroidism reduction of oxygen demand and supply can reduce the synthesis of erythropoietin and cause anemia. Autoimmune mechanisms causing hypothyroidism can also cause vitamin B12 deficiency and related anemias. Furthermore absorption of iron and other elements are disturbed and further accelerates anemia. Menorrhagia, is another cause of iron loss. Changes in WBC are not significant and platelet function may change which is not clinically important. We studied 30 new cases of hypothyroidism. Control group (32 person) was chosen among individuals having simple goiter and normal thyroid function tests. We compared hematological parameters in patients and control group. Comparison was made between patients with severe (TSH>70) and mild (TSH<70) hypothyroidism and relationship between severity and duration of hypothyroidism with these parameters. 1-anemia was found in 56.7% of patients (10% macrocytic, 16.7% normochrome normocytic and 30% hypochromic microcytic). In control group 40.625% were anemic (6.25% macrocytic, 3.125% normochromic normocytic and 31.25% hypochromic microcytic). 2- Hemoglobin, hematocrit and number of RBCs had statistically significant difference between patients and control group. 3- MCH, MCHC and MCV had no statistically significant difference between patients and control group. 4- There was no significant difference in the number of WBC and platelets between patients and control group. 5- No relationship was found between blood parameters and duration of the disease. 6- There was no correlation between severity of disease and hemoglobin and hematocrit values but MCHC was significantly lower in patients with severe hypothyroidism. Erythroid lineage showed the most important changes in hypothyroidism. All 3 types of anemia were found. Hemoglobin, hematocrit, and number of RBC showed marked decrease in patients compared with controls. White blood cells and platelets had no changes in hypothyroid patients.

Different criteria for Behcet's diagnosis reveal that there isn't still consensus about the definition of this syndrome. Although a comprehensive study about the accuracy, the sensitivity and specificity of seven different types of diagnostic criteria for Behcet's disease in children, Ras not been performed we planned this study to compare these criteria in the Iranian children with Behcet's disease. Two random samples were selected from the patients less than 16 years of age referring to the Behcet's clinic of rheumatology research center. 177 children had definite diagnosis of Behcet's disease after being visited by the three professors of rheumatology experienced in Behcet's syndrome. Control group were children suspected to have Behcet's disease but it was ruled out. Sensitivity, specificity and accuracy of each of the Behcet's criteria were calculated. Mean age in Behcet's children was 13.6 years and in control group was 12.8 years. In the patients group female to male ratio was 1.1 and in the control group it was 1.3. Sensitivity of different criteria was as follow: Manson & Barnes 55.1%, O' Duffy 60.7%, International criteria 71.9%, Japan criteria 90.4%, Dilsen criteria 79.8%, Iran criteria 93.8%, and Iranian classification tree 94.4%. Specificity of the criteria was as following: M&B 99.5%, O'Duffy 99.5%, International 100%, Japan 96.2%, Dilsen 94.6%, Iran 96.2%, classification tree 96.2%. Although some of the researchers believe that current diagnostic criteria of Behcet's diseases due to establishment on the adults clinical data, is not appropriate for children; our study revealed that the current seven Adult BD criteria are reliable and accurate in children too.

Cigarette is the first cause of morbidity and mortality in the world than can be prevented. Since the family has an essential role in forming the character of teenagers, evaluating the relationship between cigarette consumption of family members and "teenager's smoking" is very important. For this purpose, a study was designed based on WHO and GYST questionnaires in which 1095 high school students were randomly selected from different areas of Tehran city in the years 2002 and 2003. Results of this study showed that 28.9% of students (25.5% male and 30.8% female) were occasional smokers (P=0.07) and 4.4% of students (6.01% male and 1.6% female) were daily smokers (P=0.001). %23.6 of students whose family members didn't smoke, were occasional smokers whereas 53.4% of students  who had one or more smokers in their family, were occasional smokers (P=0.0001). The frequency of daily smokers among the students were 2.6% and 14.3% respectively (P<0.0001(. 27.3% of students who lived with both parents smoked occasionally but in students who lived with one of their parents it increased to 52.4% (P<0.0001).The results of regression analysis show that training and encouraging family members in regard to smoking cessation and also having a stable family environment are very important factors to prevent the initiation and continuation of smoking in teenagers.

Hypertension is a common disease, without signs and usually easily treatable. In the absence of treatment, it can lead to life threatening events. In the absence of signs, early diagnosis of the disease is reduced. Likewise as factors such as genetic, social and dietary in different societies remain different, these in itself might be effective in the development of hypertension this formed the basis of the research to evaluate the environmental and genetic factor as predisposing factors in the development of hypertension. This case control study was conducted on patients with blood pressure above 140/90 mmHg in the city of Arak in the year 2003 using multistage sampling. A total of 1000 persons were recruited. The data including demographic data, social habits comprising of dietary, social, personal habits, signs and symptoms and clinical findings were recorded. Data were analyzed using the SPSS software and statistical descriptive indices, and for comparison of the means and their relation logistic regression was employed. During the research the researchers remained loyal to the guide – lines laid down by the ministry of health, teaching and treatment. In this research 263 patients with primary hypertension were compared with 765 patients not having primary hypertension. Low level education (p<0001, or=2.78) and obesity (p<003) and short stature (p<001) and minimal touch with father and mother (p<001) and death of one degree (p<001) and aortic murmur (P=05) and family dissatisfaction (p<04) were risk factor for hypertension presentation. Design of model to predict hypertension or its absence based on clinical and anthropometric findings can be tackled via in formation cardiovascular, brain, kidney and eye complications can be reduced. According to the model obtained, regarding systemic hypertension, these models can be used in patients with a positive family history in out patient departments and private clinics.

Although it is assumed that appropriate care of endotracheal tubes and airway might prevent postintubation airway stenos is (PIAS), but this concept has not been investigated adequately. The purpose of the study was to investigate practical ways for prevention of PIAS in intubated patients. The study was implemented in 3 phases. First we collected information about methods of caring for airways and tubes in intensive care units in Tehran and other cities (control group) and data collection based on filling 10-20 questionnaires in each intensive care unit. Then we assessed patients who had PIAS had been and treated by us during a 6 year period (1994-2000) (study group). In the final phase, collected data were analyzed and we looked for important pitfalls in caring for airways in intensive care units in our country and also looked for the practical measures to prevent PIAS. In phase I, 341 questionnaires were filled out in 18 intensive care units (12 in Tehran, 6 in other cities). There were 133 females and 208 males aged 3 month to 98 years (mean 46.1). Head injury was the commonest cause of intubations in 24%. Of patients Out of 356 tracheal tubes which had been used in these patients, 318 were high volume low pressure types (new tubes), and 32 were high pressure low volume types (old tubes). In 179 patients (52.4%), there was not any type of care for tubes and airways by attending physicians, in 140 patients (41%) there was some kind of care although not organized or sufficient and in only 21 patients (6.1%) the care was organized and sufficient. Mean time of intubation was 8 days (1-45 days). Tracheotomy had been undertaken without any established criteria and mostly by junior staff with low experience (usually junior residents(. In phase II, 120 patients were treated for PIAS (36 females, 84 males aging 1-83 years, mean 25.9 years). Head injury was the cause of intubation in 78(65%) patients, the site of stenos is was tracheal in 88 and laryngotracheal in 32 patients. More than half of the patients were intubated by inappropriate old tubes. Direct cause of stenosis was the cuff in 92, tip of the tubes in 15 and stoma in 10 patients. In 3 patient's more than one factor were the causes. Mean time of intubation was 14.9 days (1-90) and mean length of stenos is was 3.2 cm (1-7). Caring of tubes and airways was inappropriate and in organized in all patients. Factors which were statistically different in study and control group were: time of intubation (14.9 day vs 8 days, P=0.000), suicide attempts (12 vs 5, P=0.000), head injuries (65%vs 24% P=0.000), Age (25.9y Vs 46y, P=0.05), using old tubes (50%vs 9% P=0.000), organized caring of tubes and airways (0.0%vs 6.1% P=0.000). The following measures are effective in decreasing the PIAS: decreasing time of intubation, using appropriate tubes, (including PVC tubes), continuous care of airway and tube, cuff monitoring and daily recording of information about tubes and cuff pressure, and special care for intubated young patients who had sustained head injury or had attempted suicide.

During the past century, because of an improvement in the socio-economic conditions in the society and as a consequence a change in the predisposing or risk factors, incidence of diseases has undergone a real change. A decrease in the incidence of infectious diseases and an increase in the incidence of non-infectious diseases and accidents are the major reasons for this changer which has specially affected the developing countries. Presently, cancer is the second most common cause of morbidity and mortality. Control and reduction of the expenses of these types of diseases need planning and execution of a national cancer, but planning such a programmed requires valid and authentic information. Such information is only possible through the registration of cancer cases. This paper provides information obtained from five provinces in the country about cancer to evaluate the incidence of it in the country, and comparison of with Globocan as an international reference about the incidence of cancer. By using statistical methods and establishing simple means about the incidence of cancer in Ardabil, Golestan, Mazandaran, Kalanshehr and Tehran according to age and gender, the incidence of cancer in the country was established. At least 50820 new cancers occur in the country yearly out of which 53% are found in males. The five major cancers to ASA in males were stomach (26.1), esophagus (17.6), colorectal (8.2) bladder (8), leukalmia (4.8), and in females were breast (17.1), esophagus (11.4), stomach (11.1), colorectal (6.7) and uterus 4.5 per 105.

Introduction: Problems associated with the field of Anesthesiology include stress related causes pertaining to the characteristics of the profession, concerns about the education process, insufficient skill attained and lack of protection against professional liability. This study is aimed at construction of a testing instrument to quantify stresses specified to the anesthesiology residents. Based on theoretical discussions as and literature published well as about the sources of stress in this specially and other professions, we compiled a primary checklist of stressors. Then, we asked specialists, professors and residents to verify face validity. Using their comments, we revised the checklist and used it in this study. Next we evaluated the content validity and reliability of the test and used loop method to qualify the effect of each question on the reliability of the test. We performed factor analysis (exploratory method) to evaluate construction, validity and used preliminary form of confirmatory method to validate correctness of five assumed factors. Using factor analysis, five previously assumed factors were reduced to three principal factors and a number of additional (miscellaneous) questions. Obtained results show that the questionnaire is reliable and valid in face and content as well as construction. The results of a complementary study using this questionnaire among another group of residents in the end of year 2003, confirms the ability of questionnaire in measuring the above mentioned factors.

Helicobacter pylori are a microaerophilic, gram negative, spiral organism. Which plays arole in the development of gastritis, duodenal gastric ulcer, and gastric cancer? Helicobacter pylori normally inhabit the human gastric mucus layer. Previous studies have shown by colonization Helicobacter in dental plaque, saliva, tonsils, adenoids and oral cavity lesions. Sinusitis is the most common hygienic problem in the world and a yearly large part of the budget is spent in the diagnosis and treatment of this problem. There are various theories for possible modes of Helicobacter pylori transmission. Although, there is a relation between colonization of Helicobacter pylori in upper gastrointestinal tract and gastro esophageal reflux. So an investigation to identify the presence of helicobacter pylori in the mucosa of the sinonasal of patients with chronic sinusitis will be needed. In the present study we used the polymerase chain reaction (PCR) and urease test (CLO) to investigate the Helicobacter pylori status of paranasal sinus mucosa specimens, obtained from patients with chronic sinusitis. The present study is designed as case-control. The study was performed on 44 patients who were admitted in the ENT clinic between April 2004 and July 2005.22 patients suffered from chronic sinusitis. All medication in this group had failed. So, these patients were selected for endoscopic surgery of sinus. This group was named the case group (22 patients). Those who had septal deviation without sinusitis, was named the control group. We obtained two endoscopic biopsy specimens from each side of nasal mucosa of patients. These specimens were studied by the CLO test and PCR for helicobacter pylori. Helicobacter pylori were not detected in the mucosa of sinonasal of patients. According to the present ideas, the presence of helicobacter pylori in the mucosa of sinonasal of patients with chronic sinusitis is of low probability.

Cancer of cervix is the second most common cancer among women worldwide, with a frequency of more than 500000 cases every year. The mean age for cervical cancer is 51/4 years and the most common type is squamous cell carcinoma. HPV can be found in a growing proportion of patients with cervical cancer, approaching 100%. HPV 16 is the most prevalent in cervical cancer, followed by HPV 18 and 33. As half of cervical cancer cases are diagnosed at an advanced at the time of stage and with the techniques available, remain untreatable. During the past 20 years, vast research has been focused to unveil definite diagnostic techniques production of vaccines and new management modalities. Cultural status, habits and social behavior of women have an important bearing in the occurrence and morbidity and mortality due to this disease. Minority class and woman with low income and women with low income undergo less screening. In America and Northern Europe, the Major cause for a reduction in the morbidity and mortality of cervical cancer has been the execution of screening at a large scale resulting in a 70% reduction in morbidity and mortality due to cervical cancer. On the other hand, in Iran according to the available statistics, the leading cause of a delayed diagnosis of cervical cancer has been the absence of the performance of Pap smear test. A high rate of false negative smears and atypical squamous cells (ASC) diagnoses has led to the development of new diagnostic techniques. More recently , the use of liquid-based technologies such as Thin Prep and AutoCyte Prep have gained popularity; It is been held till today that pap smear might increase the sensitivity of detecting cervical dysphasia. In reviewing the published literature about the efficacy of this technique and the endorsement of the results of screening, information is lacking HPVDNA typing can be used concurrently with pap smear in cases where pap smear is abnormal. A negative combination test (Pap smear HPVDA typing) in contrast three repeated Pap smear tests shall provide more reliability as regards the absence of neoplasia in future. In the year 2003, FDA approved the use of Hybrid capture 2 Assay for HPVDVA typing along with Pap smear in women above 30 years of age, so that high risk in faction in this woman is subjected to screening.