Research in Medicine
Year:2006 | Volume:29 | Issue:4|Papers Count:16

Background: Dehydration resulting from acute diarrhea kills 1.5 million children each year. Rational management is based on oral re-hydration as recommended by the World Health Organization. This study was conducted to define the rationality of prescriptions written for acute watery diarrhea in children. Materials and methods: A cross-sectional study was done on children who had been treated for acute gastroenteritis during the two weeks prior to their visit to the clinics of two teaching hospitals. Information obtained through interviewing the caretakers and scrutinizing the prescriptions, was documented. Prescribing practices of general practitioners and pediatricians were compared in three settings; private offices, hospital outpatients, and general polyclinics. Results: 273 prescriptions were analyzed. An average of 4.1±2.3 drugs had been prescribed on each visit. At least one antibiotic was included in more than 76% of prescriptions. 60% of children were not given ORS. An injection was written in 51% of prescriptions and anti-emetics in 61%. There was no significant difference between general practitioners and pediatricians in the number of drugs per prescription. 75.7% of pediatricians and 78.5% of GPs had prescribed at least one antibiotic (p=0.58). In teaching hospitals the average number of drugs prescribed for each visit was 3.1, in polyclinics, 3.2 and in private offices 3.6 (p=0.03). Conclusion: Unjustified use of medicines and sub-optimal management of acute gastroenteritis were identified in more than 70% of prescriptions. Further studies and effective training programs are urgently needed to reverse current irrational treatment practices.

Background: Iodine deficiency disorder (IDD) is a worldwide health problem. Parts of Iran, such as Mazandaran, 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-oldchildren in Mazandaran province. Materials and methods: In this cross sectional study, 1200 children (M/F ratio=1), 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 4%. The median urinary iodine was 16.5 µg/dl.82% had urinary iodine of more than 10 µg/dl, while 3.3% had urinary iodine levels of <5 µg/dl. None of the candidates has urinary iodine of less the 2 µg/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 Mazandaran province, mean while, urinary iodine concentration of children has reached to WHO approved rate. Thus, Mazandaran province could be classified among "iodine-deficiency-free" areas in Iran.

Background: Urinary tract infection (UTI) is a common health problem among children that may lead to irreversible renal injuries. The aim of the present study was to determine the association between the delay in treatment of urinary tract infection and risk of renal damage. Materials and methods: For this retrospective study 100 children aged 1 month to 14 years who were admitted with urinary tract infection in Mofid Children's Hospital from March 2000 to September 2004 were included. The lag time between the onset of disease and treatment, DMSA scan results prior to treatment and 6 months later, urine analysis, and patient's clinical manifestations were all recorded. UTI was diagnosed based on clinical manifestations, culture, and pylonephritis detected in DMSA scan. Results: The study population included 77 girls and 23 boys with the mean age of 3 years and 3 months (range 1 month to 14 years). The mean lag time between disease onset and treatment was 4.6 days. Kidney damages were reported to be least among those with mean lag time of2.6 days and worst among those with the mean lag time of 6.6 days. Conclusion: Irreversible renal scars were shown in one third of patients who had a mean lag time of 6 days. Efforts to reduce the incidence and severity of renal scarring should be directed towards rapid diagnosis and effective early management of urinary tract infections in infancy and childhood.

Background: In spite of a high risk of infection, multiple usages of disposable insulin syringes among diabetic patients is quite common. The present study was designed to assess the outcome of multiple usages of disposable insulin syringes in insulin dependent patients referring to Shahid Motahari clinic in Shiraz. Materials and methods: For this descriptive study, through a random sampling method, 117 patients were selected. Initial data were obtained by a questionnaire and the patients were asked to deliver their syringes following their last injection to be examined by microbiological tests. The injection site was also examined for the evidence of infection within a 24-hour period. In the next stage, 30 patients were randomly chosen among those who had used each syringe more than once and another reused syringe was received from them 1 week later. However, the second syringes were tested in microbiology lab 24 hours after the last injection.Results: Totally, 82.1% of patients used their syringes more than once. No infection was  detected at the site of injection, however, microbial contamination was found in four syringes and in 11 needles. 2 of these syringes were used just once. Syringe and needle contamination was found more commonly among those who did not use alcohol (for injection area disinfections) (p<0.02). Syringe and needle contamination was not significantly associated with sex, frequency of reuse, insulin type, hygiene, place and method of keeping syringes between two injections. The cultured pathogens were as follow: staphylococcus aureus in 6, staphylococcus epidermidis in 2, non-entrococci in 3, and diphtheroid , bacillus subtilis, entrococci and anaerobic gram positive bacillus, each in one. Conclusion: The risk of syringe and needle contamination is more when disinfecting methods and disinfectants are not used. Furthermore, multiple usage of the insulin syringes in this study, did not lead to injection site infection.

Background: Nosocomial sepsis continues to be a significant cause of mortality in neonatal intensive care unit (NICU). Various interventional policies have been adopted to reduce its incidence. This study was designed to investigate the role of preventive strategies to bring down the incidence of nosocomial sepsis in the NICU.Materials and methods: The NICU was moved to a new location in 2002. This study was conducted in two phases. Data was collected from case note of neonates admitted to NICU in 2001, and compared to data from neonates admitted to the new NICU in 2002, and followed prospectively. Changes in new location included: large space, elbow operated water taps, availability of disposable endotracheal tubes, and insistence on strict hand washing with continuous surveillance. Neonates who had a negative blood culture on admission, and a positive blood culture 48hr later, plus clinical and/or paraclinical signs compatible with sepsis, were selected. The incidence of nosocomial sepsis was compared in babies admitted during 2 study periods.Results: In 2001, nosocomial sepsis developed in 41 out of 285 neonates (14.3%), however, in 2003 it was developed in 24 out of298 admissions (8%) (p<0.02).Conclusion: Preventive measures including an increase in bed space from 1.5 M2 to 2.5 M2, using disposable endotracheal tubes, elbow operated water taps, and strict hand washing, result in a significant decline in nosocomial sepsis.

Background: Sound pollution has unwarranted effects on hearing loss. Despite numerous prior studies on sound pollution and its effects in industrial environments, scanty studies are available among musicians. The aim of the present study is to evaluate the association between musical instruments noise and hearing loss. Material and method: For this prospective study, 50 professional players of string, windy, and percussion instruments as well as 30 matched controls were selected. All subjects were programmed for pure tone audiometery (PTA) and classic tempanometery.Results: The study population included 19 females and 31 males aged 20 to 55 years and history of playing musical instruments of 3-44 years. Hearing threshold of 88% players was within the normal range, however, 6% revealed to have slight and the remaining 6% had mild hearing loss. In frequency of 8000Hz, 30% of players had hearing loss of 25.3db in their left and 24% had hearing loss of 28db in their right ear. Meanwhile, in frequency of 4000Hz, 16%of players had hearing loss of 25.5db in their left and 10% had hearing loss of 27db in their right ear. Those who had a history of at least 15 years of playing musical instruments were shown to have a sensorineural hearing loss in all frequencies. Conclusion: Since hearing loss is a major health concern among musicians, periodic audiometric examinations and use of protective means are strictly recommended for professional musicians.

Background: The present study aimed to examine the effectiveness of Progressive Relaxation Training (PRT) on anxiety and skills of control biofeedback responses (EMG and peripheral temperature) in anxious university students.Materials and methods: 21 pairs of undergraduate students (20-30 years old) were selected based on Cattle Anxiety Scales and assigned in two groups of experiment and control. The experiment group received PRT for 10 weeks. Pretest (Cattle Anxiety Scales, EMG, PT) and posttest (Cattle Anxiety Scales, Spilberger Anxiety Inventory, clinical interview, EMG, and P.T) were achieved on both groups. Results: Results have revealed that anxiety factors of personality (C, L ,Q3, Q4 factors), stat and trait of anxiety and EMG amplitudes were all decreased significantly (p<0.05). Thus, experiment group had obtained adequate skills to control biofeedback responses.Conclusion: PRT is useful intervention to control anxiety as well as increasing skills to control of EMG biofeedback responses.

Background: In order to assess whether maternal blue is attributed to the rout of childbirth including vaginal delivery or cesarean section, this study was conducted at Hedayat Hospital in 2000. Materials and methods: Among women who attended to the clinic of prenatal care in Hedayat Hospital those who accepted to participate were requested to fill a Beck depression inventory to rule out any underlying depressive disorder. Finally, for 200 parturient a structured questionnaire was filled out, once before and again one week after delivery. Initial data including age, education level, planned or unplanned pregnancy, familial satisfaction were inquired.Results: Results showed that 55% of the subjects had symptoms of maternal blue during post partum period. Maternal blue is more prevalent among women who had cesarean section compared to vaginal delivery candidates (p<0.08, RR=1.6); however, the symptoms of maternal blue was less serious compared to mothers with vaginal delivery.Conclusion: Maternal blue was revealed to be prevalent among parturient, thus further studies are warranted to address the problem and preventive interventions.

Background: We investigated the mechanism of action of Dendrostellera lessertii effects on decreasing size of adeno-carcinoma of rat intestine and breast tumors. This purpose followed by assessing its effects on TNF-a and 1NF-a receptors on cultured human monocytes.Material and method: The breast and intestine tumors were induced in rats by DMBA and DMH, respectively. Human monocytes isolated by adhesion procedure. TNF- α in cultured media were measured by sensitive biotin-streptoavidin ELISA method and radio iodination was used for TNF- α receptors determination on human cultured monocytes.Results: Oral administration of Dendrostellera lessertii extract during 20 consecutive weeks reduced significantly the diameter of tumor or eliminated them totally. Our data indicated that the plant extract at various doses did increase TNF-a release and in a time dependent manner decreases the TNF- α receptors in less than 90 minutes significantly in cultured human monocytes.Conclusion: Dendrostellera lessertii extract (H2O/EtOH) decreases the size of rat adenocarcinoma breast turners. Our data support that the extract probably act through increasing TNF-a releasing and decreasing TNF-a receptors on cultured human monocytes.

Background: Several studies have shown that stress has major effects on carbohydrate metabolism. There are some evidences suggesting that stress may induce type 1 and type 2 diabetes mellitus. The effects of psychological stress however need to be investigated. The present study has investigated the role of chronic psychological stress on carbohydrate metabolism in male rats. Materials and methods: Animals were assigned in two groups of control and stressed (n=8/group). The animals of the stressed group were exposed to different restraint stressors (1 hour twice daily) for 15 and 30 days. At the beginning and end of the experimental periods fasting blood samples were obtained by tail snipping and oral glucose tolerance test (OGTI) was carried out. Glucose was measured by glucose oxidase method. Insulin and corticosterone were assayed by their respective RIA kits. Results: Fasting plasma glucose level on the 15th day of the experiment showed significant increase in the stressed rats compared to the controls. The plasma levels of glucose at 15 and 60 min after performing OGTI were significantly increased on the 15th and 30th days of the experiment in the stressed group. Fasting plasma insulin showed significant decrease on the 15th and 30th days of the experiment in the stressed group compared to the controls. On the 15th day of the experiment, at 15 and 60 min after performing OGTI the plasma level of insulin showed significant decrease in the stressed group as compared to the control group. Fasting plasma corticosterone concentration was significantly increased on the 15th day of the experiment in the stressed rats compared with the control rats and the 1st day of the experiment. In the stressed group immediately after stress exposure plasma corticosterone was significantly higher than before stress exposure, only on the 1st day of the experiment. Conclusion: Results have revealed that chronic psychological stress can impair glucose metabolism and this effect may be mediated by changes in insulin and corticosterone secretion. However the role of other stress hormones has to be investigated.

Background: Community acquired pneumonia (CAP) is a common health problem and one of the main mortality factors worldwide. Legionella pneumophila is one of the most common responsible microorganisms for CAP and may lead to severe complications if left untreated. The present study was conducted to determine the frequency of this organism in patients with CAP.Materials and methods: We enrolled 118 patients with CAP, COPD and asthma in Masihdaneshvari Medical center during 2004-2005. For microbiological purposes sputum culture and legionella urinary antigen measurement were achieved.Results: The study population included 32 females and 86 males, their age range 58-77 years. The most frequently isolated respiratory microorganism were: streptococcus pneumonia (88%), candida spp. (76.2%), streptococcus beta-hemolytic (61.8%), staphylococcus (40.6%), klebsiella spp. (27.1%), fungi (16.1%), E.coli (8.4%), pseudomonas spp. (5.1%). Dyspnea, cough, sputum production, and fever were the most common findings. Smoking was the most commonly found risk factor. Conclusion: Atypical pathogens are responsible for 40% of community-acquired pneumonia and several studies have ranked legionella pneumophila among the three most common microbial cause of CAP in patients admitted to the hospitals. So this is important to notice that urinary antigen test is particularly useful, simple and rapid test for legionella positive cases, because it is often easier to obtain urine in ill patients and the results can be available within hours and also reliable to commence treatment.

Background: Meta analysis is a statistical method to combine the findings of a set of large number of published individual studies and re-analyse them. The use of meta-analysis methods in medical research has been increased, noticeably, in resent years. However, one of the major shortcomings in such analysis is that the researcher, could not access all conducted studies in the area of concern. This serious problem is called publication bias, and may lead to a misleading conclusion. In present study a meta analysis was carried out to evaluate the effect of albendazole in treating patients with ascaris and trichocephal and different publication bias detection methods were compared.Materials and methods: Data were gathered from 25 clinical trials, having two treatment groups and binary outcomes, published in international indexed journals during 1982-2000. The main objectives of all these studies were to compare the performance of single dose of albendazole to treat patients with ascaris and tricocephal parasites. Total number of participants, number of patients with ascaris and tricocephal and cure rates were recorded for each study. Log odds ratio and its variance were calculated for each study and then estimated for the overall researches using meta-analysis methods. Funnel plot, Begg correlation method, two regression methods introduced by Egger and two regression methods based on Funnel plot were used and compared in detecting publication bias. SAS software was employed for this mean.Results: Meta analysis showed that albendazole has 10.3 (95%CI: 8.35-12.65) times better performance in curing ascaris patients compared to those with tricocephal (log odds ratio 2.33). All the employed procedures showed similar and consistent results which confirmed non-significant publication bias. However, this consistency may not occur all the time. Conclusion: Since this consistency may not occur all the time, it is recommended not to rely on results of only one method, but comparing and selecting a powerful method which fits the data structure.

Background: Ramsar, a city in Mazandaran province, is located between Tonekabon and Chaboksar. It covers an area of about 30 Km2overlying alluvium and coastal deposits of Quaternary Period. Shallow depth of water table within the area increases the chance of contamination through seepage of waste water from septic wells and agriculture.Materials and methods: We have examined 31 samples to determine the contamination of water resources in 2 stages. In laboratory, the concentration of sodium, potassium, calcium, magnesium, sulfate, chloride, carbonate, bicarbonate, phosphate, nitrate and nitrite ions have been measured. Wilcox and Schoeller diagrams led to classification of the water for drinking and agricultural purposes. Finally, plotting of isoion maps of pollutants defines contaminated areas of the city. Results: With respect to Scholler diagrams, most of the wells in Ramsar could be classified as suitable water resources and are drinking water. However, rivers are non-drinking water resources due to contamination with seepage and waste water.Conclusion: Plotting of isoion maps of pollutants has clarified that water contamination is a matter of concern in Ramsar and seek further attention.

FTIR (Fourier transform infrared) is a powerful tool for biological studies. It could be used for samples in different physical status. Prior researchers have studied biological characteristics of proteins, lipids, biologic membranes, carbohydrates, drugs, etc with this unique technique. The following article addresses some of the common applications of FTIR (Fourier transform infrared).