Research in Medicine
Year:2006 | Volume:30 | Issue:3|Papers Count:22

Background: Iodine deficiency disorder (IDD) is a worldwide health problem. Parts of Iran, such as Tehran, had been known as endemic areas for goiter. IDD was accepted as a priority health problem in our country and a National IDD Council was formed in 1989. This study was performed to evaluate the National IDD Council program in 2001 among 7-10-year-old children in Tehran province.Materials and methods: In this cross sectional study, 1200 children (M/F ratio=I), aged 7-10 years, were selected and grading of goiter was performed in accordance to the WHO criteria. Urinary samples were obtained from 120 children and urinary iodine was measured using digestion method.Results: Total prevalence of goiter was 5.1% (3.5% in girls and 6.3% in boys). The median urinary iodine was 19 mg/dl 80.0.8% had urinary iodine of more than 10mg/gl, while 11.2% had urinary iodine levels of <5mg/dl. none of the candidates has urinary iodine of less the 2mg/dl. there was no significant difference between sexes and urban or rural areas.Conclusion: Results have revealed that the total prevalence of goiter has significantly decreased among children in Tehran province, mean while, urinary iodine concentration of children has reached to WHO approved rate. Thus, Tehran province could be classified among "iodine-deficiency-free" areas in Iran.

Background: Skin disorders especially infectious and contagious diseases are quite common in crowded environment. Few epidemiological studies have been conducted among university students, thus the present study was carried out to determine the frequency of skin disorders among university students in Shaheed Beheshti University of Medical Sciences' dormitories.Materials and methods: Totally, 1279 students were selected for this cross sectional study. They were examined by two dermatologists during a 3-month period. T-test and chi square were used for data analysis.Results: Of 1279 students, 1173 (91.7%) had skin disorder, of whom 658 (56%) were male and 515 (44%) were female. Acne (56%), hair loss among females (14%), seborouic dermatitis (9%), freckle (10%), hand eczema (10%), pityriasis versicolor (8%), xirosis (6%) and eczema (5%) were the most common skin disorders. There was an inverse strong relationship between acne and age.Conclusions: Skin disorders are quite common among university students.

Background: Cryptosporidium is a worldwide protozoa and one of the most important causes of diarrhea among under 5 years children and immunocompromized patients. The majority of studies conducted about the parasite is in developed countries and mainly focused on immunocompromized subjects. Also diarrhea and malnutrition are common in young children in developing countries and a reciprocal relationship has been postulated with diarrhea leading to malnutrition and malnutrition predisposing to diarrhea. Therefore this study was carried out in order to find the prevalence of Cryptosporidium infection and to assess micronutrient deficiencies in children hospitalized due to diarrhea and to compare micronutrient status in children with or without Cryptosporidium.Material and Methods: In this survey 504 stool samples were collected from hospitalized and outpatient children with acute diarrhea (259 and 245, respectively). Mean while, 114 stool samples were collected from children hospitalized for elective surgery who did not have diarrhea during the past 2 weeks before consultation (control group). All stools were screened by ELISA method for detection of Surface Cryptosporidium Antigen. In addition serum samples were collected from hospitalized children with diarrhea to assess vitamin A level by HPLC and Zn and Se by ICP-MS technique.Results: Of 504 samples, 12(2%) were infected with cryptosporidium. None of the controls were positive for cryptosporidium antigen. According to gender, there was no difference between girls and boys. Seven cases (58%) of infected children were seen in during spring. The mean of vitamin A and Zn in children with cryptosporidium were lower than other hospitalized children with diarrhea (p<0.05), however, the mean of selenium was higher in infected children although their difference did not reach a statistically significant level.Conclusions: Results revealed that the prevalence of infection with cryptosporidium in this survey was similar to the majority of studies performed in other parts of Iran. It seems that there is a need of laboratory tests to diagnose cryptosporidium infection in watery stools in Iran.

Background: Diabetic patients encounter numerous skin lesions. The present study surveyed the frequency of skin lesions among 1135 diabetic patients and their association with microvascular complications.Materials and methods: For this cross sectional study, 1135 diabetic patients (type II diabetes mellitus) wee selected through Iranian Diabetes Association, dermatologic and endocrine disease clinics in Tehran. They were all examined and skin culture, smear or biopsy was obtained when necessary. Blood pressure, weight and height were measured and neuropathy was determined using Michigan Neuropathy Screening Instrument. Retinopathy was evaluated by a ophthalmologist and all subjects were checked for FBS, HbA1c and albuminuria.Result: Totally 1135 diabetic patients including 516 males (45%) and 619 females (55%) with the mean age of 54±11 years and the mean disease duration of 9±7 years were enrolled. Skin lesions were found in 64% of the subjects. The mean age, mean disease duration, retinopathy, and neuropathy were significantly higher among subjects with skin disorder. Diabetic dermopathy was by far the most common presentation observed in 32.3% of subjects. Acantosis nigricans was found in 26.4% of subjects.Conclusion: Skin lesions are quite common among diabetic patients. Some may denote microvascular complications while the others may reveal poor blood sugar control.

Background Inhaled corticosteroids are indicated in children who have more than mild persistent asthma. Fluticasone propionate is a newer corticosteroid agent with more potency compared with previous generations. However, still few dose ranging studies have investigated optimal dosing of inhaled corticosteroids particularly in children regarding the tolerability and safety of the drug. The primary purpose of this study is to compare and evaluate the efficacy and safety of Fluticasone to Beclomethosone in the treatment of childhood asthma that is unresponsive to non-steroidal medications and also in persistent, moderate and severe asthma.Materials and methods: 70 children, aged 6 to 14 years, were enrolled in the open randomized trial of parallel group design.52 children with moderate, severe or persistent asthma received Fluticasone 100mg twice daily for 12 weeks compared with 18 asthmatic children on Beclomethasone 200mg daily. The outcome was assessed by data on questionnaires, changes in clinical symptoms, results of peak flowmetery (PEFR). More over safety was assessed by 24 hour urinary cortisol measuring at the beginning of the study and comparison of the data with urinary cortisol at the end of 12 weeks.Results: Of 70 children, 13 (18.6%) had a history of contact with pets during their life. At the beginning of the study in Beclomethasone group the following signs and symptoms were found: cough 88.9%, post exercise cough 88.9%, dyspnea 66.7% and wheeze 72.2%; however, these figures were as follow in Fluticasone group: 75%, 76.9%, 46.2%, and 59.6%, respectively. After 3 months of therapy they have been changed as follow 16.7%, 11.1%, 11.1% and 16.7%, respectively, in Beclomethasone group and 15.4%, 11.1%, 1.9% and 3.8%, respectively, in Fluticasone group. Data showed a better improvement in clinical signs of patients with Fluticasone (p<0.05). Pulmonary function test revealed a better lung function in Fluticasone group (p<0.05). In addition 24 hour urinary cortisol level was measured at the beginning and after 12 weeks of therapy and it was within normal range for both drugs.Conclusion: Fluticasone was associated with better improvement in lung function and controlled asthma symptoms much better than Beclomethasone, therefore, it is efficient in the treatment of persistent, moderate and severe asthma in children.

Background: Sensorineural hearing loss is one of the most important complications' of meningitis, however, it can be neglected during the acute course of the disease. By early detection and medical intervention, the retardation of lingual development can be avoided.Materials and methods: The hearing function of 40 children with meningitis was evaluated at 24- 72 hours after diagnosis (acute period) and 24 hours before discharging from hospital (recovery period) with auditory brainstem responses (ABR).Results: During the acute period, ABR test revealed normal hearing in 35 patients (87.5%) and severe to profound sensor neural hearing loss in 5 patients (12.5%). The same results were obtained in re-evaluation in the recovery period. There were significant differences between the female gender, positive culture of cerebrospinal fluid, the age below 2 years of old and hearing loss. (P value = 0.03, 0.02, 0.02, respectively).Conclusion: ABR can be used for early detection of hearing loss during the acute and recovery period of meningitis.

Background: H.pylori infection has been found to be associated with different diseases such as gastritis, peptic ulcer and malignancy. The present study was conducted to compare helicobacter pylori antibody in rural and urban children in Qazvin.Materials and methods: During this case-control study, 150 children aged 2-month to 12-year (75 urban and 75 rural children) who had been referred to Ghazvin Ghods Children hospital affiliated to Ghazvin University of Medical Sciences were included. Two groups of urban and rural children were matched according to age and sex. Serum IgG and IgA antibodies titer of H.pylori were determined by ELISA method.Results: Of 150 children, 23(12.3%) had positive antibodies titer against H.pylori., of whom 9 (12%) were urban and 14 (18%) were rural children (NS).Conclusion: There was no statistically significant difference between rural and urban children, however, rural children were more commonly infected.

Background: Palliative procedures in esophageal cancer to restore swallowing are preferable to- major surgery in most cases. The aim of this prospective study was to provide further information on treatment techniques, complications, and survival in the patients with malignant esophageal obstruction undergoing endoscopic palliative therapy using Self-Expanding Metal Stents (SEMS).Materials and methods: Patients with obstruction of the esophagus secondary to carcinoma who referred for stenting with SEMS between October 2004 and July 2005 were studied. In all cases the tumor was considered non-respectable and the stage of the disease was III or IV. All patients had aphagia or severe dysphagia to liquids and saliva, due to which, stenting was indicated. A follow-up in 1-11 months was taken, with physical and laboratory examinations. Symptom relief, survival rate, and complications were analyzed using Wilcoxon signed ranks test and student t-test by SPSS software version 10.0. Results were considered statistically significant for p<0.05.Results: Between October 2004 and July 2005 twenty two stents were placed under fluoroscopic guidance in 19 patients (13 males and 6 females with mean age of 65.5±12.6 years) with the obstruction of the esophagus secondary to carcinoma. Technical success rate was 100%. The dysphagia score improved significantly in a month after stenting (p=0.001). During this time period, appetite score of the patients was not improved significantly (p=0.070). Major immediate complications including severe pain occurred in two patients (10.5%). Eight (42.1%) patients died. The survival rate was 68.4%, 63.2% and 57.9% for 3, 6 and 9 months, respectively.Conclusion: Our results suggest that self-expandable metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction and its implantation will efficiently palliate dysphagia. The major problem of these patients, however, seems to be loss of appetite due to the underlying disease.

Background: The management of skin infections in wrestlers and other athletes in sports involving skin-to-skin contact is challenging, from making an accurate diagnosis to determining eligibility for play. In recent years, skin diseases in wrestling have finally received the attention it deserves. Tinea corporis gladiatorum, caused most frequently by triclophyton tonsurans, infect wrestlers at alarming rates. To control the outbreak, we conducted an epidemiologic investigation. The purpose of this study is to determine the prevalence of tinea corporis gladiatorum in wrestlers club in Tehran.Materials and methods: A study of dermatophytosis among wrestlers was carried out during March 2004 to December 2005 in 612 mycologically proven cases of dermatophytosis in wrestlers in Tehran. The wrestler mycologically examination consisting of direct microscopic observation and culture of pathologic material. Diagnosis was based on the macro-and microscopic characteristics of the colonies.Results: Trichophyton tonsurans was the predominant dermatophyte, accounting for 92.6% of all tinea corporis gladiatorum isolates in each of the 2 years analyzed. Tinea corporis gladiatorum was found to be more frequent in 10-20 (72.7%) and follow 21-30 (22.4%) age groups. The wrestlers with tinea corporis gladiatorum were mostly from wrestler clubs in south and southeast of Tehran. Transmission of tinea corporis is primarily through skin-to- skin contact.Conclusion: Practicing wrestling can lead to direct and indirect exposures to transmission of dermatophytes. The rapid identification and treatment of tinea corporis gladiatorum is vital to minimize disruption in team practices and competition, are paramount. Since infection with dermatophytes can disqualify a wrestler from competing in matches, vigilant surveillance and rapid initiation of therapy can reduce the suspension of a team's practice and competition.

Background: Vaginal bleeding is a tragedy that causes a high mortality and morbidity rate. The aim of this study was to find the most frequent causes of vaginal bleeding in first half of pregnancy. Materials and methods: This study is a cross sectional study performed on 161 cases with vaginal bleeding during pregnancy who had been referred to Taleghani Hospital. Sampling was achieved using non random convenient technique.Results: The mean age of subjects was 27.1±6.1 years and the mean gestational age was 16.3±10.1 weeks. Mean of gravidity was 2.5±1.6. Thirty three percents of subjects were primigravid. The most common causes of bleeding were: abortion (72.7%), placenta previa (12.4%), ectopic pregnancy (8.1%), and placenta abruptio (6.8%).Conclusion: Of 161 cases, 75 (46.5%) lead to abortion or curettage. Abortion was by far the most common cause of vaginal bleeding.

Background: The route of person-to-person transmission of helicobacter pylori may be either fecal-oral or oral-oral, because the bacterium is found in both dental plaque and feces. We assessed the prevalence of H. pylori, which reflects present or past infection in dental students exposed occupationally to dental plaque.Materials and methods: We examined the sera of 68 dental students and residents (24 residents and 44 students) and 69 age-matched controls by using quantitative ELISA for antibodies of lgG class to H. pylori.Results: The proportion of dental group seropositive for H. pylori was (39 of 68) 57.4%, the proportion of control group seropositive for H. pylori was (40 of 69) 58%. There was no significant difference between groups.Conclusion: We conclude that dental practice in dental students does not increase the risk of H.pylori infection.

Background: Acute otitis media (AOM) is one of the most common disease during childhood, therefore, every physician must be oriented about its diagnosis and treatment. This study was conducted to assess efficiency and performance of our medical educational system.Materials and methods: This descriptive study was performed on 100 general practitioners requesting them to fill a questionnaire composed of questions dealing with diagnosis, treatment and follow up of AOM.Results: Totally, 100 general practitioners with the mean age of 28.6±2 years wee enrolled. Averagely, 30.5% of questions had been answered correctly. Conclusion: Our general practitioners' knowledge about AGM was poor, thus, we should revise our medical educational system.

Background: Hydatid disease (echinococcosis), caused by small tape worm, is one of the most important parasitic zoonosis and remains a major public health and economic concern worldwide. Imaging and serological techniques are essential elements to control, particularly when where surveillance for the disease in humans may lead to early diagnosis and successful treatment. The present study was designed to survey hydatid cyst in rural area of Shemiranat Seroepidemiologically and determines the efficacy of IFA test.Materials and methods: For this descriptive study, 437 residents of Shemiranat were selected randomly. Indirect immunoflourescent (IFA) study was performed for all cases. Positive or suspicious subjects were confirmed by ELISA.Results: Totally, 437 subjects including 276 females and 161 males aged 4-76 years were included, among whom 1 (0.22%) was positive and 7 were suspicious.Conclusion: With respect to low prevalence rate, it seems as if health programs are adequate in the region. On the other hand, close relationship between residents of Shemiranat with modem urban culture could explain in part the low prevalence.

Background: Streptokinase has been widely prescribed as a fibrinolytic agent for myocardial infarction. Simple structural characteristics of this protein have provided techniques for production of different recombinant types of this protein. The present study was designed to prepare equisimilisH46A subtype of streptokinase in our country. Materials and methods: Having extracted the DNA, the streptokinase gene was replicated and cloned in pGEX-4T-2. The recombinant product was transformed in BL21 (DE3) plysS'. Then the recombinant streptokinase expression and performance was assessed by lasic densitometry and special test for S2251 substrate.Results: Use of a restriction enzyme for both sides of a gene may facilitate its cloning in different expressive carriers. Expression rate of recombinant protein (45%) confirmed successful cloning.Conclusions: Use of pGEX-4T-2 carrier was not only associated with active recombinant streptokinase production, added GST to its amine ending that could facilitate purification process.