Journal of Medical Council of Iran
Year:2003 | Volume:21 | Issue:3|Papers Count:16

Constipation is one of the major conflicts in the GI clinics. Diagnosis of chronic constipation in Iran by use of CTI has been limited due to high cost of imported markers and unfamiliarity of physicians to them. The aim of our study is comparing imported with the domestic markers to solve the problem of import and cost.Consenting patients with chronic idiopathic constipation without obvious clinical or laboratory abnormalities were consecutively included in the study. Each patient underwent six day CTT followed by plain abdominal X-Ray in upright position on seventh day. After two weeks the test was repeated with domestic marker.Twenty patients (M/F=3/1) with a mean age of 41.8 (22-62) years were enrolled in the study. Sense of insufficient detection was observed in 16 patients. 11 subjects gave a history of constipation in thirst degree relatives. The number of defecation was two per week in 13% one per week in 33%. One in each couple of weeks in 54% and one/per month in 5%. Mean length of en with imported marker in right colon, left colon, rectosigmoid and the whole CTT were 28.1, 19.8, 15.9 und 72 hours receptivity. These figures were 28.8, 26.6. 16.9 and 72.5 hours for the domestic markers. There was no significant difference between the 2 groups.CTT is a sate and reliable way to diagnosis chronic idiopathic constipation. Since there were no significant dit1erences between the two kind of markers and regarding the low cost and facilitated use of domestic markers, not only can they help the patients and the physicians, but can prevent the exodus of foreign currency in importing such markers.

The purpose of this study was to evaluate fractures of the mandible as regards their anatomical location and etiology.In this prospective study 468 cases of mandibular fractures which were treated at Tehran University of Medical Sciences hospitals during 1995-2000 were evaluated. The study comprised anatomical locations of the fractures, causes of fractures, and age and gender of the patients.The percentage incidences of the, anatomical locations of the mandibular fractures were as under: parasymphis is (25.2%). sub condylar (22.7%), body (22.2%), angle (21.3%), ramus (4%), alveolar (3.5%), coronoid process (1.9%) and the middle region (0.5%). The causes of the fractures were vehicle accidents, fights, motor cycle accidents, tall from height and sports accidents.

The aim of the study was to elucidate the role of some factors in the etiology of breast cancer iniranian women propounded in other countries. A hospital based case control study was conducted between December 1999-May 2000 at Emam Khomaini Cancer Institute, Emam Hospital complex and Rasool Akram Hospital in Tehran. The study included 107 cases of women with diagnosis of breast cancer after March 1999 [Mean age=47.03 (±10.04) and 214 controls admitted to these hospitals for a variety of conditions unrelated to the hypntheses in this study [Mean age=51.23 (±3.89)]. Lactation and irregular menses had protective roles, and oral contraceptive use for more than 48 months had an adverse effect (P<0.05). Employment, education, prior delivery, prior incomplete pregnancy, age at menarche age at menopause and age at thirst birth were found to have no correlation.The results of this study were found to be similar as regards some nr the risk factors where as they were contradictory regarding other variables in comparison to other countries. This tinding warrants further research in this field.

Because of the importance of physician in providing medical care to patients and because of their direct involvement in invasive procedures which make them vulnerable to hepatitis B. we decided to study the prevalence of hepatitis B vaccination and other related factors among physicians working in Tehran (Iran). 527 physicians (general and specialist) working in Tehran(2001) were selected by stratified random sampling method and via correspondence and telephone, information pertaining to their vaccination status and other related factors was obtained.Among physicians. 391 (74.1%) doctors had a positive history of vaccination against hepatitis B. This prevalence was 70.1% in male physicians and 91.4% in female physicians (p<0.001). The mean age of vaccinated physicians was 41.4 year and 50.2 year in the others (p<0.01). The mean number of years spent in profession was 13.1 years III vaccinated physicians and 22.4 years in the others (p<0.001). The frequency or vaccination in general physicians was 61.7% and in specialists was 81.5% which was statistically important (P=0.002). The most common factor for not being vaccinated was "inadequate knowledge about the place of vaccination (65.4%). Of physicians whom were vaccinated. only 28.4% had checked their serum antibody titer after last dose of vaccine.The prevalence of hepatitis B vaccination among physicians in other studies is very deterrent and with respect to those results, our prevalence is fair. The relation between vaccination of hepatitis B and age, level of education and also duration of professional work showed that physicians, who had graduated recently, had been vaccinated more than the others. With respect to the results we suggest to train and inform physicians more about vaccination.

Granulosa cell tumor (GCT) comprises 2-5% of all ovarian neoplasia and is being divided occur in two types: Juvenile and adult. To investigate the demographic and clinical characteristics of GCT a case series study were conducted in Vali-e-Asr, Mirzakochak khan and Imam Khomaini (cancer Institute) Hospitals 21 cases (5/6%) of reported ovarian tumors, through the years 1372-76 was GCT, with an age range or 16-61 years and Rout of them (38.1%) were in the age group of 31-45 years. 2 cases who were 16 years of age were of the juvenile type. 18 cases were married of whom 17 of them had a history of 3-11 deliveries. The most frequent complaints at referral were abdominal pain (38.1%), bloating (23.8%), menstrual irregularities and vaginal bleeding (23.8%).The frequent clinical findings included, palpable abdominal mass (28.6%), palpable mass on vaginal exam (23.8%) and ascites (19).Involvement of the ovary was found to be unilateral in 19 cases (90.5%) and the diagnosis was established at stage 1 in 15 cases (71.4%).Recurrence occurred in 4 patients, the earliest occurring at 17 months and the latest 15 years after the initial diagnosis. In one of the cases, skeletal metastasis was observed.In summary, 5.6% of reported ovarian tumors were GCT. The most frequent symptoms were abdominal pain followed by menstrual irregularities. The most frequent clinical findings were abdominal and pelvic masses. In 90.5% of cases there had been unilateral involvement of the ovaries. Latest recurrence was seen IS years after the initial diagnosis.

Keeping in view of the repeated warnings about prevention and control of atherosclerosis' risk factors from the onset of childhood specially in children with a positive family history of cardiovascular disease, this study was undertaken to evaluate a comparison of the prevalence of risk factors (main and recent) in children of such families including 200 children and adolescents 2-18 years of age (100 case and 100 control). Selection of samples was random, simple with an equal distribution between both sexes. Alter reporting at the clinic and having completed the questionnaire for each person, a fasting blood and urine samples were obtained. Alter data collection, analysis was performed using the SPSS soft ware and For statistical analysis, student t test, kruskal wallis and chi-square were used, and multiple linear regression was employed to find a relation between the risk factors According to the results, the prevalence of risk factors (cholesterol, LDL-C, triglycerides, lipoproteins B 100, serum fibbing and urine homocysteine was higher in cases compared to controls (p<0.05), and the prevalence of protective factors (HDL-c and apolipoproteins A1) was lower in cases as against controls (p<0.05). The prevalence of the above risk factors was more whereas the prevalence of protective factors was less in boys group of the case series (P<0.05).The mean body weight, height, body mass index blood pressure, cigarette smoking or else being exposed to cigarette smoke, and physical exercise showed no deterrence in the two groups (p>0.05). A significant relation between the mean serum lipids and lipoproteins and fibrinogen could not he found.In conclusion, keeping in view of the importance of positive family history of premature cardiovascular diseases and the absence of a relation between major and new risk factors in both groups, it is suggested that the children of such families are screened for both sets of risk factors and are controlled or primary prevention.

Malnutrition related diabetes mellitus (MRDM) is similar to that of type 1 diabetes but it develops over a background of chronic malnutrition from childhood and restricted to developing countries. This type of diabetes was added by the world Health Organization for the first time in 1985 to the classification of diabetes, and although deleted from the latest classification put forward by American Society of Diabetes in 1997 but still it is being reported from some parts of the third world countries. The prevalence of this type of diabetes in children and adolescences with diabetes ranges from about 0-80% in various reports.This study was designed in order to determine the prevalence of MRDM in children and adolescences with diabetes mellitus in Tehran province. We studied 405 subjects aged 3-18 years with diabetes mellitus.but ultimately 360 cases (186 girls and 174 boys) were enrolled into this study. using World Health Organization diagnostic criteria for MRDM, 25 patients (6.9%) were diagnosed as having MRDM. The mean age at presentation was 7.6±2.8 yr with male to female ratio 1:1.7. Moderate to severe malnutrition (Ideal body weight less than 80) was noted in 93% of the subjects.Insulin requirement was more than 2 IU/Kg/day in most of the patients and none of them had episodes of ketoacidosis. 80% of these subjects had poor socioeconomic status (Income < 350000 Rials per month + family size>6 members). Abnormal pancreatic ultrasonography was noted in 60% of cases diagnosed as having MRDM. This study and other related studies show that although the incidence of MRDM is less, and omitted from the new classification of diabetes mellitus but still some parts of the world that face malnutrition because of the varied presentation of this type of diabetes, it should be kept in mind in patients presenting with diabetes specially the younger group.

Enterobiasis can be regarded as one of the factors results in reducing the outcome of teachers' educational activities which a great deal wastage of time and money.This study was performed on 113 samples prepared from 371 pupils between the age of 5 to 12 years from kindergartens and schools of two well-to-do and not well-to-do regions in Tabriz city. The sampling was done using Graham's method and from each subject 3 samples were propend within three consecutive days. In this investigation in addition to measuring the spread of enterobiasis, the connection of individual and social elements that the students were involved with at home and at school were taken into the consideration.Among the factors whose relation to enterobiasis proved meaningful, the number of students in each class, using soap in the school's lavatories, using hose instead or Aftabeh in the lavatories of schools, number of family members, parents' occupation. parents level of education especially mothers', separation of sleeping place from eating place, number of rooms in the residential place, the means of sweeping the place, and the intervals of clipping the nails are some to be mentioned.It was also revealed that some of the hygienic habits cannot be effective enough to protect the individual from enterobiasis contamination, if they are not met by all people related to the individual or applied along with some other hygienic methods.

Hyperthyroidism is second to diabetes mellitus as the most common endocrinopathy in pregnancy. It has been shown that experimental hyperthyroidism in pregnant mice, produces some difficulties in their embryos. The goal of the present paper is to evaluate some probable reasons for occurrence of congenital facial dysmorphy and hydrocephaly in a Hamadanian newborn after maternal hyperthyroidism and chemotherapy.A female newborn was reported to have facial dysmorphy and hydrocephaly. She was born after a period of 8 month pregnancy by cesarean section and died after a few minutes. Her 28 year old mother was affected with hyperthyroidism and before pregnancy and also during the first two, weeks of pregnancy was treated with Methimazole After being informed of pregnancy, physician prescribed tabl Propyl thiouracil (50 mg/day). Their pedigree pattern and family history were studied and familial effect was ruled out.It seems that probably maternal hyperthyroidism and/or drug therapy was the cause (s).There are numerous evidences that show that when maternal hyperthyroidism is not under control maternal, fetal and neonatal complications are frequent.Although the role of chemotherapy and drugs in producing congenital anomalies in human beings is difficult to be established but the results of the present study reveal that pedigree pattern was not involved in producing the congenital anamoly.

A comprehensive perinatal care program involves an integrated approach to medical care, psychosocial support that begins preconceptionally and extends throughout pregnancy and the post partum period. preconceptional counseling is a preventive medicine for ohstetrics.All factors that could potentially affect preinatal outcome are identified, and the woman is advised of her risks and a strategy is provided to reduce or eliminate the pathological influences of these factors. Some of the maternal problems or congenital fetal malformations observed during the pregnancy could perhaps be prevented by appropriate counseling and timely intervention. Organogenesis begins around 17 days after fertilization, therefore steps to provide the ideal environment for developing concepts arc most likely to be effective if precede the traditional initiation of prenatal care. The components of preconception counseling are family history, genetic history, reproductive history, medical history and current medication, nutritional assessment, use of durgs and substances abuse, social and environmental assessment.