Journal of Medical Council of Iran
Year:2007 | Volume:24 | Issue:4|Papers Count:17

Background: Pelvic relaxation is a common complaint in women admitted to gynecology clinics, with a prevalence of about 50% in the US. In this study, our goal was to identify factors which may contribute to the development of pelvic floor disorders.Methods: We conducted a case-control study, with cases selected from all the women who admitted to a gynecology clinic in Mashhad over a four month period. 100 cases who had some type of pelvic floor disorder were studied and compared with 100 controls without any pelvic problem. Each patient filled a questionnaire. Data was analyzed by SPSS, using chi-squared, t-test and logistics regression. P-value < 0/05 was considered as significant.Findings: Compared with controls, cases were more likely to have a higher body mass Index (27.6±3.7 v.s 23.9±3.7, P<0.001), to be younger at first delivery (18.5±3.1 v.s 19.7 ± 3.5, P=0.01), and to have more parity (4.1 ± 2.9 v.s 2.1 ± 1.2, P< 0.001). 14% of cases had a history of gynecology surgery versus 3% of controls (P=0.005), and 12% of cases had a history of operative vaginal delivery versus 2% of controls (P<0.006). 26% of women who had pelvic organ prolapse had a history of macrosomic infant (weight ³4kg), while only 5% of controls had this history (P<0.001). There were no significant differences in occupation and type of delivery between cases and controls.Conclusion: In our study, difficult delivery, operative vaginal delivery, and history of bearing a macrosomic infant were significantly associated with subsequent development of pelvic floor disorders.

Background: AIDS is an infectious and very dangerous disease that in spite of many attempts to find effective drugs and treatments, is still a global health problem. It seems that in addition to medical efforts, social matters and personal hygiene play a big role in controlling this disease. Aim: To evaluate knowledge and attitude of high school students (boys and girls) about AIDS Methods: A descriptive, cross-sectional study was performed. Using cluster random sampling, 22 districts of Tehran were divided to five areas according to their geographic position and in each area, two districts were selected and in each district, two boy and girl high schools were selected. Finally, from each high school, 40-45 students in grade 1, 2 and 3 were selected through simple random sampling, and information was gathered from 5000 students by interviewers using questionnaires.Findings: Data showed that students’ knowledge about AIDS was moderate and their attitude was negative, especially in boys. There was a direct, significant correlation between amount of knowledge and attitude, with higher knowledge leading to more positive attitude. Student’s knowledge was also increased by increasing level of education. Conclusion: Given the direct association between knowledge and attitude and the importance of preventive behaviors, improvement of students’ knowledge is of great importance. This can be achieved by building committees in different provinces across the country and by public education of all the students.

Background: Imprisonment is an important issue in the area of contagious disease transmission. On the other hand, different risk factors are responsible for the transmission of hepatitis and HIV in prisoners, of which intravenous drug abuse is notable. Whether the frequency and the duration of imprisonment can affect the chance of transmission of these diseases is a question. This study tried to explore this issue in some prisons in central regions of Iran.Methods: This was an analytical, cross-sectional, descriptive study performed in 4 prisons during 1382. The prisoners were grouped according to the periodicity and duration of their imprisonment. Then, blood samples were obtained from selected prisoners and tested for HBsAg, Anti HCV, and HIV antibody. Data was then analyzed.Findings: 1431 male prisoners were studied. 51 (3.6%) subjects were HBsAg positive, 541 (37.8%) were Anti HCV positive, and 95 (6.6%) were positive for HIV antibody. The prevalence of positivity for HBsAg, AntiHCV and AntiHIV was higher in prisoners with more periodicity and/or longer duration of imprisonment.Conclusion: Regarding the prevalence of infection with these viruses, our results are similar to the results of previous studies in foreign countries. However, former studies had not evaluated the relationship between periodicity and duration of imprisoning and the risk of these infections. We recommend harder effort for preventing the transmission of these diseases in prisons, and consideration of strategies for decreasing the periodicity and duration of imprisonment.

Background: Observations have shown that women undergoing coronary artery bypass graft (CABG) surgery appear to have more complications compared with men. In this respect, factors such as small body size, body mass index (BMI), narrow coronary arteries, hormonal changes, and high incidence of diabetes and it’s associated complications are believed to be effective. This study was designed to answer the question whether such differences in the clinical outcomes exist between men and women.Methods: An analysis of 500 consecutive patients undergoing CABG was performed in Imam Ali Hospital during 1382-1384. Categorical and continuous variables were compared using chi-squared and t-test, respectively. Binary logistic regression was performed, with death as dependent and gender as independent factor. Odds ratio of significant variables was calculated, and p less than 0.05 was considered as significant. Findings: Women represented 36.7% of patients. Compared with men, values of variables such as smoking, BMI, weight and hematocrit, were lower in women (p<0.05). Other factors such as low ejection fraction, infection, hypertension, ICU stay and myocardial infarction were higher in women than man (p<0.05). In binary logistic regression, low ejection fraction and use of inotrope predicted death in women, and congestive heart failure and inotrope use did so in men.Conclusion: In univariate analysis, diabetes was more common in women than men. After removal of confounding factors, postoperative MI, use of balloon pump, diabetes and inotrope use were more common in women. Using multivariate regression analysis, female gender was a predictor for hospital stay and morbidity.

Background: Hypertension (HTN) is an important worldwide challenge. The 7th report of the Joint National Committee (JNC7) provided the last classification of blood pressure levels and introduced the new category of prehypertension. The aim of this study was to estimate the national prevalence of HTN and prehypertension according to the JNC7 guideline and to determine the status of HTN awareness, treatment and control in Iranian adults aged older than 20 years.Methods: This cross-sectional study was a part of a nationwide survey on the risk factors for non-communicable diseases, which was conducted in 2004. In 75112 over 20 year old adults, two blood pressure measurements were obtained by a standard method and blood pressure levels were classified according to the JNC7 criteria. Data on patients’ awareness, management and treatment of HTN were also collected. Findings: The age-adjusted prevalence of HTN and prehypertension was 25.3% and 49.7% in men, and 26% and 38% in women, respectively. Only 35% of hypertensive subjects were aware of their disease, and effective control was observed in 21.4% of them.Conclusion: Considering the high prevalence of HTN and prehypertension and the low awareness and effective control of HTN, our country is facing a serious health problem.

Background: Osteoporosis is a growing health problem worldwide, and priority setting of researches and prevention efforts is a necessary issue.Methods: In our study, we calculated the Generalized Impact Fraction (GIF) index and avoidable burden of osteoporosis related to low calcium intake, smoking, reduced sun exposure, low physical activity, low body mass index (BMI) and systemic glucocorticoid therapy. These risk factors all can be intervened. Data about prevalence, casual effect and counterfactual prevalence of any of the above risk factors were obtained from different Iranian (and if needed non-Iranian) studies that contained best qualified evidence that was attainable.Findings: When counterfactual prevalence was considered 0% (theoretical minimum risk), GIFs of smoking, low calcium intake, reduced sun exposure, low physical activity, low BMI and systemic glucocorticoid therapy, were 0.038, 0.038, 0.110, 0.290, 0.211 and 0.020, respectively. When appropriate feasible minimum risk was considered as counterfactual prevalence, GIFs of smoking, low calcium intake, low physical activity, and systemic glucocorticoid therapy were 0.019, 0.010, 0.140 and 0.007, respectively.Conclusion: Interventions that reduce low physical activity should be given the highest priority in osteoporosis prevention strategies. However, the cost-effectiveness and practicality of any intervention must be appreciated.

Background: Tracheal stenosis is one of the most important complications of intra tracheal intubation, resulting in heavy economic burden and several somatic problems in patients. Therefore, its prevention and treatment are important issues. Current study was performed to evaluate this complication in a series of patients.Methods: This was an observational, descriptive cross-sectional study in Masih-Daneshvari Hospital (Tehran, Iran) during 1999-2006. A total of 197 patients were enrolled in this study.Findings: Mean age of the patients was 24.8 years. 74.1% were male and 25.9% female. The most common reasons for intubation were trauma and drug suicide. Mean duration of intubation was 17.76 days and stenosis was developed 32.8 days later on average. Therapeutic method was endoscopic resection and dilatation of the involved region in 98%, and laser-therapy in 2% of patients. In-hospital mortality rate was only 0.5%.Conclusion: Despite many difficulties that post intubation tracheal stenosis cause, it is a preventable complication. Role of intensive care personnel is very important in this regard.

Background: Autoimmune idiopathic thrombocytopenic purpura (ITP) is a common hemolytic disease in which platelets are destroyed in the reticuloendothelial system by the opsonization of antiplatelet antibodies, leading to thrombocytopenia and spontaneous skin and mucosal hemorrhage (epistaxis, gingival hemorrhage, GI hemorrhage). Glucocorticoids especially prednisolone are generally used in the treatment of ITP, which causes several mental and physical adverse effects, particularly if used in long terms.Methods: This randomized clinical trial study was conducted in 80 ITP patients from 5 hospitals. Subjects were divided to two groups by random allocation, 40 patients received oral prednisolone with conventional dose of 1mg/kg/day and 40 patients received 0.5mg/kg/day oral prednisolone (low dose group). The two groups were matched with respect to age and sex. Patients were studied for 14 months and platelet count (the main indicator for treatment response) was checked before treatment and at the end of 3rd and 24th months. Findings: 90% of patients (n=72) showed complete or relative response to oral prednisolone therapy. There was not any significant difference between groups regarding response to treatment (p>0.05). Splenectomy were performed in 8 patients due to failure of medical therapy, and showed no significant difference between the groups (p>0.05).Conclusion: Comparing normal and low dose steroid therapy, the latter carries similar response rate, lower adverse effects and better patient's compliance. Thus, we recommend low dose therapy for the initial treatment of ITP.

Background: Some skiers suffer from medical symptoms during or after skiing, especially downhill skiing. However, there has been no investigation on medical problems in skiers. In this study, our main objective was to evaluate the frequency of medical symptoms during or after ski among Iranian skiers.Methods: This cross sectional descriptive study was performed in winter of the year 2005, at Dizin piste (Iran). We evaluated demographic data and medical history of skiers, as well as the frequency of medical symptoms during ski using a questionnaire. The relations between sex, medical and drug history, smoking habits, and symptoms were assessed by chi-squared and fisher’s exact test. The relation between age, duration of skiing, history of previous skiing (in years) and symptoms was analyzed by means of independent t- test. P <0.05 was considered significant.Findings: Out of 1448 skiers, 74% were male and the mean age of subjects was 25.2 (±8.4) years. A total of 1208 skiers wore medical glasses or lenses during skiing, and visual disorders were found in 15.2% of skiers. Among all subjects, one medical symptom was found in 20.1% and two medical symptoms or more in 3.6%. The most common clinical profile was headache, nystagmus and true vertigo. Occurrence of symptoms had significant association with wearing glasses or lenses during routine life, habit of smoking and previous ski injury. Alcohol consumption was seen in 31.2% skiers, and it had a borderline relation with incidence of symptoms. There was not any association between incidence of symptoms and sex, age, duration of skiing, wearing glasses or lenses during skiing, and history of motion sickness. Conclusion: There were at least two symptoms in 3.6% of skiers. This finding shows ski sickness is different from other altitude sicknesses.

Background: Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. Methods: A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology (EAU) Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented.Findings: The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined.Conclusion: An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible.

Patients without known identification often cause problems in daily routine admission and discharge processes, and this asks for further consideration. If patient's identity is not determined until discharge, problems might be imposed on judicial system and forensic medicine authorities. Therefore, it's expected that authorities take appropriate universal measures, in all of the hospitals nationwide, immediately after such patients' admission to the hospital; hence, assisting in patient's immediate or later identification. In addition, these measures would protect authorities and clinicians against potential complaints and lawsuits. In our country, until now, there have been no approved guidelines, specifying the manner in which these unidentified patients should be admitted, and it is not established what specific measures should be adopted by health service providing centers while dealing with these patients, in order to prevent liability of hospitals and curtail further problems for patients. In this article, we examined this issue and reviewed the points that must be taken into consideration when admitting these patients. We also proposed a proceeding designed for covering necessary issues during admission of this group of patients.

A 2 day old term male newborn infant was admitted in our neonatal intensive care unit with irritability and jittery movements. No remarkable findings were detected on physical examination except irritability, increased tonus, and jitteriness. All of the paraclinical studies were within normal limits. His mother had been on 20 mg fluoxetine throughout her pregnancy for depression. The patient recovered quickly after supportive care, with no possible cause other than his mother’s drug use. The symptoms were interpreted as withdrawal syndrome caused by the mother’s use of fluoxetine during pregnancy. It is recommended that neonates born to mothers who have taken antidepressants up to delivery be observed during the first few postnatal days.