Journal of Medical Council of Iran
Year:2007 | Volume:25 | Issue:2|Papers Count:18

Background: Overweight and hyperlipidemia are known risk factors for CHD; especially, in high-stress and low-activity jobs. Therefore, in this study, we investigated the effects of an eight-week aerobic training program on blood lipids in hypertensive male employees. Methods: Sixty male employees, with an age range of 35-55 years, who had hyperlipidemia (high LDL or TG) and hypertension (SBP > 140, and DBP > 90 mmHg) participated in this study. Subjects were divided to experimental and control group in a random manner. Subjects in the experimental group performed an eight-week moderate aerobic training program (5 d.wk-1; 45 min per day); while subjects in the control group received no training. Blood samples were taken before and after treatment in both groups to measure blood lipids. All statistical analyses were carried out using SPSS for windows. Statistical significance was accepted as p<0.05. Conclusion: In the experimental group, blood lipids (TC, TG, and LDL) decreased significantly; however, levels of HDL did not increase significantly. The changes in these factors were not significant before and after treatment in the control group. The results of this study suggest that a moderate aerobic training program could decrease the levels of blood lipids in men with lowactivity jobs.

Background: Dyslipidemia and type 2 diabetes are common and complex metabolic diseases with strong genetic basis. There are many candidate genes for phenotypes that are related to these diseases. Studying the genetic factors related to these diseases is very important. ApoA-I is the main protein composing HDL particle. The correlation between two polymorphisms of apoA-I gene (G-75A, C+83T) and HDL level have shown controversial results in various populations. This study was carried out to illustrate the role of these polymorphisms in an Iranian population. To the best of our knowledge, a similar study has not been done in an Iranian population so far. Methods: In a case-control study, a total of 215 volunteers were randomly selected from 17 districts of Tehran. DNA extraction was performed from their blood samples. Genotyping was done by Polymerase Chain Reaction (PCR) and then Restriction Fragment Length Polymerase (RFLP). Findings: There was not a significant relation between apoA-I gene promoter polymorphism and type 2 diabetes. In the non-diabetic population with dyslipidemia, we found a significant relation between AA polymorphism and increasing TG (P= 0.03). Also, there was a relation between GA polymorphism and increasing uric acid (P= 0.045). In the same polymorphism, GA/AA allele had a protective role for dyslipidemia (P value= 0.028, OR=0.423, 95% CI=0.195-0.918). In C+83T polymorphism, the genotype CT was a risk for developing diabetes (P Value = 0.028, OR=3.694, 95%CI=1.076-12.690). Conclusion: This study shows that apoA-I gene can be considered as an important goal for further etiologic studies in the field of metabolic disorders and dyslipidemia.

Background: According to the American Diabetes Association, 75- 80% of diabetic patients finally die due to cardiovascular complications. Many studies have suggested that cardiovascular complications of diabetes can affect the quality of life in patients. The current study aimed to assess the quality of life in diabetic patients with cardiovascular complications. Methods: This research is a descriptive-analytical study. A total of 302 diabetic patients with cardiovascular complications were selected by convenience sampling method. Data were collected through interview and physical examination. The means of data collection was the information sheet of medical records and a questionnaire that consisted of three parts, demographic and disease characteristics, list of cardiovascular complications of diabetes, and questions about dimensions of quality of life. The validity performed by content validity and its reliability carried out by test-retest method. Scores were analyzed by linear regression analysis. Findings: Findings showed that majority of signs or symptoms were cramps (76/2%), hypertension (62/9%), and palpitation (61/6%). The results demonstrated that quality of life in all of diabetic patients was moderate and there was a significant relationship between cardiovascular complications and quality of life (p<0/001). Conclusion: According to the findings of this study, there is a considerable association between cardiovascular complications and quality of Life. It is recommended that nurses pay attention to use of prevention factors of cardiovascular complications and promote different dimensions of quality of Life in diabetic patients with chronic complications.

Background: More recent studies indicated that elective cesarean section has negative effects on the physiologic responses of newborn, increases the risk of resuscitation need and respiratory distress syndrome (RDS), and prolongs hospital stay. Previous data and primary evaluations indicated that the cesarean rate in Malayer was very higher than the province’s mean. So, it was necessary to carry out a training intervention to decrease cesarean rate in this city. Methods: In this quasi-experimental study, 453 healthcare workers participated. These individuals were taught and their knowledge was evaluated by a pre-test and post-test. Then, they began to train pregnant women, individually or in groups, referred to healthcare centers for receiving primary health care (PHC). Findings: During 9 month from the beginning of our study, 2726 mothers were taught and 1896 of them reached to the end of pregnancy term and delivered. The study showed that there was a significant association between decreasing cesarean rate and training (OR=0.46 99% CI [0.38, 0.56]). On the other hand, total cesarean rate of Malayer city decreased in the year 1383 compared with that in the year 1382, and the association between decreasing cesarean rate and training intervention was statistically significant (OR=0.76 99% CI [0.68, 0.85]). Conclusion: Thus, it seems that intervention can decrease cesarean rate effectively and is estimated that if this intervention is carried out in health centers all over the country, its effectiveness would be considerable.

Background: Ancient time policy makers had especial emphasis on the rules governing human resources engaged in healthcare sector; nevertheless, this important issue has not been satisfied yet. Objective: This investigation is concerned with designing a legislation mechanism for human resources engaged in the healthcare sector. Methods: This study is descriptive-comparative, and study procedure is field study, and the investigation result may be applied to Iran’s legislation department. It is specially used for the healthcare sector. Findings: Five variables of legislation in various countries as well as Iran have been studied. They include the variable of legislation innovators, legislation institutions, methods and procedures of legislation issues, identification as well as the supervisory institutions on approved legislation, and legislation supervisory methods in enforcement of rules and policies. Conclusion: It seems that the review of present legislation structure concerning the healthcare of human resources according to the present analysis could result in legislation of more appropriate rules. The present rules must be more compatible with the standards of human resources in Iran’s healthcare.

Background: Although many parents believe that childhood injuries are normative events or non-reventable, inadequate supervision has been recognized as a leading contributor to child injuries in some studies. The objective of this paper is to determine the association between the level of parental supervision and childhood road traffic injuries in 6 to 9 year old children. Methods: In a case-control study, 100 children who were taken to one of Shaheed Beheshti Medical University affiliated hospitals for traffic injuries were compared with 100 matched controls who had no history of a road traffic accident in the past one year. The level of parental supervision and characteristics of mother, child and road traffic accident was collected by self-administered questionnaires and interviews according to ICD-10. Chi-squared test, Fisher’s exact test and Conditional Logistic Regression were used for data analysis. Findings: Children travel to and from their schools without adults' supervision was more common in cases (24%) than controls (10%) (P<0.01). Older children had a lower level of parental supervision for independent outdoor activities (P<0.001) and appropriate parental supervision was significantly higher in controls (24%) compared with cases (8%) (OR= 3.63, 95% CI: 1.45-9.38). Conclusion: Because of the important role of parental supervision in preventing traffic injuries among 6 to 9 year old children, in addition to environmental and legislation modifications, more attention needs to be paid to this issue.

Background: Mycoplasmas have been incriminated as causes of rheumatoid arthritis (RA) in many animal species. In contrast, the role of mycoplasmas in human RA is controversial. Numerous attempts using conventional methods for the detection of mycoplasmas in RA have not yielded suitable results for setting relationships between mycoplasmas and RA. The advent of molecular techniques, particularly the use of the polymerse chain reaction (PCR), has brought new insights for the accurate diagnosis of mycoplasma DNA and RNA in RA samples. To search for evidence that mycoplasmas are involved in the pathogenesis of RA, we use PCR techniques for detecting the possible presence of mycoplasmas in the bloodstream of patients with RA. Methods: A highly sensitive, broad range PCR protocol using SHAH-GPO-3, MGSO primers and standard mycoplasma species, targeting the bacterial 16S rRNA gene, was designed and applied to Anti-CCP positive, negative, healthy control and RA patients’ sera. Amplicon (272 bp) was cloned by PCR-cloning and then was sequenced by dideoxy chain termination. Findings: The mycoplasma spp. sequence, on the basis 16S rRNA, was detected in 12/100 (%12) serum of Anti-CCP positive, 4/100 (%4) of Anti-CCP negative, 1/100 (%1) of healthy controls and 10/91 (%11) serum of RA patients. Using species-specific primers, we were able to detect infections with all of mycoplasma genus in RA patients. Conclusion: These findings suggest an association between mycoplasmal infection and rheumatoid arthritis in some patients. However, further research is required to determine the role of these organisms in the pathogenesis of RA.

Background: In the evaluation of adults suspected of meningitis, physical findings are more reliable than the history. This study was designed to evaluate the incidence & sensitivity of meningeal signs (Kernig, Brudzinski, Tripod Phenomenon & nuchal rigidity) in adults with meningitis admitted to Loghman-e-Hakim Hospital from 2002 to 2005. Methods: A total of 85 patients (59 males: 64.7% and 26 females: 30.6%) older than 14 years with acute meningitis admitted in Loghman–e-Hakim Hospital were evaluated in an analytic descriptive study. The patient’s data and physical examination for meningeal signs was taken before lumbar puncture, and the data was analyzed by using SPSS software (version 13). Findings: Sixty-seven patients (79%) had nuchal rigidity, 24 cases (28%) had Kernig’s Sign and 24 cases (28%) had Brudzinski’s sign. We found pleocytosis, more than 1000 WBCs, in the CSF of 16 patients (19%). The relation between WBC≥1000 in CSF with all meningeal signs was statistically significance (P<00.5). We found statistically significant associations between PMN≥80% in CSF and Kernig’s sign, and Tripod Phenomenon too (P<00.5). Conclusion: Our findings re-emphasizes on the importance of CSF’s WBC count and its differential in the diagnosis of meningitis. On the other hand, the low sensitivity of meningeal signs alerts us of the need to design more accurate studies for finding more sensitive physical findings in these patients.

Background: Incidence of medical emergency in dental office is about 0.08%, and syncope is the most frequent one. Other emergences in dental office include seizure, cardiac emergency, respiratory emergency and loss of consciousness. There is not enough data on the incidence of medical emergencies in dental offices of Isfahan. This study was carried out to evaluate the incidence of medical emergencies in dental offices in the city of Isfahan. Methods: This study was carried out in spring 2005. A total of 150 dentists were randomly selected and, using questionnaires, asked about the number of medical emergencies, types of emergencies, and referrals to hospital they had over the past year. The data were collected and analyzed with SPSS software. Findings: Total number of medical emergencies in the study group was 106 and syncope was the most frequent one. According to this study, the incidence of medical emergencies in the dental offices of Isfahan was 0.076% that was comparable to Malamed, Edward, Morrison and Gonzaga reports. Dentists reported 13 different kinds of medical emergencies and this means that dentists must be informed and prepared to face different medical emergencies.

Background: The most important elements for evaluation and clinical diagnosis are history and physical examination. History and physical examination are the first steps and the most effective tools for diagnosis. In order to determine the importance and power of physical examination, we decided to compare the results of physical examination in patients with distal forearm penetrating wounds with observations and findings during surgery. Methods: This descriptive-cross sectional study was performed on 64 patients with distal dorsal forearm sharp injury, who were admitted to emergency ward. Findings in physical examination were compared with what was a definitive diagnosis or golden standard. Research morals were considered in all the stages of study. Findings: Based on the findings in physical examination, diagnostic values of physical examination were computed as follows: sensitivity=88%, specificity=40%, PLR=1/46, NLR=0/3, PPV=94%, NPV=22%, ACC=92%. Conclusion: Because of the high sensitivity of physical examination, it is a good method for screening. Physical examination has a higher value in ruling in extensor tendon sharp injuries rather than ruling them out.

Celiac disease (CD) is a common autoimmune disorder, induced by the intake of gluten proteins found in wheat, barley and rye. Contrary to common beliefs, this disorder is a systemic disease with different manifestations, rather than merely a pure digestive alteration. CD is closely associated with genes that code HLA-II antigens, mainly DQ2 and DQ8 classes. Previously, CD was considered to be a rare childhood disorder, but it is actually considered a frequent condition and can present at any age. Tissue  transglutaminase (tTG) appears to be an important component of this disease, both in its pathogenesis and its diagnosis and follow up. Active CD is characterized by intestinal and/or extra-intestinal symptoms, villous atrophy and crypt hyperplasia, and strongly positive anti-endomysial antibody or tTG autoantibodies. The duodenal biopsy is considered to be the “gold standard” for diagnosis. Occasionally, it results in false-negative results because of patchy mucosal changes and that, in some patients, mucosal villous atrophy is more severe in the proximal jejunum which cannot be reached by routine endoscopes. Sometimes, the presentation of CD is with iron deficiency anemia, osteoporosis, dermatitis  herpetiformis, persistent chronic hypertransaminasemia of unknown origin and neurologic disorder. The association of CD and endocrine diseases, autoimmune disorders and various types of cancer is known. Treatment of CD is a strict, life-long gluten-free diet. Gluten-free diet results in remission of most symptoms.

Based on Albert Einstein’s theory of spontaneous and stimulated emission of radiation, Maiman developed the first laser protype in 1960. Since then, lasers have been widely used in medicine and surgery. Lasers designed for surgery deliver concentrated and controllable energy to tissue. Typically, lasers are named according to the active element(s) that is induced to undergo the stimulated quantum transitions which, in turn, create the energy beam. Thus, lasers commonly used in dentistry consist of a variety of wavelengths delivered as either a continuous, pulsed (gated), or running pulse waverform. Wavelength affects both the clinical application and design of the laser. The wavelength of lasers used in medicine and dentistry generally range form 193 n.m to 10600 n.m, representing a broad spectrum. The lasers most commonly used in dentistry are Co2, Nd: YAG, HO: YAG, Er: YAG, Er, Cr: YSGG, Nd: YAP, GaAs (diode), and argon. Clinical application of lasers includes: intra-oral soft tissue procedures, such as frenectomy, gingivectomy and gingivoplasty, removal of granulation tissue, second stage exposure of dental implants, lesion ablation, incisional and excisional biopsies of both benign and malignant lesions, irradiation of aphtuous ulcers, coagulation of free gingival graft donor sites, and gingival depigmentation, and also hard tissue procedures such as scaling of root surfaces, crown lengthening, osteoplasty and ostectomy. The purpose of this article is to provide information about the current and potentinal application of laser technology to periodontal practice.

Fetus in fetus (FIF) denotes a rare congenital tumor containing a vertebrate fetus incorporated within its twin. The most common area for this tumor is retroperitoneum, but it has also been reported in intracranial fosssae, oropharynx, mediastinum, lung, pelvis, and adrenal gland. Retroperitoneal tumor in children comprises a list of differential diagnoses including hydronephrisis, neuroblastoma, Wilms’ tumor, teratoma, and extragonadal germ cell tumors that should be kept in mind. The main method to differentiate FIF from other tumors, especially mature teratoma, is imaging and to confirm the presence of vertebral column which is in favor of FIF. Due to the probability of malignant transformation, surgery is always indicated and is curative but conservative management with serial follow-upimaging has been carried out too. Recent review of the literature demonstrates that less than 100 cases have been reported so far. The most common site of FIF is retroperitoneal region but it has been reported in several other parts such as brain, mediastinum, lung and liver. Appropriate treatment is complete surgical excision because of its malignancy potential. Here, we report another rare case of FIF and review the literature.

Hypokalemic periodic paralysis is a rare autosomal dominant disorder in skeletal muscles which is characterized by episodic attacks of muscle weakness with concomitant hypokalemia. The precipitating factors include carbohydrate-rich meals, and rest after exercise. Rapid diagnosis of the disease is important for its management and prognosis. In this study we evaluated clinical and laboratory findings and inheritance pattern of the disease in a large affected family in Lorestan province. Proband is an 18 year old man who develops sudden weakness in his four limbs after taking carbohydrate-rich meals. Clinical and laboratory findings during attacks are coincident with a hypokalemic situation. In his pedigree, his father and some of his family are affected. The disease shows reduced penetrance in females. Pedigree shows several instances of male to male transmission. In most cases, the disease is not due to consanguineous marriage. Analysis of the pedigree revealed that inheritance pattern was autosomal dominant with reduced penetrance in females. The disease has genetic heterogeneity but in most cases it is caused by mutations in a calcium channel gene (CACNL1AS) or a sodium channel gene (SCN4A). It is important to notice that in this study, unlike other studies, the penetrance of the disease in males is not 100%.