Journal of Medical Council of Iran
Year:2005 | Volume:23 | Issue:2|Papers Count:17

The results of high tibial osteotomy in 27 patients with medial compartment osteoarthritis (OA) were evaluated after an average 5.6 years follow up to determine the amount of correction, degree of arthrosis and functional knee score.Radiologically, the mean arthritis score according to Ahlback grading decreased from 2.1 to 1.6.The average knee functional score improved from 42 preoperatively to 60 at the last follow up We did 30 (HTO) in 27 patients including 22 women &5 men with medial compartment osteoarthritis of the knee and they were evaluated .The average age of the patients was 51years. the mean follow up was 5.6 years with the average preoperative varus of 6 degrees.and average postoperative valgus of 5degrees.The fuctional grade of the knee improved 1.6 grades at the last follow up and 90% of patients had excellent or good functional knee score at the final follow up examination.These results suggest that valgus producing osteotomy can realign a deformed knee, reduce pain and improve knee function and also postpone the need for total knee arthroplasty.

lntraarticular corticosteroids (IAC) are recommended in the treatment of knee osteoarthritis (KOA) specially those cases in whom there is joint effusion. On the basis of the recent data, their efficacy is limited in relieving pain for a short duration. To investigate the efficacy of IAC in patients with inflammatory pain (IP) of KOA, the present noncontrolled prospective study was performed.Patients with KOA according to ACR criteria who presented with persistent IP and joint effusion were enrolled in the study. lntraarticular triamcinolone hexacetonide was prescribed after complete joint fluid aspiration. Patients were evaluated for pain (at rest and movement), performance restriction and physical disability at baseline and 4 weeks after IAC treatment using SPSS software by Wilcoxone match pairs signed rank test and Chi-square Mc nemar test.71 patients (26 females and 45 males) with mean age of 60+10 years were studied. Persistent IP and joint effusion were detected in 100%, night joint pain in 95%, performance restriction in 75% and physical disability in 80% of patients. Four weeks after treatment the joint pain (Lickert pain score) decreased from 2.9 + 0.9 to 0.96+1.2 (P< 0.01), performance restriction (Lequesn's functional index) from 6.4+1.9 to 2.2+1.9 (P<0.01), and physical disability (WOMAC functional index) from 10.2+2.6 to 3.3+2.6 (P<0.01). At the end of study the proportion of patients with persistent joint pain at night and rest; joint effusion; performance restriction and physical disability was, 2%; 5%; 15%; and 45% respectively (P<0.01).In patients with IP of KOA, IAC treatment is accompanied by rapid alleviation of pain and physical disability.

Cicatricial alopecia means permanent destruction of hair follicles that leads to scar formation. This alopecia is irreversible. According to our knowledge, there has been no previous study about the causes of scarring alopecia in Iran. Our objective was the study of this entity in Iran.In a retrospective study, skin biopsies of the patients with clinical diagnosis of scarring alopecia since April 1998 to March 2001 in the file of department of pathology of Razi Hospital were evaluated. Among 9000 of skin biopsies, 207 had the diagnosis of scarring alopecia. These specimens underwent reevaluation.Data on demographic and clinical features were obtained from patients' files. The mean age of patients was 35.2. According to sex distribution, 49.3 percent were women and 50.7 percent were men respectively.The causes of scarring alopecia in order of decreasing frequency were as follow: Discoid lupus erythematous, lichen planopilaris, folliculitis decalvans, basal cell carcinoma, deep folliculitis, morphea, cicatricial pemphigoid, follicular mucinosis, aplasia cutis congenita, dissecting folliculitis, granuloma, epidermal nevi, necrobiosis, and psoriasis. In eight cases no specific pathologic diagnosis was reported for scarring alopecia.Discoid lupus erythematous was the most frequent cause of scarring alopecia in this study. Lichen planopilaris and folliculitis decalvans were the next frequent conditions respectively.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders that are encountered by primary care physicians and specialists. This disorder affects approximately 15% to 20% of the general population. Also this is the second cause of drug consumption and absence from workplace. These patients frequently refer to different physicians that cause an increase in cost and time loss. We can decrease the signs and symptoms of patients with correct diagnosis, assurance of the patients and appropriate treatment. The purpose of this study was to evaluate the prevalence of IBS symptoms in medical students in this center.This study is cross-sectional and the method of sampling is convenience of nonprobability. After collection of data and analysis, the state of investigated population, comprising of 197 students, on the basis of; age, sex, marital status, living place, was as follow: 40.8% were above 25 years, 73.1% were male; 71.9% single, 74.9% resided in student dormitory. Results suggest that in general, 17% of medical students have got symptoms of IBS on the basis of diagnostic criteria of Rome significant. Statistical relationship was achieved between IBS frequency and sex (P<0.05). 20.2% of men and 8.2% of women were patients in this study. But there was no statistical significant relationship between IBS frequency between aging group, marital status, and living place. Also there wasn't meaningful statistically relationship between IBS frequency and dysmenorrhea in women (P>0.05).On the basis of multiple logistic regression analysis, Relative Risk for IBS involvement in men, age more than 25 years, single and living in dormitory with 95% confidence interval was 3.23 (1.01-10.39), 2.79 (0.96-8.07), 0.30 (0.10-0.93) and 2.07 (0.65-6.63). As a consequence, the frequency of IBS in medical students was similar to the prevalence of IBS in the general community. More prevalence of IBS in male students can be due to sociocultural factors and different stresses between the two groups.

Myeloma is a hematologic malignancy in which there is monoclonal proliferation of bone marrow plasma cells that produce abnormal proteins.Reviewing the medical records of patients admitted to Dr.Shariati and Imam Khomeini Hospitals of Tehran University of Medical Sciences from 1991-2000, we assessed distribution of epidemiologic and clinical parameters of patients with Myeloma and for each parameter we evaluated the missed data percentage as an index of active data collection.Among the epidemiologic parameters only age and sex had no missing data. For smoking, missing data were 22.9% and in other parameters there were more than 90% missing data. For clinical parameters, missing data percentages were between 46.2% and 93.1%.Establishing a documented system for object oriented data collection based on specific epidemiologic and clinical parameters is essential for optimum prevention and management of Myeloma.

During the course of treatment with anti - tuberculosis drugs in patients with pulmonary and extrapulmonary tuberculosis, unusual reactions such as hepatitis, rash, fever, flu like syndrome, neuropathy, ... due to three potentially hapatotoxic drugs, Isoniazid, Rifampicin, and Pyrazinamide occur. Hepatotoxic reactions are vital because fulminant hepatic failure is devasting and may be fatal without liver transplantation.To determine the frequency and predisposing factors of drug reactions in patients managed with anti- tuberculosis drugs, we arranged retrospective case control study in Imam Khomeini Hospital. 120patients with hepatitis and other adverse reactions after receiving anti- tuberculosis drugs in case groups and 240 patients without any drug reaction after receiving anti tuberculosis drugs in control group were evaluated.Most common adverse events were hepatitis 35.8%, abnormal liver enzyme without overt hepatitis 18.3%, skin rash 11.6%, nausea and vomiting 8.3%, arthralgia 5.8%, flu like syndrome 5%. Old age more than 65 years (P=0.047), chronic liver disease (P=0.008), renal failure (P=0.009), severe tuberculosis (P=0.001) and HIV/AIDS (P<0.039) were predisposing factors for adverse reaction in our patients.In conclusion, close monitoring for symptoms or signs of hepatitis among patients receiving anti-tuberculosis drugs especially old patients, who have chronic liver or kidney failure, patients with HN/AIDS and patients with severe tuberculosis must be considered.

Pregnant women are exposed to biological, physiological, and psychological changes. Furthermore in many patients referred to the medical care (as pregnant women), psychiatric problems are the main causes or complications.Our aim in this descriptive study is to determine the prevalence of fear and anxiety of childbirth in pregnant women referred to four educational hospitals in Tehran; this study was performed from Mar 2003 to Jul 2003. 300 pregnant women who were in 20 to 40 days after childbirth completed 4 questionnaires. Prevalence of the fear of childbirth in our study was 59.7 %. And prevalence of anxiety of childbirth was 14.7% mild, 26 % low moderate, 23 % high moderate, 23.7 % slightly severe and 12.7 % severe. Also demonstrated was that an increased increase of age, decrease of the rate of fear and anxiety of childbirth. The rate of fear and anxiety of childbirth in employed women is more than unemployed (housewives) women, and it was demonstrated that increase rate of gravidity and parity of pregnant women, decreased the rate of fear and anxiety of childbirth. The rate of fear and anxiety of childbirth in women who had difficult labor in the past is more than other women. Also the rate of fear and anxiety of childbirth in women with cesarean section delivery is more than in women with vaginal delivery.

Cesarean section is one of the most common surgical procedures done in today's medicine. Many studies have shown that a high percentage of these surgeries are not necessary. The increase in the caesarean-section rate has been a cause for serious concern. The importance of promoting the mother and child health in the society requires that health professionals and policy makers pay more attention to the concept of normal vaginal delivery and formulate proper policies to support this process. The aim of this research is to determine the frequency of normal vaginal and cesarean section and reasons for doing cesarean surgery at the Isfahan Medical University Hospitals (IMUHs) in 2002 in Iran. In this study, all normal vaginal and cesarean deliveries performed in IMUHs (6855 cases) were investigated via a questionnaire.The prevalence rates of normal vaginal and cesarean delivery were 46.6 and 55.4 percent. The most common reasons for conducting cesarean section were dystocia (32.4 %), repeated cesarean (30 %), fetal distress (14.8 %), Pregnancy- Induced Hypertension (9.3 %), Thick Mecunium (5 %), Abruption (4 %), decrease of fetal movement (3.3 %), Elective cesarean (3.2 %) and Premature Rupture of Membranes (2.8 %).Cesarean delivery rates are high. This has created many concerns in relation to the costs of the operation and problems for mother and her child among health care professionals. A study of the reasons of this delivery can be useful for providing strategies for prevention and reduction of unnecessary cesareans.

Back school was developed as a preventive measure for reducing low back pain in those who suffer from the disease. Despite diversities in approaches, all back school programmes involve classes in which patients receive theoretical and practical information to know their back and to cope with their limitations. Some studies showed benefits of back school including reduction in pain severity and functional disability in the short and medium terms. The purpose of the present study was to evaluate the short term effect of the multi-dimensional and inter-disciplinary modem back school program in women with chronic low back pain in Tehran, Iran.This was a randomized controlled clinical trial carried out in Teheran, Iran. All 102 eligible women with chronic low back pain were randomly allocated to either back school program (n=50) or control group (n=52). The back school subjects received 5 group sessions of back school education over 12 hours and followed up weekly until 3 months but control group was not offered any education. The two groups underwent physician visits and medication. Outcome variables were the pain severity as well as measures of physical, social and emotional functioning using the SF- 36 questionnaire.The findings indicated a significant improvements in pain, physical, emotional and social functioning scores in the back school group compared to control group. Although pain reduction was reported in both groups after 3 months but the difference was significantly greater for the back school group. Also regression analysis showed that back school program was the best predictor for improving low back pain.The back school program is an effective measure in reducing pain severity in those who suffer from low back pain.

Congenital long-QT syndrome is infact a form of anomaly characterized by prolongation of cardiac repolarization with a prolonged QT interval on the Scalar ECG and a tendency to develop polymorphic ventricular tachycardia which in itself may change into ventricular fibrillation.Because of the importance of its diagnosis and steps necessary to prevent sudden cardiac death, knowledge about its clinical and paraclinical presentation seems essential.In this article, a case of long QT Syndrome in a 14 year old boy without a history of any disease in the past is reported who eventually underwent ICD+pacing implantation.

As international travels have become increasingly common for both business and tourism, physicians are confronted with innumerable travelers suffering from unknown syndromes and infectious diseases, thus it is necessary for physicians to maintain familiarity with current guidelines and recommendations about travel medicine and prevention of related infectious diseases.Fever, travelers' diarrhea, skin eruptions, respiratory and CNS involvement are diseases seen among travelers on return which make them visit the physicians.Consultation and a check up prior to traveling with the aim of immunization, recommendations about traveler's diarrhea, malaria and diseases transmitted by blood or sexual contacts are steps that could be taken by the physicians before travel. Knowledge about the epidemiology and etiology of traveler's diseases, destination and immunization status of travelers can prevent complications, morbidity and mortality attributed to infectious diseases in travelers.