Research in Medicine
Year:2009 | Volume:33 | Issue:2|Papers Count:15

Background: Hemostasis has turned into one of the major concerns in surgery and anesthesia. Anesthesiologists are always pursuing new methods and medications to avoid allogenic and autologous blood transfusion. The present study aimed at examining the effects of tranexamic acid on the reduction of hemorrhage and the need for transfusion. Methods: A sequential controlled clinical trial was performed on 60 patients referred to Imam Hossein Hospital, with femoral fracture, aged between 20 to 50, and with no coexisting diseases. The patients were divided into trial and control groups of 30 each. Prior to the surgery, the trial group received 10mg/kg dose of Tranexamic acid. Results: There were significant differences between the two groups with the average blood loss in trial group 675±208.7cc and in control group 998.4±230.9cc. In trial group, 5 patients and in control group 14 patients received Allogenic blood in which the difference was also statistically significant (P<0.02). Conclusion: It is concluded that the use of Tranexamic acid reduces operational hemorrhage and blood transfusion during femoral fracture surgery. Further evaluation of safety is required before recommending the use of antifibrinolytics in orthopedic surgery.

Background: Water and electrolyte balance are critical for the maintenance of general health. Exercise creates much variation in renal homodynamic and electrolytes excretion. Sauna is also an extreme hot environment placing an individual in heat stress. The aim of this study was to compare the effects of one session aerobic activity and sauna on serum and urinary sodium and potassium concentration in athletes. Methods: A quasi-experimental study was conducted on 15 football players of Shahid Beheshti University M.C (Age: 24.5±2.5 yr; Weight: 72±8 kg). Blood samples were taken before and after aerobic activity and sauna, and 24 hours urine was also collected before and after exertion of independent variables. The data were analyzed using mean and standard deviation for statistical description and dependent t-test for inferential analysis. Results: The results showed that one session physical activity significantly increased serum sodium andpotassium (p£0.01) concentrations. Also one session attending in the sauna significantly increased serum potassium concentration (p£0.05), but did not significantly increase serum sodium concentration. When aerobic activity and sauna were compared, the results showed no statistical significant differences in the mean of serum sodium and potassium variations. Other findings indicated that one session physical activity significantly increased urinary sodium (p£0.01), but did not significantly change urinary potassium concentration. Also one session attending in the sauna did not significantly change urinary sodium concentration, but significantly increased urinary potassium concentration (p£0.05). There was no significant difference between the mean urinary potassium concentration in one session attending in Sauna and aerobic activity. Conclusion: The concentration of sodium and potassium in plasma and urinary sodium increased during prolonged physical aerobic activity but did not significantly change urinary potassium concentration. Physical exercise and heat stress lead to both water and electrolyte imbalances.

Backgraound: Carpal tunnel syndrome (CTS) is the most common nerve compression neuropathy. It is a multifactorial syndrome and several systemic and local factors such as carpal tunnel anatomy and its variation change the size, shape and volume of this tunnel. In this study, we seek to explain the relation between anatomic variation of thenar muscle and CTS. Methods: This descriptive study was conducted on 155 patients with CTS undergoing operation. Care was taken to exclude patients with Rhumatoid Artritis, Hyperthyroidisem, Hypothyroidisom, Diabetic Melitus, acromegaly and previous fracture of distal wrist. During surgery thenar muscle anatomic variations of carpal tunnel have been observed. Results: Of 155 patients, 140 were female (90.3%), and 15 male (9.7%) patients with the mean age of 57.9 years. The anatomic variations have been observed in 35(22.5%) patients. Conclusion: Thenar muscle anatomic variation in CTS is prevalent but further evidence is required.

Backgraound: The indexed scientific publication in valid information databases like ISI is an important scale for rating universities. Publication of scientific productions in these databases increases accessability, resulting in greater citation. In this survey, the status of publishing and citing of the SBMU (Shahid Beheshti Medical University) articles from 1997 to 2007 has been studied. The findings are expected to be useful for SBMU schedules and policy making decisions in future. Methods: This is a descriptive scientometric survey of all the articles published by SBMU members in the citation indexes of ISI from 1998 to 2007. The findings have been reported, using descriptive statistics. Results: A total of 1431 articles were investigated. According to the results, the rate of SBMU articles has increased considerably in the study period. Most articles have been published in "American journal of Gastroenterology" and "Journal of Endourology" (each with 35 articles, comprising 2.5% of the articles). All of the articles were in English and most in the field of pharmacology & pharmacy. In 70% of the articles, SBMU researchers were the first author. Most rating citations belong to the articles published in 2006 while articles of 2003 have the highest rate of indexing. The citation diagram shows an increasing curve. Conclusion: The number of article publications and their citations has increased during 1997-2007 which may be an indicative of encouragements and supports provided for the researchers by the university.

Background: Sporadic colorectal cancer is the fourth most common cancer in Iran. The DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) is involved in the cellular defense against alkylating agents. Genetic alterations in the MGMT gene may impair the protein’s ability to remove alkyl groups from the O6-position of guanine, thereby raising the mutation rate and increasing the risk of sporadic colorectal cancer. Methods: We hypothesized that amino acid substitution polymorphisms in the MGMT gene may be associated with the genetic susceptibility to sporadic colorectal cancer. We assessed five non-synomymous polymorphisms (Pro58Ser, Leu84Phe, Arg128Gln, Ile143Val, and Gly160Arg) in the MGMT gene by PCR/Pyrosequencing. The population studied consisted of 200 sporadic colorectal cancer patients and 200 healthy individuals (blood donors), all of Iranian origin. Allele frequencies and genotypes were compared between the two groups. Odds ratios were calculated and the interactions among the polymorphisms, age and sex were examined. Result: There was a significant association between two amino acid substitution polymorphisms (Arg128Gln and Gly160Arg) of MGMT gene and sporadic colorectal cancer. Conclusion: we could show a significant association between the two polymorphisms and colorectal cancer. This might be a superior marker for colon cancer screening in the future.

Background: Hereditary non-polyposis colorectal cancer is the most common cause of early onset of hereditary colorectal cancer. In the majority of Hereditary non-polyposis colorectal cancer families, microsatellite instability and germline mutation in one of the DNA mismatch repair genes in clouding MSH2, MLH1, MSH6 and PMS2 are found. The Objective of this study was to determine the involvement of mismatch repair genes mutations in Iranian population, and microsatellite instability profile in patients with colorectal cancer. Methods: We analyzed 592 patients with colorectal cancer. The entire coding sequence of each gene was analyzed using direct sequencing. Results: We were able to find three novel MLH1 germline mutations in three Iranian patients suffering from hereditary non-polyposis colorectal cancer. The first was a transversion mutation c.346A>C (T116P), which occured in the highly conserved HATPase-c region of MLH1 protein. The second was also a transversion mutation c.736A>T (I246L), which caused an amino acid change of Isoleucine to Leucine. The third mutation (c.2145,6 delTG) was frame shift mutation, and resulted in an immature stop codon in five codons downstream. All of these three mutations were detected in MLH1 gene. In all patients, an abnormal expression of MMR proteins was related to the above mutations. MSI assay revealed high instability in microsatellite for two patients and microsatellite stability for one patient. Conclusion: These novel mutations may imply the different characteristics of hereditary non-polyposis colorectal cancer in Iranian population as compared to reports from the western countries.

Medical education in Iran consists of undergraduate, postgraduate and continuing medical education (CME), like most other countries. Experts in medical education, in various meetings, recommended strategies to implement fundamental changes and improve medical education to alleviate current defects in medical education. One of the most important suggestions was to develop information technology in the field of medical education. Nowadays, most colleges in developed countries use online systems for communication with students, and also most courses are presented as online. These changes have been occurred in Iran, and medical schools of Iran have implemented electronic learning (E-learning) in their strategic planning. Efforts have been made in some universities to implement E-learning in CME courses. This may advance E-learning in medical education, especially in basic sciences. In this study, more than 50 international articles, 10 domestic articles and 80 websites related with E-learning in medical education were evaluated. Our findings showed that E-learning has been a routine program in world medical universities. Some Universities, such as North American Universities, have implemented E-learning in the education of all courses of basic sciences. Some Iranian Universities have set up CME programs in this topic, and have presented some courses as E-learning.

Background: Conjunctivitis, one of the most prevalent eye complications, is usually self limited but may result in optical disorders .Classification is based on the cause including bacterial, viral, fungal, allergic or chemical. Considering antimicrobial resistance, determining the exact cause may lead to improved medical therapy. Methods: In this descriptive-analytic survey, 92 patients with conjunctivitis, who attended Shaheed Labbafi Nezhad medical center, were enrolled. Samples were accurately collected by the physician working in the center and were transported in a sterile condition to the Laboratory of Pediatric Infectious Research Center of Mofid hospital. Determination of mycobacteria, aerobic and anaerobic bacteria was accomplished using standard methods. Data was analyzed using SPSS 13. Results: Samples were obtained from 49 men (61.4%) and 43 women (38.6%), (median age 36.2). 85% of patients with bacterial conjunctivitis had mucoplurant discharge as a main symptom. 45 (58.5%) cultures were positive. Aerobic organisms were isolated from 40 patients (57.1%) and anaerobic ones from 5 (7.1%), of which 4 were mixed with aerobes. No mycobacterium was found. The most common aerobic organism cultured was staphylococcus epidermidis (30%) and the other aerobic ones were: Staphylococcus aureus (12.9%), E coli (7.1%), Bacillus cereus (5.7%), Moraxella catarrhalis (4.3%), Diphteroid (4.3%), Acientobacter baumanii (2.9%), Citrobacter fraundii (2.9%), Staphylococcus oricularis (1.4%), Streptococcus viridans (1.4%), Bacillus subtilis (1.4%), Pseudomonas aeruginosa (1.4%), and Proteus mirabilis (1.4%). Anaerobic organisms cultured were Peptostreptococcus (4.3%) and Bacteroides fragilis (2.9%). Conclusion: Since various organisms are responsible for bacterial conjunctivitis, therapeutic strategies should be based on the results of microbiological investigations.

Background: Provision of prompt medical services is the main purpose of the emergency department. Waiting time for receiving appropriate services is considered as an important indicator for evaluating hospitals. The objective of this study was to determine the average waiting time for receiving treatment and diagnostic services in the emergency department from the point of arrival of the patient up to his exit in Rasool Akram and Firoozabadi hospitals in 2007. Methods: Data was collected using designed questionnaire based on" the time study of emergency services provision form" prepared by the Ministry of Health. The waiting time for receiving medical services was studied for 239 consecutive patients from their arrival up to their discharge in the emergency department of two selected hospitals for a period of one week from 8th to 22nd of December, 2007. Results: Average length of stay for patients in the emergency department was 283.6 minutes. The average waiting time in Rasool Akram teaching hospital, (346.3 min), was much more than Firoozabadi hospital. Average time spent from patient arrival up to the first visit, (checkup) was 13.1 minutes and the average time spent between first visit and the first treatment step was 105.3 minutes. Furthermore, the average duration between the times the patients were discharged by the physicians till the time of exit from the emergency department was 49.3 minutes. Conclusion: In order to decrease the waiting time for receiving medical services in emergency department of teaching hospitals and to increase patient satisfaction, reviewing the process of service provision to patients and training of service providers is urgently needed.

Background: Hydatid cyst mostly presents solitary cyst in right lobe of liver. It is asymptomatic and patient presents with pressure effects or rupture of cyst. Case Report: We introduce a patient who was referred to the emergency room with history of blunt trauma and symptoms of abdominal pain and generalized severe pruritus without anaphylaxis and urticaria. Explorative laparotomy showed a ruptured hydatid cyst. Albendazole 400 milligram was prescribed twice a day for 4 weeks after operation. The patient discharged with healthy appearance. There were no abnormal findings in further follow-up visits.

Background: Yellow nail syndrome is a rare disease of unknown etiology, presenting with lymphedema, respiratory symptoms and yellow nails. Case Report: We have reported a 10 year-old female who presented with yellow discoloration, thickness and increased convexity of nail cuticles in all fingers and toes. On examination, non-pitting edema was present on both lower limbs.