Research in Medicine
Year:2005 | Volume:28 | Issue:4|Papers Count:17

Background: Hepatitis B can be easily transmitted form mother to child and can be prevented via vaccination of the newborn. American Academy of Pediatrics recommends preterm infants weighing less than 2000 grams at birth and born to HBS-Ag negative mothers should have their first dose of hepatitis B vaccine moved up to 1 month of age. The aim of the present study was to assess and compare the immune response of preterm and term infants to hepatitis B vaccine.Materials and methods: For this case-control study, 48 preterm (cases) and 49 term (controls) neonates were enrolled. The vaccine was administered at birth, 1.5 and 9 months of age. Antibodies against surface antigen (Anti-HBS) were measured at 15 months of age in all infants.Results: Cases were 24 boys and 24 girls and controls were 26 boys and 23 girls. The mean birth weight was 1595.7±388.3 and 3238.8±511.9 gr in the case and control group, respectively. Immune response to HB vaccine was protective and similar in both preterm and term groups (85.4% vs. 85.7%, respectively; NS). There was no significant association between the type of response and the infant's birth weight or sex. However, there was a significant relation between antibody titer and mechanical ventilation and sepsis (p=0.01).Conclusion: Hepatitis B vaccine is effective in most preterm infants when given at birth. Thus, there is no need to delay the timing of vaccination.

Background: With respect to the high prevalence of cardiovascular diseases and their related risk factors, obesity and abdominal obesity, among Iranians, the present study was conducted to determine the prevalence of obesity and abdominal obesity and their association with diet pattern of male adolescent in Tabriz.Materials and methods: 341 male adolescent aged 14-16years were randomly selected through a cluster sampling in Tabriz high schools. Anthropometric indices including weight, height, and waist and hip circumference were measured. According to the NHANES- I criteria, BMI≥85 was considered as overweight/obese and BMI<15 as underweight. Waist to hip ratio (WHR) at or above the 85th percentile was considered as abdominal obesity. Food intake pattern was assessed using a 24-hour food recall questionnaire. Underreporting of energy intake was also assessed.Results: The mean weight of the subjects was above the 50thpercentile of NCHS; however, their height was in accordance with the 50th percentile. The mean of weight, height, and waist and hip circumferences increased with advanced age. Based on NHANES-I criteria, underweight was found in 12%, overweight/obese in 20% and abdominal obesity in 16%. There was a significant difference between the overweight/obese -and underweight subjects regarding the energy intake (3154±738 vs. 2072±482 kcal/day), percent of energy derived from lipid (31±7vs. 17±3) and saturated fatty acid (14±4vs. 7±1 gr/d) (p<0.05). The overweight/obese subjects have also diminished the break fast more commonly than the other group (p<0.05). BMI showed a positive correlation with energy (r=0.2, p<0.05) and lipid(r=0.25, p<0.05). fiber association inverse an> Conclusion: High prevalence of overweight/obesity in adolescents and further intake of energy and lipid in the affected subjects necessitate an educative program dealing with the complications of obesity.

Background: Fungal respiratory infections are being recognized with increasing frequency in parallel with an expanding population of immunocompromised patients. In the present study 347 patients including 155 females and 192males with suspectedrespiratory fungal infection were included.Materials and methods: Bronchial alveolar lavage, bronchial brushing, and biopsies from chest wall, lungs and sinuses were studied. Diagnosis was made through direct fungal observation or culture.Results: Of 347 suspected specimens, 127 including 79 males and 48 females revealed to be infected by clinical examination: Fungi were more commonly found (54.3%) in subjects with at least one predisposing factor for fungal infection. Isolated organisms were candida albicans, candida spp., aspergillus fumigatus, aspergillus flavus, aspergillus niger, aspergillus spp. fusarium spp. cladosporium bantianum, pseudalleScheria boydii, and actinomyces spp.Conclusion: Controlling environmental transmission of fungi can be an important adjunct in managing an outbreak of nosocomial mycoses. Air conditioning system should be microbiologically monitored especially during period of repair or malfunction. High-efficiency particulate air filters should be utilized, when possible, in hospital areas with granulocytopenic patients.

Background: Pain relieving is one of the main aspects of obstetrics. Mental and physiologic complications of acute labor pains on fetus and mother are well known. In our maternity hospitals, relieving the labor pain is not routinely applied. Hence, it seems necessary to evaluate the cheap and safe methods in this regard. The present study has been accomplished in 2001 on those referring to Tehran's Mahdieh maternity hospital, with the aim of comparing the impact of inhalation of a mixture of oxygen and nitrous oxide (Entonox) with Transcutaneous Electrical Nerve Stimulation (TENS) on the labor pain.Materials and methods: 60 volunteer parturients were randomly placed in two groups of TENS and Entonox. The two groups were the matched according to the labor stimulation and the number of parities.The relevant data were collected via the questionnaire, observing and physical examination. Mothers of both groups applied each method in the form of self administering and showed their pain severity in certain intervals (4-5 cm, 6-7 cm, 8-9 cm, 10 cm dilatations) to the researcher using visual analog scale.Results: The mean of the pain severity in the whole active phase of labor was 6.91±1.03 the TENS group and 5.18±1.15 Entonox. (p=0.0001).Conclusion: Results have revealed that application of Entonox relieves the pain of the active phase of labor more satisfactory than TENS. The two mentioned ways left no negative or harmful impressions on the fetus and mother. Further studies in order to compare Entonox with other pain relieving techniques are recommended.  

Background: Following previous reports of impaired physical and intellectual growth, hearing deficit, hypothyroidism, and hyperendemic goiter in Kiga, and the administration of iodized oil injection, this study was conducted to evaluate if the effect of the injection could be sustained by iodized salt supplementation.Materials and methods: In 1989, one ml of iodized oil solution containing 480 mg of iodine was injected in 198 schoolchildren aged 8 to 14 years in Kiga. Four years later, in 1993 iodized salt consumption was begun and has been continued. Serum thyroid hormones, RT3U and TSH were measured before and 3, 4 and 6 years after intervention (1989, 1992, 1993 and 1995). Assessment of urinary iodine was performed at the same intervals mentioned above by Foss method.Results: Prior to the injection, 94% of the subjects had grade 2 goiters; 4 years after injection 30% and two years after iodized salt consumption 56% were agoiterous (p<0.001). Urinary iodine was 11.4±19.8 before and increased to 93±66 and 92±34 µg/L, 3 and 4 years after intervention. Two years after iodized salt consumption it was 161±34 µg/L(p<0.001). Mean serum Increased T4 level was observed following the iodized oil infection and continued after iodized salt consumption. Serum TSH was 20.3±22.8, 2.1±1.9, 2.5±1.6 and 2.9±1.7 mU/L; before and 3, 4 and 6 years after the beginning of study, respectively. All children were euthyroid at 3, 4 and 6 years of study. Conclusion: Findings show benefits of iodized oil administration in decreasing goiter size and in reversing abnormal thyroid function. These effects are sustained by iodized salt consumption in schoolchildren previously hypothyroid due to iodine deficiency.

Background: Special attention has been paid to the management of acute diarrhea in children during the recent 15 years. Diarrhea-related CME courses have been established in Iran since 1991 (Control of Diarrheal Diseases) in order to improve physicians" knowledge and attitude towards the appropriate management of acute diarrhea. The present study was conducted to assess knowledge of private physicians attending CME courses for acute diarrhea in Tehran.Materials and methods: Case group included physicians attending the CME courses and the controls were those not attending these courses. All were requested to reply a 13-question exam.Results: The mean score of pediatrician cases (n=48) and control (n=21) was 10.3±1.5 and 7.5±3.1, respectively (p<0.026).Conclusion: Results have revealed that CME courses have effectively improved the physicians' knowledge.

Background: The Association between physical and psychological disorders has been demonstrated repeatedly. Gastro intestinal disorders are common medical diseases which have similar symptoms with mental disorders and also may produce psychiatric problems or be aggravated under psychological distress. Gastro intestinal complaints are among the most common symptoms in primary care and internal clinics that frequently remained unexplained. Most of prior studies are dealing with mental changes following the digestive disease. The present study has evaluated mental changes during the prior year of digestive disease diagnosi in a group of patients with definite peptic ulcer.Materials and methods: 200 peptic ulcer cases (140 males and 60 females) who had referred during 1376.10.20 and 1377.10.20 and indicated for endoscopy were randomly selected. We completed Holmes- Rahe mental-social table and a questionnaire dealing with risk factors of digestive diseases such as cigarette smoking, NSAIDs, alcohol, and caffeine use and also 0 blood group. Patients were assigned in two groups of A (disease onset prior to 6 months ago) and B (disease onset during the past 6 months).Results: The mean stress of male patients in group A and B was 253 and 218, respectively. These figures were 257 and 221 in females. Of 140 males, 104 (74.2%) had blood group 0, 17.2% were smoker and 8.6% had the history of NSAIDs use. The corresponding figures were 46.6%, 26.6% and 26.7% in females. Among 200 patients, endoscopy failed to show evidences of cancer or helicobacter pylori infection in 120. These patients were discharged by antacid, H2blocker and mild tranquilizer therapy. The remaining 80 cases had positive pathologic findings favourable of helicobacter infection with gastric, esophageal, or pancereas malignancies.Conclusion: Results have revealed that 60% of the studied patients had just one stress tension during their life. Thus, mental changes are prior to physical changes. Physicians should concern more about the mental-social changes in patients liable to digestive system diseases. Stress should always be kept in mind in the management of the affected patients.

Background: Barrett"s esophagus is a precancerous lesion leading to esophageal carcinoma in 10% of cases. It is usually remained undetected during endoscopy and most of physicians do not take biopsy from gastroesophagealjunction (GEl) when it seems to be normal. In the present study we have determined the frequency of Barrett"s esophagus in a group of Iranian patients referring for endoscopy to our unit. Materials and methods: During an eight-month period, 146 patients who had referred to our endoscopy unit entered our study regardless of their indication for endoscopy. A questionnaire dealing with demographic features, clinical manifestation of reflux, and indication for endoscopy was completed. During endoscopy, 2-4 biopsies obtained from Z-line. Finally, data were analyzed using SPSS software. Results: The study population included 78 females and 68 males. Abdominal discomfort was the most common presenting manifestation (67.8%). Other symptoms were reflux (7.9%), dysphagia (17.1%),chest pain (28.1%), and regurgitation (4.8%). Endoscopy revealed short segment Ban-ett"s esophagus in " 13%, long segment Ban-ett"s esophagus in 4.8%, esophagitis in 11% and hia4il hernia in 11%. Pathologic studies showed Ban-ett"s esophagus in 4 (2.7%) patients, of whom, 2 had clinical manifestations of reflux and 3 failed to have endoscopic appearance of Ban-ett"s esophagus. Conclusion: As noted previously, 10% of cases with Ban-ett"s esophagus may lead to esophageal adenocarcinoma, thus, appropriate criteria should be established to diagnose patients with Ban-ett"s esophagus during their early stage.

Background: Finding an association between HFE mutations and hepatitis C especially in those with iron overload is the focus of recent researches. We examined the frequency of these mutations and ferritin level in a group of patients with different stages of hepatitis B and healthy individuals.Materials and methods: A total of 75 (18 carner, 57 chronic) cases of HBsAg positive patients and 194 healthy individuals were enrolled. C282Y and R63D mutations were sought in all subjects by digestion of PCR products with Rsa I and Ksp22I restriction endonucleases.Results: Ten (13.3%) of cases and 31(16%) of controls were heterozygote for R63D that showed no significant statistical differences (NS). For C282Y mutation, we found 3(4%) heterozygote patients but none in the control group (p<0.021). The frequency of C282Y heterozygosity was 5.2% in chronic group while there was no similar case in carrier group. Significant statistical differences were also found between chronic and the control group (p<0.005). No statistically significant difference for frequency of RFE mutations was found between carrier and chronic group with each other (NS). Mean level of ferritin in those with the mutation showed no statistically significant difference with that of patients without mutation (NS).Conclusion: Our data indicate that the frequency of C282Y mutation is significantly higher in seropositive hepatitis B patients than in the healthy individuals and suggest that heterozygotes for C282Y mutation that have exposed to hepatitis B virus may have an increased risk of virus persistence or even chronicity.

Background: Parasites are important enteric pathogens among patients with immunodeficiency virus (HIV) infection. In our country there are very few reports on prevalence of intestinal parasites among these patients. Materials and methods: In the present study we have determined the prevalence of intestinal parasites among RIV-positive individuals visited in different medical centers in Iran. Single stool samples were collected and analyzed for various intestinal parasites from 206 RIV-positive individuals with different immune status. The data were tested for statistical significance with X2 and Mann-Whitney U tests. Results: The overall prevalence of intestinal parasites was 18.4% (95%CI: 13.7-24.3). In particular, the following parasites were identified: Giardia lamblia (7.3%), Blastocystis hominis (4.4%), Entamoeba coli (3.9%), and Cryptosporidium parvum (1.5%). Strongyloides stercoralis and Hymenolepis nana were also found in two cases and Dicrocoelium dendriticum in one. Intestinal parasites were significantly more common among patients with diarrhea (n=28) than those without (n=178) (p<0.001).Conclusions: This study highlights the importance of testing for intestinal parasites among Iranian HIV positive patients especially those with low immunity presented with diarrhea.

Background: Elevated levels of intracellular and extracellular carbohydrates or even in vitro can cause cellular dysfunction that may lead to death. This disorder in diabetic and galactosemic patients paves the way for systemic immune dysfunction and made the patients susceptible for infections. The present study was conducted to determine the effect of glycation of culture medium on phagocytic and respiratory burst of peritoneal macrophages from Balb/c mice.Materials and methods: It was an experimental study. Macrophages were obtained from peritoneal cavity lavage of the pure Balb/c mice. Cells were harvested in complete tissue culture medium including different levels of glucose and galactos (5 mM to 30 mM) while control group lack any sugar in the medium. E.coli has been used to study the rates of ingestion and killing activity of the cells under these conditions. The adhesion of macrophages was assessed by the average adhered cells in some microscopic fields and also the morphological changes were evaluated. The oxidative and respiratory burst were measured with NBT reduction test. With the counting of the E.coli ingested in cells and also with the numbering of the cells ingested the E.coli, the rate of ingestion, was determined. In order to study the killing activity of the macrophages, after incubation of the macrophages and E.coli with some stimulators, the number of E.coli left in the culture medium was determined by two different ways: Standard mc farland tubes and colony counting.Results: Reduced adhesion and phagocytic morphogenesis were found in media with 15 and 30 mM of galactose as compared with other media and control group (p<0.05). M. eanwile, number of ingested bacteria was significantly differed in media with concentration of 30 mM and the control group. Elevated levels of carbohydrates significantly impaired the bacterial activities (ingesgtion and killing) however, respiratory burst of the cells were not changed. Conclusion: Increased concentration of glucose and galactose cause impairment of the morphological chnges andadhesion of the macrophages, whereas, respiratory burst function remains unchanged. Recurrent infections in diabetic and galactosemic patients may be explained by this phagocytic imparment.

Background: Familial Mediterranean fever (FMF) is an autosomal recessive disease, which is characterized by recurrent short episodes of inflammation in serous membranes. It is most prevalent in Western Mediterranean population. MEFV is the only gene currently known to be associated with this disease. Previous studies revealed that 6% of Iranian Jewish residents in Israel were carriers of MEFV mutation. The present study was undertaken to analyze the three known mutations of this gene in Iranian patients.Materials and methods: Thirty patients met full inclusion criteria and 30 healthy controls enrolled in the study. To detect M694V, M680I and V726I mutations, genomic DNA, extracted from peripheral blood lymphocytes, was examined using amplification refractory mutation system (ARMS-PCR) and common, normal and mutant specific primers.Results: Fever and intermittent episodic abdominal pain were the most common manifestations among the cases. Of the 30 cases, 9(30%) were positive for M694V mutation (2 homozygote, 6 simple heterozygote, and one compound heterozygote), 4 (13.3%) for M680I mutation (one homozygote, 2 simple heterozygote, and one compound heterozygote) and one (3.3%) for V726I mutation. All controls were negative for these three mutations.Conclusion: As in other ethnic groups, M694V mutation is the most common MEFV mutation in Iranian FMF patients but it exists in lower frequency. Consequently we recommend full mutation analysis of MEFV gene in all of our samples especially in those we could not find any of the three mutations mentioned above.