Research in Medicine
Year:2009 | Volume:32 | Issue:4|Papers Count:17

Background and Aim: Use of pacifiers by young infants has been recognized as one of the factors that interfere with the establishment of successful breast-feeding. Our aim was to find out if pacifier-use results in early termination of breast-feeding. Materials and Methods: A historical cohort study was done on mother-infant pairs visiting health centers for check-ups, routine vaccinations or common childhood ailments during the year 1385-1386. All subjects satisfying the enrollment criteria, and available to the study team, were interviewed by trained personnel and relevant information documented on predesigned questionnaires. Duration of breastfeeding was compared between pacifier-users and non-users.Results: Four-hundred and fifty infants were enrolled; after exclusion of babies with confounding factors, data of 307 infants was analyzed. Two-hundred thirty-nine mothers had continued predominant breastfeeding for 3 months and 218 mothers had done so for at least 6 months. Breast-feeding was discontinued in 59 infants before 6 months. 24.75% of infants were regular pacifier users, 80% of these had started pacifiers during the first few days of life.The rate of termination of breast-feeding at 3 months in pacifier-users was 28.9% as compared to 5.7% in non-users, (P=0.000).At 6 months the rates in pacifier-uses and non-users were 46.1% VS. 10.4%, respectively, (P=0.000).Conclusion: Our findings show that while over-all breast-feeding rates in 6 month-old infants are high at 71%, pacifier use in infants is associated with early termination of breast-feeding.

Background and Aim: Major Depression is associated with alterations in the neuroendocrine system, dysfunction of hypothalamic-pituitary-adrenal axis, and elevated blood cortisol levels. These changes may result in an increased risk of osteoporosis in depressed patients. The aim was studying the relationship between bone density and major depression.Materials and Methods: In a historical cohort study, we performed bone densitometry in 75 persons; 25 of them suffered from major depression, the remaining 50 were healthy volunteers as controls. The groups were matched for age, sex, BMI, supplemental calcium intake, regular exercise and menstrual status. Bone mineral density (BMD) was measured by the DXA method. The two groups were compared regarding T-score and BMD of lumbar and pelvic regions.Results: BMD (gr/cm2) of total femur, femoral neck, and lumbar regions were all significantly lower in cases than controls, (0.94±0.13 versus 1.16±0.15, 0.92±0.12 versus 1.09±0.14, and 1.05±0.22 versus 1.32±0.21, respectively). Osteoporosis was more frequent in patients with depression than in controls, 32% versus 4% in total femur region (Odds ratio: 5.4, CI 95%: 1.4%-20.3%), and 36% versus 14% in lumbar region (Odds ratio: 3.5, CI 95%: 1.1%-10.8%).Conclusion: In this study major depression was associated with lower bone density and increased frequency of osteoporosis. Based on these findings, it seems reasonable to advice that patients with depression should be screened for osteoporosis.

Background and Aim: Health management for special patients is a serious challenge for policy makers. Because of chronic nature of these diseases the community has to cope with huge expenses, and a considerable part of health funds is allocated for the continuing care of these patients. Therefore, designing appropriate policies for organizing, financing and providing optimal health-care is of special importance. In this study, our main objective was to design a model for special patients' health management in Iran by studying the management strategies of similar patients from selected countries. Materials And Methods: We scrutinized studies done in England, Australia, United state, and Canada and used these as suitable references from which we selected applicable strategies and submitted these for approval to relevant experts to sketch out a service management model for health care management of special patients. The final model was developed by the use of 3-stage Delphi technique.Results: In almost all of our references we found that:. Health and welfare ministries along with the private sector provide decentralized health care to. special patients. Health care programs for special patients encompass free services for regular check ups, vaccinations, life style training, acute illness care, health advisors, health aids and equipment, and . laboratory services. Policies are made by a committee named as "committee of health of special patients" having its . base at the supreme council of health. Finances are provided mainly by governmental funds and, subsequently by societies and NGO's with some participation of the special patients themselves (as premium and franchise).Conclusion: Our model for management of special patients includes formation of "committee of health of special patients" in the supreme council of health, establishment of office of health of special patients in the Ministry of Health and Medical Education, and provision of decentralized provincial services.Finances should be provided through taxes, charity aids and supports from international organizations. Nongovernmental and charity aids may be increased to decrease the financial burden on governments.

Background and Aim: Osteoarthritis is one of the most important etiologies of pain in weight bearing joints. Our objective was to investigate the efficacy of Subchondral percutaneous drilling for degenerative disease of the knee (DJD) and compare it with conservative treatment.Materials and Methods: 44 patients with knee DJD were studied from Oct 2005 to Dey 2006.21 knees (17 patients) underwent surgery, and 29 knees (27 patients) were treated conservatively. Pain, patient satisfaction, pain free active range of motion (ROM), and quality of life were assessed at the time of first visit, 2, 6 and 12 weeks and at the end of one year after treatment. Patients were followed at least for 1 year.Results: Mean age of surgically treated patients and controls was 47.3 and 58.3 years, respectively. Best results for the surgical group were achieved at second week after surgery and many of pain free patients deteriorated at 6 and 12 weeks and at one year. Patient satisfaction and pain free ROM of patients were better in control group in comparison with first group (P<0.05).Conclusion: Subchondral percutaneous drilling doesn't have the ability of decreasing pressure. Subchondral site is not the source of pain in most patients with DJD. The origin of pain should be investigated in the joint cartilage or other sites. Both these theories need further studies.

Background and Aim: In most part of the world detection of cysts and trophozoites of Entamoeba is based on morphological structure of this species in stool sample by microscopy. However, microscopic examination is unable to distinguish between similar morphological protozoa such as Entamoeba histolytica and Entamoeba dispar. A simple and cost-effective method is needed in medical aboratories for detection and differentiation of these two species.Materials and Methods: Stool samples of patients who were referred from health care centers were examined by direct microscopy and trichrome stain. Polymerase chain reaction (PCR) utilizing *pEd30F and pEd21AS primers from Peroxiredoxin gene, was used for differentiation of E. histolytica and E. dispar. Genomic DNA from samples was amplified by these primers. The fragment under 100 bp was related to E. histolytica and in contrast the fragment above the 100 bp was related to E. dispar. Results: In this study from 22 microscopic positive samples, E. histolytica was observed only in one patient and E. dispar was detected in the other 21 samples.Discussion: The result of this study indicate that the PCR reaction could amplify E. dispar and E. histolytica with just one primer pair and this is a cost-effective method for distinguishing between these two species.

Background and Aim: In addition to medical care, psychological support is needed to treat depression in rehabilitated cardiac patients.In this study we have compared the effectiveness of two different methods i.e. behavior-intervention and cognitive management in decreasing intensity of depression in rehabilitated cardiac patients. Materials and methods: All cardiac patients who had undergone surgery Coronary Artery Bypass Graft (CABG) during 2005-2006 in Khatam-al-Anbia general hospital of Zahedan were included in the study. Sixty seven patients fulfilling the criteria for inclusion were divided randomly into three groups, each comprising of 15 patients, two groups as experimental and one group as control. We used dual therapeutic methods of behavioral management and cognitive management in the two experimental groups, no intervention was done in the control group and multi group dependent variables were defined as the degree of depression in rehabilitated cardiac patients which was assessed by scale of light depression.Beck depression test was utilized for data collection for pre and post-tests; unilateral variance analysis (ANOVA) was used for data analysis. Results: The average score of depression in both test groups showed remarkable difference before and after intervention, whilst subjects in the control groups did not show any intervention. Cognitive method proved more efficient in lessening the intensity of depression.Conclusion: We can apply psychotherapeutic intervening procedures in order to enhance cure and improve to deal with psychological issues in such patients.

Background and Aim: Pregnancy induced hypertension (PIH), is a highly prevalent disorder. This study was done to define the relationship between pregnancy induced hypertension and migraine in women attending Kashan hospitals, Iran, in 2007. Materials and methods: This was a case-control study. The subjects were recruited using a consecutive sampling method, based on documented practitioner diagnosis of PIR. Subjects were assigned to two groups of case and control. Ninety women were allocated to each group. Data collection was done through a questionnaire that included demographic details, medical and obstetrics history, and details of migraine attacks. Validity and reliability of the questionnaire were assessed using content validity and test-retest methods. The two groups were matched to eliminate confounding factors. SPSS software was used for data analysis.Results: 180 women in two groups of 90 cases and 90 controls, with average age of 27.3±5.9 and 27.66±5.2 respectively, participated in the study. Majority were housewives with primary to middle school education, with a BMI >26, and no history of hypertension in their family or in previous pregnancies. Ten percent of subjects were affected by migraine and there were no cases of migraine with aura. Results demonstrated that history of migraine was positive in 14.4% of the case group and 5.6% of controls (Odds Ratio= 2.87).Conclusion: History of migraine could be considered as a risk factor for Pregnancy Induced Hypertension. 

Background and Aim: Giardiasis, a wide-spread, small intestine parasitic infection, is one of the main causes of human diarrhea, especially in young children. The prevalence of Giardia lamblia was reported to be between 1 and 25 percent; however, it is considerably higher under poor sanitary conditions. Metronidazole is used for the treatment of Giardiasis but it may have undesirable side effects. Carum copticum, a medicinal herb, has been used for its antibacterial, antifungal, and antiprotozoal effects for centuries. The present study was conducted to evaluate the in vitro effects of alcoholic extract, and essential oil from Carum copticum on Giardia lamblia.Materials and Methods: In this experimental study, Giardia lamblia cysts were incubated with the two different extracts of Carum copticum under standard laboratory conditions. Results: After 60 minutes Minimum Inhibitory Concentrations (MIC) of Carum copticum alcoholic extracts and essential oil were 100 mg and 8 mg/ml, respectively. After 120 minutes, MIC of Carum copticum alcoholic extracts and essential oil were 75 mg and 6 mg/ml, respectively; and after 180 minute MIC of Carum copticum alcoholic extracts and essential oil were 75 and 4 mg/ml, respectively.Conclusion: Findings of this study indicate that Carum copticum is effective against Giardia lamblia in vitro.

Background and Aim: In recent years, a number of studies have been done on patients with first-episode of psychosis. The importance of this issue is to improve outcome of the psychosis. Due to lack of similar research in Iran and differences in culture as well as in treatment program, investigation of demographic characteristics and treatment of patients with first-episode of psychosis could be useful in planning standard treatment. The objective of the present study is to survey the current situation of patients admitted to a psychiatric ward.Patients and Methods: This study was a descriptive study on recorded data. Files of patients hospitalized in the psychiatric ward of Taleghani Hospital from 1379 to 1384 with first episode of psychosis were selected. Data comprising of demographic characteristics, course of illness and treatment variables was documented on a pre-designed form. SPSS program using Chi-square and T-Test statistics were used to analyze the data.Results: Subjects were 75 patients, (64% male, 34% female), with age range between 17 to 72 years, (mean=31.3, mode=21), and 46.7% were married. 33.3% had suicidal thoughts or history of attempted suicide. 24% reported substance abuse. Three prevalent diagnoses were, bipolar disorder (32%), other psychoses (29.3%) and schizophrenia (14.7%). 80% of patients were prescribed classical anti-psychosis medication.Conclusion: Results showed significant differences in the demographic characteristics and treatment plans between this group of Iranian patients and published research. Based on observed data, development of appropriate protocols for optimal management seems necessary. Due to incomplete information in clinical files, prospective studies are recommended.

Background and Aim: This study was conducted in the first 6 months of the year 2005, to define the prevalence of alcohol, psychostimulant, and psychedelic drug abuse in teenagers and adults ranging 15 to 35 years old living in Tehran.Materials and Methods: This is a cross-sectional analysis and the study population encompassed persons aged 15 to 35 years living in Tehran. The study was performed from January to June 2005 in all of the 22 urban regions in Tehran. The information was collected through a written survey including demographic and relevant specified variables. The sampling method was clustered randomization in which 8175 individuals were surveyed. After sampling, the information was entered in the data bank and was analyzed with SPSS version 13.Results: The prevalence of psychedelic drug abuse was 3.8%, psychostimulant drug abuse was 7.2%, and alcohol abuse was 25.7%. The mean age in each group of substance abusers was similar to that of the whole population, and the sex distribution was significantly higher in males. Physical exercise, marriage, and the presence of both parents in the family were variables which had a significant correlation with low prevalence of drug and alcohol abuse. Unstable relationships of parents had the most significant positive correlation with drug and alcohol abuse.Conclusion: In this study, we have shown that alcohol abuse has a high prevalence of 25.7% among the individuals of our study population, followed by psychostimulant and psychedelic drug abuse, (7.2% and 3.8% respectively). Also, parental discord has a significant positive correlation with prevalence of drug and alcohol abuse.

Back Ground and Aim: Superficial fungal infections of the skin, including the dermatophytosis, are a public health problem. The aim of this study is to determine the prevalence of fungal infections and identify the causative agents of dermatophytos is and other related factors in children in Tehran, Iran. Patients and Methods: In this descriptive study a total of 984 children aged 2 months to 14 years, who were referred to the Medical Mycology Department, Pasteur Institute of Iran, in Tehran, in 2005 and 2006, were surveyed for the presence of dermatophytosis infections. All children were referred with a dermatological disorder, for direct examination, fungal culture and identification, and the incidence of each species was calculated.Results: In this study 264 cases were positive for fungal infections. The patients comprised of 182 male and 82 female. This study found a high prevalence of tinea corporis (51.7%) and tinea capitis (36.8%) in the population studied, with high proportions of Trichophyton tonsurans. The most frequently isolated etiological agent was Trichophyton tonsurans (44%), followed by Trichophyton verrucosum (19.6 %), Epidennophyton floccosum (10.5%), Microsporum canis (6.75 %) and Trichophyton violaceum (6.75%), Trichophyton rubrum (4.8%), and Trichophyton mentagrophytes (4.8%), and Trichophyton schoenleinii (2.8%) infections occurred sporadically among patients. A male preponderance (69%) was observed. In the present study 19.7% of our patients participated in wrestling.Discussion: Our experience has confirmed previous observations that during recent years there has been an increase in incidence of dermatophytosis due to Trichophyton tonsurans, in children. Consequently, development of infection control programs can be a challenging task. These findings suggest that further measures regarding public health and personal hygiene have to be taken to reduce the risk of dermatophytosis in Iran.

Background and Aim: Strategic thinking is the most essential part of educational planning. The main purpose of the present study is developing the Strategic educational planning of dermatology in Iran from 2007 to 2010.Materials and Methods: A qualitative investigation using focused group discussion was implemented for developing educational strategy in dermatology. Six to ten academic members of dermatologic departments and other stakeholders participated in this study. Strengths, weaknesses, opportunities and threats of dermatology education in Iran were analyzed. Strategic objectives in three domains, viz. education, research, and provision of health services were identified. Results: Educational objectives included training personnel at different academic levels ranging from general practice and specialization to fellowship in dermatology in accordance with the needs of the general public. In the field of research, necessity for more national and international participation and scientific discourse was recognized. In the health services domain designing cost-effective techniques for optimal management of dermatological problems are needed.Conclusion: Results of this study underscore the necessity of support for decision makers in Iranian health system.

Background and Aim: Children who were born from untreated hypothyroid mothers, have lower intelligence quotient (IQ) levels in school age in comparison with same age group. Nonetheless, the effect of hypothyroidism, especially subclinical form on fetal neuronal cell growth and subsequent imprints on intelligence and learning are unclear.This study was designed to evaluate intellectual development of children of mothers who had hypothyroidism, especially subclinical type during their pregnancies. Material and Methods: In this historical cohort study, out of 441 hypothyroid women, 90 patients with 106 pregnancies were reviewed. 44 children were enrolled in this study. They were divided to case (N=25) and control groups (N=19) according to the maternal TSH level during pregnancy. For all children serum TSH arid free T4 were measured by radioimmunoassay and urine Iodine concentration was assayed by acid digestion method. IQ level and cognitive performance of all children were also evaluated.Results: The basic characteristics of children except maternal TSH and T4 were the same between two groups. The age range of children was 4-14.5 years. All laboratory parameters (TSH, free T4 and urinary iodine) were similar in two groups. There was no significant difference in IQ level and cognitive performance between two groups. Using Pearson correlation test, except mother education level and neonatal weight there were no relationship between variables and IQ level.Conclusion: This study showed that IQ level and cognitive performance in children who were born from sub clinical hypothyroid mothers are similar to control group.

Hydroa vacciniforme is a rare acquired photodermatosis which usually presents in childhood. It is characterized by vesicle, crust and scar formation following exposure to sunlight. Vacciniform scars of face and dorsa of the hands are common features but oral ulcers and eye complications also occur rarely. Another rare manifestation of the disease is ear mutilation which is presented in this report.