Journal of Medical Council of Iran
Year:2006 | Volume:24 | Issue:3|Papers Count:14

Background: Ectopic pregnancy (EP) is one of the major causes of maternal death during pregnancy. This study was designed to determine the risk factors of EP in Mahdiyeh Hospital over 10 years. Methods: This case-control study included 200 women who underwent laparotomy with the diagnosis of EP in Mahdiyeh Hospital between the years 1991 and 2001. Also, 400 randomly selected pregnant women with normal vaginal delivery were included as controls. Finding: A direct relationship was found between EP and history of abortion, previous EP, PID, pelvic surgery, appendectomy, infertility, using clomiphene, current IUD and IVF. The chance of developing an EP (odds ratio with 95% confidence interval) was 26.7 (9.01-79.06) in women using clomiphene, 21.16 (2.71-164.8) in women with a previous history of EP, 3.29 (1.94-5.58) in those with prior appendectomy, and 9.63 (5.24-17.67) times greater in women who got pregnant while having an IUD. Conclusion: It is concluded that among outpatients, previous abdominal or pelvic surgery, current IUD, history of previous EP, and history of using clomiphene increase the risk of developing an EP. This study did not find any association between EP and previous usage of IUD, mini-pill or age.

Background: "Light" cigarettes (tar<15 g, nicotine<1mg) have been in the market for more than four decades. In Iran as well as many other countries around the world, consumption of light cigarettes is on the rise because of persuading advertisements of tobacco companies about the fewer dangers and milder taste of these cigarettes. In fact, they encourage smokers to choose light cigarettes as an alternative to cessation of smoking. Methods: This was a cross-sectional study performed via questionnaires which were designed based on the WHO and IUATLD samples. Thirty volunteer health care workers were chosen from health centers of three educational universities in Tehran to carry out the study. Findings: Out of 3026 subjects who answered the questionnaires, 1321 persons (47.4%) smoked light cigarettes, 71.8% of females and 41.8% of males (P<0.001). Among participants, 71% believed that health risks of light cigarettes were fewer than regular cigarettes. Also, 30.3% of smokers supposed that the chance of addiction to light cigarettes was lower than that to regular cigarettes. 42.9% of the smokers considered three light cigarettes as equal to one full flavored cigarette in terms of tar and nicotine content. Conclusion: The prevalence of light cigarette smoking is high in the studied population. Knowledge and attitude of smokers about the dangers and effects of light cigarettes are not right and need to be corrected.

Background: Firearm-related injuries pose a serious public health problem in many countries, such as the United States and South Africa. The aim of this study was to report the pattern of firearm injuries using data collected by the national trauma project. Methods: The national trauma project has been conducted by Trauma and Surgery Research Center of Sina Hospital in 8 cities of Iran (Tehran, Shiraz, Tabriz, Ahvaz, Kermanshah, Mashhad, Babol and Qom) and it includes information of 16753 trauma patients. Findings: Overall, 104 patients (0.6%) were identified as having sustained a firearm injury. They were 94 (90.4%) males and 10 (9.6%) females, with a mean age of 28.2±10.3 (range, 15 to 60 years). The age group of 21-30 years comprised 49.5% of our patients. Extremity injury was the most common type of injury (47.9%). Eight patients (7.6%) died resulting from the severity of injuries, with head injury as the main cause of death in 4 of them (50%). Most patients (73.3%) sustained injuries in an assault. Conclusion: More restricted rights toward keeping and using firearms seem to be necessary. Awareness of physicians of firearm related injuries and their treatment is essential for the appropriate management of patients and reduction of hospital mortality in victims. On the other hand, attempts should be made to build an especial system for monitoring firearm-related injuries in Iran.

Background: Pulmonary arteriovenous fistula (PAVF) is a rare cyanotic disease. Until 1942 when the first surgery was performed for PAVF, there was not any treatment option available for this disease. In 1977, the first embolotherapy for PAVF was carried out and today, this procedure is the treatment of choice for PAVF. There has been no report of PAVF patients from Iran so far. Methods: In a retrospective study, all PAVF cases who had been hospitalized since the inauguration of the center were identified, and data regarding demographic information, symptoms, signs, complications, paraclinical studies, treatment complications and results, and long-term follow-up were gathered and analyzed. Findings: Our patients comprised 11 cases and had a lower mean age (16 years) compared with previous large studies. We found that the lower referral rate of non-Tehranian adult patients to our center, as compared to non-Tehranian pediatric patients, might have been responsible for the observed difference. Other statistically significant differences were lower prevalence of chronic headaches (9%) and higher rate of polycythemia (70%) in our patients compared with other studies. The first PAVF surgery had been performed in 1991 and the first embolotherapy in 2001 at our center. After 2001, no PAVF patient had been referred for fistula surgery. Conclusion: PAVF is a rare and interesting disease. Embolization has opened new horizons into the treatment of PAVF.

Background: Ovarian cancer is usually diagnosed after it has widely spread and is difficult to cure. Most of attempts to identify its early symptoms have either lacked a control group or have been based on interviews of patients with possible recall bias, and most studies have been performed on all age groups. Objective: To examine the early symptoms of ovarian cancer in young women aged between 15 and 35 compared with a matched control group. Methods: Hundred women with ovarian cancer were selected out of 565,611 women aging 15 to 35 years who were referred to Vali-Asr Gynecology Oncology Clinic of Imam Khomeini Hospital between 1998 and 2005. Symptoms of 100 cases were compared with those of 100 matched control women during one year before diagnosis. Results: The proportion of cases who complained of at least one symptom up to one year before the diagnosis was significantly higher than controls, 95% versus 28%, respectively (p<0.05). Most of these symptoms were abdominal in nature. Other symptoms included urinary problems, infertility and abnormal vaginal bleeding. The most common symptoms among cases were: unusual abdominal or lower back pain (52%), unusual bloating, fullness and pressure in the abdomen (37%), gastro-intestinal problems (36%), and unusual lack of energy (22%). The proportion of controls reporting these symptoms were 11%, 3%, 12% and 7%, respectively, resulting in odds ratios (95% confidence intervals) of 8.765 (4.18-18.355), 18.989 (5.614-64.228), 4.125 (1.991-8.546), and 3.747 (1.520-9.237) for these symptoms, respectively. There were only minor differences between cases with early and late stage disease. Conclusion: Unusual abdominal or lower back pain, unusual bloating, fullness and pressure, gastro-intestinal problems, frequent urination, urgency or burning, and infertility should make women and physicians more aware of possible changes associated with ovarian cancer in young women.

Background: Neonates with a birth weight lower than 1500 g (VLBW) compose almost 1% of all newborns, and 50% of neonatal mortality as well. Nutrition is one of the most important problems in these neonates given that they are not able to suck. So, we decided to study intermittent feeding through NG tube every 2 hours and continuous feeding by pump in order to compare weight gain and complications between these two methods. Methods: This study was a randomized clinical trial on neonates admitted to the NICU of Imam-Reza Hospital between 2004 and 2005. All neonates, with a birth weight lower than 1500g, were enrolled and randomly divided into two groups. Weight of each neonate was measured every 3 days. Data were gathered and analyzed using Chi-squared test and Student's t-test. P-value less < 0.05 was considered significant. Findings: Studied neonates with birth weights lower than 1500g, were either in the intermittent feeding or continuous feeding group. Neonates entered the investigation when milk volume reached 100 ml/Kg. The two groups were matched with respect to birth weight, gestational age, feeding start age, and weight and age at the time of study entry. Of 73 neonates, 61 were discharged and 11 died. One neonate was excluded from the study because of early discharge. No significant difference was found between the groups in weight gain, feeding tolerance, and reaching birth weight or discharge weight (p=0.33). Conclusion: There does not seem to be any difference between the efficiency of the two feeding methods.

Background: Cigarette smoking continues to be a major public health problem that specifically affects the adolescent population. The aim of this study was to ascertain the prevalence of smoking and to examine personal and environmental factors related to smoking among adolescents (15-19 years old) in the city of Tabriz. Methods: A school-based study was conducted using a random sample of 1785 students from 30 schools in five regions of Tabriz. A self-administered questionnaire was used for data collection. The questionnaire inquired about smoking status, demographic characteristics, and personal and environmental factors, such as parental and friends' smoking status, and group membership. Multivariate logistic regression analysis was used to determine the association between independent variables and smoking status using SPSS software. P<0.05 was considered statistically significant. Findings: About 23% of participants reported ever smoking. 77.4%, 18.2%, and 4.4% were never smoker, experimenter and regular smoker, respectively. Group membership, having smoking friends, and being offered cigarette by others, were strongly associated with smoking status in adolescents. Conclusion: The prevalence of smoking in Tabrizi adolescents is considerable, and having smoker friends is strongly related with adolescent smoking.

Background: Pediatric renal calculus disease has been a management dilemma. Achieving excellent results with percutaneous nephrolithotomy (PCNL) in adults have led to use this technique in children. Our experience with this procedure in pediatric age group is reviewed and discussed. Methods: In a descriptive cross-sectional study, we retrospectively analyzed case records of 39 patients younger than 15 years who underwent PCNL between September 2000 and April 2004. Antegrade percutaneous access was obtained in all patients and the tract was dilated to 24F. Pneumatic lithotripsy and forceps extraction were used with a rigid nephroscope to disintegrate and remove stones. In all patients, a nephrostomy tube was placed intraoperatively, and a plain abdominal X-ray and nephrostogram were obtained postoperatively. Findings: Complete clearance was achieved in 36 patients (92.3%) and relative clearance in 3 patients (7.7%). Of these, 33 (91.7%) required a single tract, while 2 (5.6%) required two tracts and only one patient (2.8%) required 3 tracts. The greatest stone diameter in 11 (30.5%) patients was less than 20 mm and in 20 (55.6%) patients was more than 20 mm or multiple; 5 (13.9%) patients had staghorn stones. Stone location was lower calyx in 2 (5.1%), upper calyx in 3 (7.7%), renal pelvis in 15 (38.5%), and staghorn or multiple in 19 (48.7%) subjects. Open surgery was not required in any patient, and patients with residual stone after second look surgery were sent for SWL treatment. There was no contiguous organ injury, and no open surgery or blood transfusions were required.Conclusions: Percutaneous nephrolithotomy is safe and effective in children, and should be considered as a viable management option. However, staghorn and multiple renal calculi may require alternative managements.

Background: Ovarian cancer is still the leading cause of mortality among genital cancers. Despite advances in the treatment of this malignancy, it remains the fourth cause of death in women. Thus, the diagnosis of its related risk factors and prognostic factors can be very useful. Our aim in this study was to evaluate the risk and prognostic factors of ovarian cancer. Methods: A descriptive analytic study was performed in the oncology departments of Ghaem and Omid Hospitals, Mashhad University, over seven years (1998-2005). Randomized sampling was applied, and all patients admitted and diagnosed of ovarian cancer were enrolled in the study. Our tool was a questionnaire which included information regarding age of menarche, age of menopause, gravity, oral contraceptive usage, histological diagnosis and grading of tumor, type of surgery and postoperative treatments, and the level of serum tumor marker CA-125. Data was analyzed through SPSS statistical program and results were reported using t-test and Pearson correlation coefficient. The confidence interval was set at 95% and P<0.05 was considered significant. Findings: 188 patients with ovarian cancer were studied. Mean age of subjects was 43.196±17.88 years and their average weight 55.03±15.529 kg. The most relevant risk factors of this cancer among our patients were the history of infertility and a family history of ovarian, breast or endometrial cancers. The most significant prognostic factors of ovarian cancer were the histological characteristics of tumor, age of patient, and CA-125 level. Conclusion: The history of infertility is one of the most prominent risk factors and CA-125 level is among the most decisive prognostic factors for ovarian cancer.

Halitosis is a general term used to describe an unpleasant offensive odor emanating from the oral cavity. Under normal conditions, breathing has a special and not a bothering odor, which is called human odor. Around 90% of all the causes of bad breath originate from the oral cavity, and more specifically, it has been reported that around 40% come from the dorso-posterior region of the tongue. Moreover, nonoral pathologic conditions, including upper and lower respiratory tract and gastro-intestinal infections, as well as some metabolic diseases, have also been identified as halitosis-inducing factors. Oral cavity malodor can be attributed to a variety of products arising from bacterial amino acids’ metabolism. These metabolites include many compounds, such as indole, skatole and volatile sulfur compounds, like methyl mercaptan, hydrogen sulfide, dimethyl sulfide, which are the main components of bad breath originating from the oral cavity. The microorganisms that contribute to halitosis include gram negatives, anaerobes, klebsiella, and bacteroids. Local pathologic factors like poor oral hygiene, chronic gingivitis, dental caries, dental plaques, malignancies of the oral cavity and surrounding tissues, tonsillar chronic infections, foreign bodies in tonsils or oral cavity, fissured tongue and sino-nasal diseases can also induce halitosis. In addition, systemic pathologic etiologies like lower respiratory tract infections, gastro-intestinal disorders, blood dyscrasias, diabetes, liver cirrhosis, renal failure, vitamin deficiencies, especially vitamin C deficiency, and some drugs can cause halitosis. Local non-pathologic factors, such as smoking, dental prosthesis, saliva stasis, and systemic non-pathologic ones, like pregnancy, menstruation, menopause, fasting, old age, and some foods can bring about malodorous breath. Old age, salivary gland aplasia, diabetes, menopause, bad oral and dental hygiene, and spices can cause mouth dryness and reduce salivary flow and mouth washing, hence leading to a foul-smelling mouth. Complete and close physical examination and history taking can guide the physician toward the diagnosis and help to find the exact cause of halitosis. Bad odors of short time duration are mainly caused by infections, severe systemic diseases, foreign bodies, or recent drug therapy. In contrast, majority of long-lasting bad odors are due to poor oral hygiene, malignancies of the oral cavity or surrounding tissues, respiratory tract, or bronchiectasis. Intake of some foods and sleeping may result in intermittent halitosis. Eradication of halitosis inducing factors is the first step toward problem solving. Besides, care of the oral hygiene, teeth, gums, tongue brushing, and dental flossing help to overcome bad breath originating from the oral cavity.