Journal of Medical Council of Iran
Year:2000 | Volume:18 | Issue:2|Papers Count:12

The study evaluates the effects of diabetes mellitus on hearing threshold. 150 patients with NIDDM and 150 healthy control subjects were enrolled in study. Patients were classified as having complication of disease (neuropathy, nephropthy, retinopatiy, hypertension, vascular disease and hyperlipidemia (group I VS group II). Hearing thresholds were determined by pure-tone air and bone conduction audiometry (PTA) performed by technicians. Patients with disturbed bone -conduction were excluded from the study PTA was performed in the frequencies 500, 1000, 2000, 4000 and 8000 HZ. To compare of hearing thresholds in groups, first of all in each group, low frequencies were seperated from high frequencies (4000, 8000 Htz) and then, hearing thresholds of groups were compared with -t test. A thigh frequencies (above 4000 HTZ), there was a significant increment in PTA threshold (15±5/3 dbVS 35±4.3,P<0.05). Also the threshold in patients with complication was higher than patients without complication or controls (29.6±12 VS 19.9±10,P<0.05).Again the presence of diabetic hyperlipidemia has significantly increased hearing thresholds.(18.7±6 VS 28.9±11,P<0.05).This study suggests that, in patients with NIDDM, vascular damage of inner ear can cause higher hearing threshods.  

Continuous midazolam infusion was tried as treatment for 15 children with refractory convulsive status epilepticus, at the mofid children hospital over one year period. Ten patients had generalized convulsive status epilepticus and 5 had partial one. All patients had received intravenous diazepam, phenobarbital and phenytion, before midazolam infusion was started (0.15µg/kg bolus, followed by 1-6 µg/kg/min infusion). The siezures were controled in 9 out of 10 (%90) patients with generalized status, and 2 of 5 (40%) cases of partial status. The average required necessary period for complete cessation of seizures in generalized status was about one hour. The mean infusion rate was 3.6µg/kg/min. In two of children with generalized status, decreased oxygen saturation necessitated endotracheal intubation and mechanical ventilation. This modality of therapy did not cause any metabolic derangement in any of our cases. Thus midazolam infusion is an effective and safe therapeutic approach for management of childhood refractory generalized convulsive status epilepticus, although its effect in controlling partial type of convulsive status epilepticus is not remarkable in comparison to the generalized one.

Due to the increase of addiction in the society specially that of opium, it seems that the number of children admitted for opium poisoning in childrens' Hospital Medical Center has increased. In this study, patients who had been admitted for opium poisoning were evaluated and 34 cases were confirmed between 1370-1377. The minimum age of these children was7 days & the maximum3.5 years (the mean being 7 months). In the majority of cases, opium was prescribed by the relatives for diarrhea (32.4%) acute respiratory infection (26.5%) and irritability (20.6%).An addict person in the family was confirmed. The pathognomonic signs of opium poisoning in all the patients had been a decrease level of consciousness, respiratory depression and miosis. Besides supportive measures, naloxone was prescribed as a bolus of 3.5 IV and as an infusion in half of the patients. Unfortunately 4 of these children expired because of severe respiratory insufficiency and deep coma. Because of the easy access to narcotics especially opium, families are warned of the dangers of opium use in children for diseases such as diarrhea, respiratory infection and irritability, a greater attention is to be paid to the problem of addiction to decrease the occurrence of such problems.  

According to the standard criteria offered in the literature, establishment of a trauma center is expensive and it's efficacy is dependant on development of a trauma system. The objective of this article is to determine the need of a level I trauma center in Tehran, and has been based upon the data of all trauma patients visited in three general hospital with the highest load of trauma patients in Tehran. Total number of patients was 58005, and 7% of these patients either needed hospitalization or were dead. As a whole our patients were not matched with MTOS patients (M index = 0.832), but when we selected dead or hospitalized ones, these patients were comparable with MTOS patients with a M index greater then 0.88. Calculated Z and W statistics (-13.44 and - 2.55% respectively) showed that the quality of care of our centers are significantly lower than standard. On the other hand the observed frequency of trauma patients shows that 8 establishment of a level I trauma center in Tehran is quite logistic and essential. It should be mentioned that establishment of a trauma center should be accompanied by an efficient trauma system and especially development of a dynamic Emergency Medical service. Design of this center should be based upon delicate scientific evaluation of situation, resources, personnel, educational and therapeutic protocols. Evaluation of the efficacy of this center can be made by calculating the M, Z, and W statistics.  

Diabetes is a widespread disease in advanced societies with serum glucose level equal or above 140 mg/dl. The disease has a trend with complications affecting organs, namely eyes and legs. The studies leading to finding the causes of these complications and ways to reduce them seem to be important. Zinc is one of these trace elements that plays an important role in thy biochemistry of cell. It is present in many cellular enzymatic reactions resulting to concentration changes in the body. This could lead to several complications. Zinc is one of the compounds of insulin isophane that is used in type I diabetes (IDDM).It regulates the insulin function of lipid accumulation in tissues. It has an effect on thyroid hormone, especially the T3 type. Zinc can enhance the activity of enzymes such as Superoxide dismutase, Glutathion reductase and Catalase that have important functions in diabetes. In addition, it activates the enzymes 17-ß-hydroxy steroid dehydrogenase, that is responsible in conversion of androstenedione to testosterone. The lowering of activity of this enzyme in diabetic patients cause the levels of testosterone, prolactin and dihydrotestosteron to decrease. Considering the effects of zinc in normal and diabetic subjects, it seemed interesting to carry out a prospective study of its serum concentration in diabetic patients. These studies were done on diabetic sera using atomic absorption spectroscopic method. The survey proved that the Zn concentration decrease significantly in NIDDM patients compared to the controls in Iranian population.

During a one year period 1600 specimens of fecal swabs of children having diarrhea, were collected. 5-years old were received from the Islam Shahr health centre. The specimens were processed for various bacterial pathogens such as, E. coli, Salmonella, Shigella, Yersinia and Campylobacter. The highest isolation was related to E. coli with 109 positive culture (6.8%), and the lowest isolation was related to Yersinia with 11 positive culture (0.7%). Seasonal surveys showed that all pathogenic bacteria had been more commonly isolated in summer, whereas Yersinia was predominantly isolated in winter. The results of this study revealed the relative importance of Yersinia and campylobacter in comparison to other pathogenic bacteria in patients with diarrhea.  

Necrotizing Fasciitis (NF) is frequently seen in adujts, having a low incidence in children and being rare in neonates. The disease has an acute and progressive course which mostly ends up in the death of the patient. In neonates, if usually follows omphalitis, nipple infection, following surgery and fetal monitoring. A strong clinical suspicion and other criteria, coupled with employing broad spectrum antibiotics and prompt surgery can decrease the mortality. We report one case of NF which occurred following acute omphalitis in a newborn. The newborn was 12 days old in whom primary care and antibiotics proved ineffective and the infection rapidly spread to soft subcutaneous tissues in the thorax and abdominal wall. On the 1st day of admission, operated and debridement carried out and was discharged fully well.  

Nonsteroidal anti-inflammatory drug (NSAID) can cause sever gastrointestinal problem by affecting the prostaglandin synthesis. Therefore it is necessary for high risk patients to receive prophylactic treatment in case of NSAID administration. In that case the drug of choice would be omeprazole. If a patient take in NSAID develops duodenal or gastric ulcer, he or she should discontinue it and be treated, other wise maintenance treatment, preferably omeprazole should be taken. Regarding the relation between helicobacter pylori and NSAID induced ulcers. There still exists a host of debate and more research is necessary.  

Ensuring the health of the armed forces and volunteers plays a decisive role in the outcome of wars. An epidemic outbreak of communicable diseases during can inflict a severe blow on forces even if they excel in number and armoured paraphernalia, eventually leading to their defeat and retreat. The outbreak of such epidemics can lead to population transfers and a change in the ecosystem of the region. Important among these diseases include meningitis, malaria, cholera, tetanus, bilharziasis, scabies. This paper in addition to briefly referring to these diseases offers basic suggestions in preventing outbreaks of epidemics of such diseases during war time. In the memory of those martyrs who laid down their lives during the sacred 8 year imposed war, specially those personnel from the Ministry of Health, treatment and Medical Education who willingly and whole heartedly laid down their lives while defending the country, and with thanks to those personnel of khuzestan health network who conducted their holy obligations despite problems and limitations in their personal life, an attempt is made to dilate upon the importance and etiology of these communicable diseases in the war zones.