Journal of Medical Council of Iran
Year:2002 | Volume:19 | Issue:4|Papers Count:13

Status epilepticus is a medical emergency occuring more in children and the elderly with a high morbidity and mortality.Status epilepticus in these groups usually is a manifestaion of underlying brain disease. considering the special care and management needed in this disorder, study of clinicoepidemiologic aspects seems to be important.This prospective cross sectional study was performed on all cases 15 years old or above admitted to Kerman Meidcal University Hospital (number 1 and 2) from the beginnig of 1997 till end of 1998.Incidence of status epilepticus in Kerman city is 39.5/100000,in patients above 60 years it is 75/100000.The incidence rate in fall and winter is significantly more than in spring and summer. There is no statistical difference in the rate of status epilepticus in epileptic patients using established antiepileptic drugs.The causes of status epilepticus were established in 56% of cases and the incidence rate was found to be in the following order: discontinuation of antiepileptic drug in 41.5%, brain stroke in 14%, brain tumor 10%, brain infections (meningitis or encephalitis) 8%, brain hemorrhage 6%, head injury 5%, over dosage with antiepileptic drugs 4%, metabolic derangement 3.3%, multiple sclerosis 3.3%, and systemic lupus erithematoses in 3.3%. An underlying epilepsy of 55% was seen in 64% patients with status epilepticus which could be associated with other disorders as well. Other coexisting problems included focal neurologic deficit in 12.5%, history of status epilepticus in 16.5%, history of head injury in 12%, mental retardation in 3.7%, asthma in 3.3%, chronic renal failure in 2.3%, diabet mellittus in 1%. The mortality rate was 1%, attributed to the underlying cause of status epilepticus.

Height and weight measurement is an important data source in affairs related to growth and development, puberty and nutritional status of children and adolescents. In clinical setting American NCHS charts are used in Iran. In 1997, anthorpomentric evaluation of 6-18 year old male students was conducted in Isfahan. The goal of the study was to establish the normograms of heights and weights in Isfhan and their comparison with NCHS and related studies in Iran.By a random cluster sample survey 4364 out of 200000 male students 6-18 year old were selected in The city of Isfahan. Their heights (cm) and weights (Kg) were measured by trained health staff and all the percentiles were determined. To compare the results with similar studies elsewhere in Iran like Isfahan city (1975), Rasht (1989) and east of Tehran (1983, 1994), statistical analysis by student t-test wes used. P- values < 0.05 were considered significant.The findings showed that growth percentiles of 6-18 years Isfahani male students in 1997 lay approximately with those of NCHS charts, These students were taller and heavier than their fellow citizens 22 years earlier, their compatriots in rural areas of Isfahan (1988) and Rasht (1989). They were also taller than those who were living in Tehran (1994).Although a variety of factors such as racial and gegoraphic factors playa role in an increase in the heights and weights of children and adolescents of a particular region, it appears that nutrition status in Isfahan has improved during the last 22 years compared to that which existed in the past in this city and also compared to other cities, which has improved the parameters of growth. The height and weight curves of 6-18 year old students of Isfahan and almost identical with those of NCHS charts and their utilization in clincal settings is recommended. Improvement in parameters of growth in Isfahan city could be due to improved mutritional status or other unknown environmental factors influencing growth.

As radioligand studies have defined, overlaping of "mu" and alpha two receptors distribution in the basal nuclei of the brain (locus ceruleus), and anterior horn of the spine, act synergistically. In fact, simultaneous administration of opiate and alpha two agonist have a sinificant synergetic effects in reducing pain. Therefore, we decided that using an alpha two agonist such as clonidine, could prolong the anesthesia and painless period, without the need to increase doses of morphine related compounds and as a result ,patients would not encounter side effects found with these drugs.This study was conducted on 60 patients with different sex and age, who had to be operated for orthopedic, surgical and urological problems under epidural anesthesia. They were randomly divided into two groups of A and B. Definite doses of anesthetic and morphine related drugs were administered to both groups, but an additional dose of clonidine was given to the group A only.According to the above table, with nearly equal conditions in both groups;(age, sex, HR and SBP),The effect of drugs was more prolonged in group A (338 min) who had recieved clonidine, than group B without it which revealed a shorter period of drug effect (116 min). Knowing clodidines synergetic effect with morphin related drugs. Addition of clonidine in the epidural space significantly prolongs the pain free and anesthetic effects. As a reasult makes the anesthetic and painless period much longer than the time it is not being used. Thus clonidine is recommended when a longer anesthetic and painlese state is needed. in order to avoid the difficulties and complications associated with epidural catheter usage or side effects secondary to increase in morphine dosage (respiratory depression etc),addition to an alpha two agonist such as clonidine could be useful. of using epidural catheter and more important than that here is no need to increase the dose of morphin related drugs as a reasult keeps us on the safe side as far as the respiratory depression and other opiate side effects are concerned.

In order to find the probable effect of difference in physician"s and patient"s gender on the quality of a clinical visit, without the doctor"s knowledge, we included 160 general practitioners: 140 men and 20 women from Isfahan ubran area in an observational study.Forming five standardized cases, medical students were trained to act as simulated cases and fill checklists. Observers of both sexes were to evaluate doctor"s professional capability in encountering every disease. General diseases not related to gender were, selected to form simulated cases: peptic ulcer, hyperlipidemia, migrane headache, brucellosis, and insulin dependent diabetes with mellitus urinary tract infection.The findings showed no difference in moral conditions, duration of consultation, quality of medical interviewing and physical examination and suitability of prescribed drugs between two gender groups of physicians.The only small difference observed was between general quality of clinical interviewing and physical examination between two sexes of physicians (P=0.056). The data indicate that at present physician"s gender does not playa significant role as regards application of clinical skills and overall patient care, although ethically consultations are ideal.

In this study, paraclinical and clinical characteristics of causative factors of vaginal secretion, chlamydia culture and Mycoplasma specific cultur were evaluated.Among 103 patients that had questionnaires, 70 patients had their test obtained of ghaem paraclinic and 29 of them returned to visit after treatment Among those whom were studied Chlamydia trachomatis was found to be 45.71% as the most prevalent organism, followed by candida Albicans as 38.57%. Mixed infection, was found to be 18.58%, Trichomona and bacteria each one was 4.29% cases without infection and as 25.71% . Chlamydia with cervicites had a strong correlation but cases of normal cervic with associated chlamydial infection were also not lese in number (34.1%).Vaginal douche, Coitus during the menses and contraceptive methods with chlamydia. The more prevalent clinical symptoms associated with the organsim were menses disorder, suprapubic pain, Lumbago, bad odour secretions. Prevalence of symptoms in mixed infection was similar to that seen in pure chlamydia.Dyspareunia, itching, burning, urinal symptoms were more prevalent in candidal infection. Candida was associated with a rised WBC and Doderlin bacillus and Miexd infection accompanied greater with WBC> 20 and low Doderlin bacillus but had no association with each other. Among patients were studied the most prevalent age was 31-35 and cervicitis occured more freauentely between 26- 35 years. Chlamydia more more prevalent in persons performing coitus more 2 times in a week, coitus during menses period, low educational status 3-5 children, longer time symptoms vaginal douche users and house wives. Candida was the more prevalent in persons of >36 years, coitus less 2 times a week, hoving 6-8 children, diplomag education and length of symptoms less than one week or without symptom. Instances of unifection needed to more studing about other differential diagnoses.Instance of persons who returned after treatment, patients were affected to candida had given satisfactory response (80%) and chlamydia affected patients were responsed 44.44% to treatment clinically. Therefore it is necessary spouse treatment.

To estimate the economic cost of coronary heart disease in the Iranian Oil Ministry"s personnel in 1999;we calculated the costs of essential diagnostic and therapeutic services rendered to hospitalized coronary arfery disease patients in the Central Hospital of National Iranian Oil Corporation.The calculated sum of direct costs of the hospitalized patients was 10.94 billion Rls. and the yearly cost person was found to be 8.70 million Rls.We estimated the total direct costs of coronary heart disease patients in Iran Oil Ministry as 22.77 billion Rls. Coronary heart disease caused 62832 days of absence from work which accounted for more than 4 billion Rls. of economic loss (Indirect costs of coronary heart disease due to absentia).The heavy economic loss clue to coronary heart disease in Iranian Oil Ministry obligates implementation of a comprehensive preventive cardiology program in its personnel.

The mycobacterium growth Indicator tube (MGIT) was evaluated and compared with the BACTEC-460 TB system and Lowenstein - Jensen (LJ) medium for isolation capactiy and detection time of mycobacteria.Sputum specimens were collected from 156 patients admitted to NRITLD (Aug 98-Mar.99) with clinical signs of pulmonary tuberculosis. Specimens were decontaminated using the standard NaOH- NALC method, then processed in MGIT broth, in BACTEC vial and on LJ media for comparative study. Smears from sample sediment of all specimens were prepared and stained with Ziehl Neelsen.the result of our study shows that:1) The recovery rate in smear positive cases (n=82) with LJ medium was 90% with MGIT was 87.8%, and with BACTEC-460 was 89%.2) The recovery rate in smear negative cases (n=74, with clinical sign of TB) with LJ medium was 94%, 86% with MGIT and it was 94% with BACTEC-4603) The mean time of detection was 6.6 day (range: 2-12) in MGIT,11.7 days (range:10-15) in BACTEC, 27 days (range: 25-42) in LJ medium4) Overall, the sensitivity of LJ was 92%, MGIT 88% and BACTEC 92.2% whereas the specificity of them was 93%, 88% and 90% respectively.The MGIT is an easy, rapid culture media and can be used in addition to L.J culture media for clinical specimens.

Rett syndrome is a sexlinked neurodegenrative disorder causing disability and occurs only in young female children with unknown etiology. The disorder begins in the late infancy with regression of neurodevelopmental state and psycho-behavioral signs and symptoms such as autistic behaviour, hand wringing, speech regression, choreo-athetotic movements in limbs and trunk, spastic and ataxic gait, inability to walk and talk, demented state and severe deformity of the spine.In the past three years, three new cases of them were diagnosed and managed. In this article, we would describe in short the physiopathology, the clinical signs, the clinical course and the probable treatment modalities of this syndrome.

Nonalcoholic steatohepatitis or NASH is one of the types of chronic hepatitis Although it is observed innon-alcoholic persons, pathologically it resembles live diseases that are secondary to alcohol consumption. At present, NASH is recognized as a form of non-alcoholic fatty liver disease or NAFLD. New studies reveal that the prvalence of NAFLD could be much more than believed so far and most of those with this disease entity are devoid of the known risk factor associated with this disease. At present, the clinical characteristics of NAFLD are not fully known and as such it is considered in the differential diagnosis of most of the diseases of the liver. On the other hand, progression to cirrhosis, and the develop ment of portal hypertension and hepatic failure in some of the patients has been established. The prevalence of NAFLD and the scarcity of information regarding the course of this disease has ushered in different beliefs pertaining to diagnostic invasive investigations and specific treatment modalities. Unfortunately an exact information about the fate of these patients does not exist in Iran and the adjoining countries, and this reality in addition to the problems mentioned earlier makes a research and treatment protocol about-this disease all the more necessary and evident.