Research in Medicine
Year:2003 | Volume:27 | Issue:1|Papers Count:19

Background: Balloon valvuloplasty is a relatively new technique for relief of obstruction of aortic valve.The primary results of this procedure are similar to surgical valvotomy with fewer complications and mortality.Materials and methods: One hundred fifty-five patients with congenital aortic stenosis were enrolled in this study over a period of 6 years (1991-1997). Participants were all under 16 years old. Amongthem 17 (10.9%) had subvalvular and 6 (3.9%) had supravalvular aortic stenosis. The remaining 133 patients (85%) had valvular aortic stenosis. Of these, 18 cases were excluded from the study because of severe aortic insufficiency (AI) and associated cardiac anomalies. Among the remaining 115 patients with valvar aortic stenosis, 48 (42%) underwent balloon valvuloplasty and 67 (58%) subjected to surgical aortic valvotomy.Result: Comparison of balloon valvuloplasty and surgical valvotomy data revealed that the gradient reduction across the aortic valve was greater in patients who underwent valvuloplasty (P=0.012). Decreased incidence of aortic insufficiency and mortality in balloon valvuloplasty group in comparison with surgical group are other notable points in this study.Conclusion: Successful results of balloon valvuloplasty for aortic stenosis and the advantage of relative safety of this procedure in comparison with surgical valvotomy appears reasonable to use this technique primarily almost for all patients who meet necessary criteria for relief of the aortic stenosis.

Background: Previous evidences have been demonstrated that serum zinc deficiency in thalassemia major (TM) children is probably due to increase of zinc excretion, elevated ferritin level and desferal consumption or hepatic dysfunction. The aim of this study is determination of serum zinc concentration in thalassemia major children.Material and methods: This study has been carried on 77 children 7-12 years old. 10 ml blood from 40 TM children (case group) and 33 matched healthy children (control group) were obtained. Serum zinc level was measured using Rundox Factory Kits by atomic absorption system SP9-PYE (Unican) and results were analyzed by t test.Results: Results indicated that mean of serum zinc in case group (TM children) has been significantly decreased in comparison with control group (p<0.000). The mean of serum zinc level in the case and control groups was 37±1.9and 51±1.8, respectively.Conclusion: Results have revealed that serum zinc level has been significantly decreased in TM children.

Background: The present study was conducted to compare the efficacy and safety of intracervical Foley catheter with vaginal prostaglandin E2 suppository for cervical ripening before the delivery induction with oxytonin for second trimester pregnancy termination in Imam Reza hospital, in Mashad, 1998-2000.Materials and methods: In this randomized prospective study, seventy pregnant women with gestational age of 14-28weeks who had unfavorable cervix (Bishop score <4) referring for pregnancy termination were enrolled. They were assigned randomly to either vaginal prostin E2 (dinoprostone) group (received 3mg every 6 hours up to two doses) or supracervical balloon of the Fo1eycatheter group.Results: There was no significant difference between the two groups with respect to the Bishop score changes, but the mean time interval between induction to delivery was significantly shorter in the catheter group compared to PGE2 group (l5±7.7 vs. 20.8±5.8 hours, p<0.01).Conclusions: Our findings showed that using Foley catheter for cervical ripening in second trimester pregnancy termination is as effective and safe as PGE2 and it is associated with a more rapid evacuation of the uterus and fewer side effects than intravaginal PGE2 suppositories. Meanwhile, it is more available and cheaper than PGE2.

Background: Exercise test is the only means of assessing a child's physical functional ability. All other cardiovascular tests are performed during the resting phase and do not appear to be strong concurrence of homodynamic data to physical performance. The most common exercise protocol utilizing in children is Bruce treadmill protocol and work capacity is best evaluated by maximal exercise.Materials and methods: Forty patients after total correction for Tetralogy of Fallot (TOF) were selected. In 19 patients (11 males and 8 females) surgery was performed with and in 21 patients (11 males and 10 females) surgery was performed without transannular patch. Maximal treadmill exercise (Bruce protocol) was performed in these two groups of patients and results were compared.Results: Of 19 patients with transannular patch, 10 (52.6%) had PS (pulmonary stenosis) and 14 (73.7%) had PI (pulmonary insufficiency). These figures were 28.6% and 33.3% for the other group. In patients with transannular patch, mean maximal blood pressure during exercise test was 124.8mmHg, however in the other group it was 132mmHg.Conclusion: There were statistically significant differences between the prevalence of PI and mean maximal blood pressure in two groups of patients. Although working capacity was better in patients operated without transannular patch but there was no statistically significant differences. The better exercise test results in patients operated without transannular patch is related to lower prevalence of PI and PS in this group.

Background: There are various methods for morphine extraction and detection, for this, Thin Layer Chromatography (TLC) is a useful tool. The most common detection technique of TLC plates is slit scanning densitometry. The aim of the present study was to compare the ability of a solid phase extraction (SPE) system with liquid-liquid extraction (LLE) for urinary detection of morphine by a TLC scanner.Materials and methods: Ten urine samples were collected from opioid abusers and each sample was divided in 4; two fractions were extracted by the SPE system and the other two were extracted by LLE technique (Chloroform/2-Propanol, shaking and centrifugation). One sample of each fraction was hydrolysed. Finally, all samples were quantitatively analyzed by TLC-scanner.Results: Results have revealed that the area under curve (AUC) on hydrolyzed samples was higher than non hydrolyzed ones.Conclusion: Both techniques have showed better results for hydrolyzed samples. The recovery rate of SPE and LLE techniques were 94 and 80% respectively.

Background: Lichen planus is a mucocutaneous inflammatory disease with adnexal involvement. Pathologic studies were commonly used for definite diagnosis. Hyperkeratosis, hyper granulosis, acanthosis, elongation of rete ridges, basal cell degeneration and band like lymph infiltration are 6 histopathological findings in diagnosis oflichen planus.Materials and methods: In this research 200 pathological reports of patients with lichen planus (114 males and 86 females) have been studies.Results: Lymphocytic infiltration (band like or focally) was the most common findings, whereas intact basal layer was the rarest finding. In 60 patients the diagnosis was confirmed by the 6 classic histopathological findings. Sampling was performed in 18% of the patients form mucosal lesions. Histopathologic findings have shown no significant correlation with age and sex. Focal degeneration of basal layer and focal infiltration of lymphocyte in mucosal lesions have shown significant increase as compared with skin lesions (p<0.05).Conclusion: Unfortunately, the pathologic studies of lichen planus encountered lots of problems. Further studies are strongly suggested.

Background: The present study was conducted to determine the dietary diversity score and its association to other measure of diet quality, including mean adequacy ratio.Materials and methods: After excluding the underreported subjects, 581 individuals over 18 years old (295 women & 286 men) were selected. Their dietary intake assessments were based on.2 day 24 hour food recall interview. A dietary diversity score was based USDA-defined food groups calculated as part of the pyramid serving database that categorized into 23 broad food groups. The dietary diversity score reflects a weighted average of scores for each of the 5 primary food subgroups. Therefore each of the 5 broad food categories received a maximum diversity score of2 the 10possible score points. To be counted as a "consumer" for any of the food groups categories, a respondent needed to consume one-half serving, as defined by Food Guide Pyramid quantity criteria, at any time during the 2-day survey period. The nutrient adequacy ratio for a given nutrient is the ratio of a subject's intake to the current recommended allowance for the subjects' sex and age category.Results: The minimum and maximum dietary diversity score was shown in grain (0.85:i0.24) and fruit (1.48±0.6) groups, respectively. There was no difference in dietary variety score between men and women.Half of people in this study had the dietary diversity score less than 6. There were no signification correlation between energy intake, fat (%), carbohydrate, protein, fiber and cholesterol (gr) with dietary score. The dietary diversity score was correlated with mean adequacy ratio score (P<0.05).Conclusion: Based on this survey and prior reports, dietary diversity score provide and ideal method to determine the differences of dietary patterns of different peoples and a new measure to predict dietary adequacy. Half of the people of this survey hadn't ideal dietary diversity score, so nutrition education as a more concrete concept of a varied diet is necessary.

Background: The role of citalopram (a tricyclic antidepressant of SSRI group) on ouabain-induced arrhythmia in guinea pig was well established.Materials and methods: Thirty-two guinea pigs were randomly assigned in any of the four groups; citalopram, ouabain, citalopram+ouabain" and control. The Na, K, and Ca concentrations were measured using atomic absorption technique.Results: Citalopram could significantly reduce the contractility and pulse rate. Ouabain-induced arrhythmia occurred after 4.5 minutes and ouabia-induced asystole and toxicity was revealed after 20 minutes, however, previous administration of citalopram (8 mg/ml) prolongedthe time of arrhythmia to 9 minutes and the atria were alive till the 20th minute (p<0.05, and p<0.001, respectively), Ouabain administration was accompanied with increased Na concentration, however, K and Ca concentrations have not significantly changed.Citalopram has changed the K concentration (p<0.05).Conclusion: Citalopram has a direct negative inotropic effect on guinea pig atria. This may be explained through an inhibitory effect on Na and K channels or potassium hyperpolarization. Meanwhile, citalopram prevent ouabain-induced arrhythmia and toxicity. This activity could be due to cell membrane stabilization and cessation of ionic changes.

Background: Smoking is one the most important risk factors of non-contagious diseases in Iran. The present study was carried out to determine the pattern of smoking habit in an urban area in Tehran.Materials and methods: The study population included 5023 males and 6778 females aged 2:15years enrolling for Tehran Glucose and Lipid Study. A questionnaire dealing with their smoking habit and demographic data was completed by interview.Results: Totally, 10.6% were daily smokers (22% were males and 2.1% females), of which 8% smoked more a pack a day. 1.5% was occasional smokers, and 6.1%were ex-smokers. 63.2% of-males and 95.6% of females were non-smokers (81.8%). Smoking was increased as age increased in both sexes; indeed, peak age group was individuals aged 35-44 years. 1364 (12.6%) of educated subjects and 61 (6%) illiterates were daily or occasional smokers (p<0.001).Conclusion: Smoking could be a potential risk factor especially in males. Educational interventions are highly suggested.

Background: Autoimmune hepatitis is a chronic liver disease that could lead to cirrhosis, hepatic insufficiency, and even death in case of delayed diagnosis or improper treatment. It has a wide range of clinical, paraclinical and histological manifestations. Our aim was to determine the clinical and paraclinical manifestations and response to treatment among Iranian patients with autoimmune hepatitis.Materials and methods: Thirty-one patients with autoimmune hepatitis, referred to hepatology clinic of Taleghani & Day hospitals were included according to the criteria of International Autoimmune Hepatitis Group. Score of 2:15 was considered as definite diagnosis. Initial data including history, physical examination, age, sex, liver function tests, electrophoresis, serologic tests, pathologic reports, treatment and response to treatment were all determined.Results: The study population included 22 females and 9 males with the mean age (SD) of 34::1:y:2§ars. The most common clinical manifestations were fatigue, jaundice and menstrual disturbance respectively. 38% of patients were ANA positive and 54.8% ASMA positive. Of22 patients undergone liver biopsy, 6 showed cirrhosis. Among non-cirrhotic patients the mean histologic grade was 6.5 and stage was 3. Mean duration of complete response was one year. Response to treatment and remission phase was longer in cirrhotic patients Conclusion: Autoimmune hepatitis in Iranian patients and response to treatment resemble that in western countries, however, serologic criteria differed. It seems as if impaired laboratory techniques and lack of sufficient kits are the reason for such difference.

Background: Osteoporosis is the disease of middle- and old-aged individuals that has continuing rise with respect to the better health conditions and increased mean age of population. Physiotherapy has established its role on osteoporosis prevention, treatment, and rehabilitation. The present study has determined the physiotherapists' performance and attitude towards osteoporosis in Teltran, in 1999-2000.Materials and methods: Data were gathered using a questionnaire. 125 physiotherapists were randomly selected. The mean age was 33.1±6.7 years and mean experience was 8.1±6.1 years.Results: The mean score of awareness and performance were 5.8±3.6 and 12.1±3.2, respectively. Good, relative and poor awareness was reported in 20, 58, and 221% of individuals, respectively. However, good, relative, and poor performance was reported in 23,58, and 19%of individuals, respectively. 82% of subjects believed that physiotherapy could be helpful for prevention, whereas 72% for treatment and 57% for rehabilitation. 24% of the subjects stated that physiotherapy could not be employed in the present conditions of our society.Conclusion: Results have revealed that the studied subjects have relative awareness and performance. To promote their attitude, education seems to be helpful.

Background: Giardia lamblia is a common intestinal parasite associated with social or personal problems.With respect to the controversies regarding the efficacy and side effects of Metronidazole, Furazolidone and Paromomycine, the present study was conducted on adults infected by Giardia lamblia.Material and methods: 210 individuals infected with Giardia lamblia were assigned in 3 groups. They were 15-45 years old. Patients were surveyed one and four weeks following the therapy with Metronidazole, Furazolidone and Paromomycine. Results were compared using chi square method.Results: Of 210 infected patients, 53.3% were urban residents, 44.6% were males and 51.4% were females.Infection was more commonly found in illiterates (46.7%), whereas it was less commonly observed in educated subjects (6.7%). Diarrhea was the most prevalent clinical sign (89.5%). Four weeks after the therapy, the efficacy of Metronidazole, Furazolidone and Paromomycine were 90, 81.4, 64.3%, respectively.Metallic taste (17.2%), darking of the urine (18.6%) and tenesmus were the most frequent side effects of Metronidazole, Furazolidone and Paromomycine, respectively.Conclusion: With respect to the varied efficacy of antihelmentic drugs in the treatment of Giardiasis,-further studies in different part of the country are highly recommended.

Background: Medical education program for general practitioner is the most common tool of medical education; however, its efficacy is a familiar challenge among researchers. We have evaluated one of these programs, which were held in Shiraz in 1998.Materials and methods: All volunteer general practitioners were assigned randomly in either case or control groups. Subjects in the case group were asked to complete a questionnaire before the program but the control group was asked to complete the questionnaire after the program.Results: Results have showed that the mean scores of the case and control groups were 10.72 and 10.09, respectively (NS). Participants' opinion regarding the trainers' behavior was good. However, they believed that the program could relatively respond the physicians' needs. Totally they were satisfied with the program.Conclusion: Results have shown the effectiveness of medical education program, however, further programs should be evaluated so that the most appropriate strategy could be drawn.

Many research articles in medical sciences, public health services and health behavior of the population are being published, yet, few of them are qualitative. About 3 to 4 per 1000 indexed medical articles during1998 to 2001 are qualitative studies. This figure is 0.7 to 1per 1000for Iranian Journals. Qualitative approach in health research can produce deeper and unique knowledge concerning the socio-cultural aspects of health habits and health needs of the communities and completes the findings of the quantitative investigations. This article compares the strengths and weaknesses of both approaches.