Research in Medicine
Year:2005 | Volume:29 | Issue:2|Papers Count:20

Background: Recent studies show the prevalence of obesity to be increasing at alarming rates worldwide. This study was conducted to examine trends of prevalence in overweight, obesity and central obesity among Tehranian adults during a 3-year period, between 1999-2002. Materials and methods: Height and weight of 2102 adults, aged 20-80 years, participants of the Tehran Lipid and Glucose Study (TLGS) were measured twice between 1999-2002. Criteria used to define overweight and obesity were body mass index (BMI) 25-29.9 and ≥30, respectively. Central obesity was defined as waist-hip ratio (WHR) ≥0.8 in women and ≥0.9 in men. Individuals were assigned in 10-year groups, then the prevalence of obesity, overweight, and central obesity were compared in different sex and age groups. Results: During the study period, the mean (±SD) of BMI was changed from 26.1 ± 4.1 to 26.7 ± 4.1 kg/m2 in men (p<0.001) and 27.8 ± 4.9 to 28.7 ± 5.9 kg/m2 in women (p<0.001). The mean of WHR in women was 0.84 ± 0.08 in 1999 while it changed to 0.88 ± 0.08 in 2002 (p<0.001). The prevalence of obesity was increased from 32.7% to 40.3% in women and from 16.5% to 20.8% in men. However, the prevalence of overweight did not change (40% vs. 39.5%) in women during the study period. The prevalence of obesity was 32.7 and 40.3 percent in men and 16.5 and 20.8 percent in women in 1999 and 2002, respectively. In both sexes the fastest increasing trends in obesity and central obesity were seen in the 30-40 year old and 20-30 year old age individuals, respectively. Comparison of the 50th percentile of BMI in all age groups showed a dramatic increase in 2002 as compared to 1999.Conclusion: Our results revealed a significant increment in the prevalence of both total and central obesity, calling for urgent reaction to educate people in life style modifications.

Background: Avulsion injury of the brachial plexus is a disease of middle-aged population and is associated with psychological and economical problems. The present study demonstrates our 10-year experience with spinal accessory neurotization for restoration of elbow flexion in affected subjects in Tehran. Materials and methods: During this clinical trial, 32 patients undertook spino-bicipital procedure, of whom 14 were treated with fascia lata to transmit biceps force to 2nd-5th flexors. Three years later patients were reevaluated for flexor performance.Results: Medical Research Council (MRC) grading for these patients were as follow; MRC4: 21 patients (67%), MRC3: 8(25%), MRC2: 2(6%) and MRC1: in one patient (3%). Of 14 MRC4-patients who were treated with fascia lata, 9 (64%) could carry a 9kg weight and 5 (36%) could carry a 4kg weight. Elbow flexion of 90 and wrist flexion of 25-30 were seen in all patients.Conclusion: Spinal accessory neurotization can be safely employed for restoration of elbow flexion in avulsion injuries of the brachial plexus.

Background: Attention deficit hyperactivity disorder (ADHD) is a frequent psychiatric disorder detected in at least 5% of school-aged children. Boys are more commonly affected. Besides imposing large expenses on society health care system, ADHD may influence occupational, social and educational aspects of child's life, thus, establishing an appropriate therapy is of utmost importance.Materials and methods: During this clinical trial, 40 students were randomly assigned in two groups of experiment (receiving methylphenidate) and control (methylphenidate and behavioral intervention).Results: Results have revealed that a combination of behavioral intervention and methylphenidate is associated with better outcome in inattentive and impulsive children; however, it is less likely to treat hyperactivity and distractibility better than methylphenidate alone. Conclusion: Although the combination therapy did not successfully treat all manifestations of ADHD, behavioral intervention and educating the sufferers family member could improve child performance in school and his self-confidence.

Background: With respect to the high prevalence of mental disorders world wide, and their importance when occurred during adolescence, this study was conducted to evaluate the general mental health status of adolescents in district 13 in Tehran as a part of Tehran Lipid and Glucose Study (TLGS).Materials and methods: In this descriptive cross-sectional Study, 346 adolescents, 12-19 years old, were randomly selected. A demographic questionnaire as well as General Health Questionnaire (GHQ-28) which had already been validated for the Iranian population, were gathered by face-to-face interview. We have considered score of 6 as cut off point. Freedman, chi squared and Mann Whitney tests were used, when appropriate. Results: The study population included 150 males and 196 females. Totally, 184 subjects (53.2%) were suspected to have some kinds of mental disorders. The mean (SD) score of GHQ was 6.9±5.1 with the median of 6. The means of each of the subscales of the questionnaire were 0.9 ± 1.4 for somatic system 1.3 ± 1.7 for anxiety and sleep disorders, 3.7 ± 2.0 for social dysfunction and 1.0 ± 1.7 for depression. The median of these subscales were 0, 1, 4, 0, respectively. Compared with other subscales, subjects with social dysfunction had lower mental health statues (p<0.001). Females were affected more frequently than males (65% vs. 35%, p<0.001).Conclusion: More than half of the subjects were suspected of having some kinds of mental disorders, the frequency of females being higher. With respect to the importance of mental health in adolescence, investigating the risk factors of mental disorders, especially the social dysfunction scale, in future studies is recommended.

Background: Intractable epilepsy is defined as epilepsies that are not controlled with routine pharmacologic therapy. The present study was conducted to evaluate the efficacy and side effects of topiramate as an add-on therapy in drug-resistant (intractable) epilepsies. Materials and methods: For this quasi experimental study 42 children who have referred to Mofid hospital with refractory epilepsy were enrolled. The study population included 14 girls and 28 boys, aged 1-15 years. Seizure attacks were not controlled despite receiving 4-13 drugs (mean 9). Topiramate was added to the patients drug in a 4-week titration regimen (1st week 3, 2nd week 5, 3rd week 7, and 4th week 9 mg/kg). Then, after 3 months he/she was reevaluated.Results: Of 42 patients, Lennox-Gastaut syndrome, idiopathic epilepsy, symptomatic epilepsy, and progressive myoclonic epilepsy were revealed in 14 (34%), 8(19%), 16(38%), and 4(9%), respectively. After the 3-month add-on therapy with topiramate, 17% became seizure-free and the frequency of seizure attacks decreased by 50% in 26% of the patients, however, attacks were exacerbated in 5%. Fortunately, hematologic, renal or hepatic side effects were not reported, however, mild transient neurologic complications were observed in 12% of the patients.Conclusion: We have noticed a satisfactory response to topiramate, thus, it can be safely prescribed for intractable seizures.

Background: Virologic characteristics and liver enzyme status as well as histopathologic features could be used to determine prognosis of hepatitis B. The present study was conducted to determine the virologic characteristics of chronic hepatitis B in a group of Iranian patients. Materials and methods: For this cross sectional study 150 patients who had referred to a GI clinic in Tehran were selected. They had positive HBsAg for at least 6 months. Complementary laboratory tests were achieved as follow: liver function tests, HBeAg, HBeAb, HBcAb and HBsAb. Liver biopsy was performed if indicated. Results: Totally, 40.1% were carrier, 48.3% had chronic hepatitis, and 11.6% had developed cirrhosis. 45 were HBeAg positive as compared to 77 who were HBeAg negative. Four patients had concurrent HCVAb and HBsAg. HBsAb was positive in 5 patients. HBeAg was positive in 13 (26%) females and 32 (33%) males (NS). Results have revealed that HBeAg was correlated with chronic hepatitis B (p<0.001).Conclusion: The high frequency of negative HBeAg in patients with chronic hepatitis B necessitate the introduction of DNA assay for definite diagnosis.

Background: Irrational use of antibiotics, particularly their uncontrolled use, has led to an increase in the resistance of bacterial species, especially in hospital infections and also caused the emergence of hazardous side effects, albeit avoidable. This results in financial and clinical damages on the health system, some of which are irreparable. Materials and methods: This study was carried out to determine the consumption pattern of antibiotics as per separate disease in the Taleghani Hospital in Tehran, between July and December 2001 based on the International Standard System, ATC/DDD, which is recommended by WHO, within the frame of DUE retrospective studies.Results: During the study period, 2137 cases were investigated, among which 57% (1222 cases) had received antibiotics. The cost of these antibiotics amounted to 19.4% of the total drug expenses of the hospital. Of all the antibiotic-treated cases more than 68% had undergone surgery, among whom 49.9% (elective surgeries) received prophylactic antibiotics. The total amount of antibiotics was 99.8 DDD/100 bed days, 79.3% was in parenteral forms. Orthopedic and reconstructive surgery cases received the greatest amount of antibiotic consumption (23%). The most commonly used antibiotics were cephalosporins (49%) and penicillins (27%) followed by aminoglycosides (6%), imidazole derivatives (5%), and fluoroquinolones (4%).Conclusion: Our results are in agreement with other similar Iranian studies; however, it differed significantly from European studies. The use of prophylactic antibiotic preoperatively on a few days basis (especially in elective surgeries), deems to be irrational. This is because reliable sources have highly recommended a reduction in dosage administration to less than 24 hours.

Background: Students comprise a considerable percentage of the population who are vulnerable to different socioenvironmental stimuli. Providing them with healthy nutrition may not only compensate their deficiencies but also ensure better learning performance. Materials and methods: During this descriptive study, the nutritional pattern of 7610 primary school students residing in district 19 of Tehran was assessed. Data were obtained by face-to-face interview.Results: Unfortunately, 6.9% of the students do not have breakfast and 17.7% ignore between- meals. However, most of the subjects (45.7%) had bread, cheese and tea for the breakfast, while 42% had milk. Biscuit and cookies were the most commonly used allowed between-meals (47.8%) followed by fruit and fruit juice (38.9%). Totally, 14.2% of studied subjects took disallowed foods. Unfortunately, dried fruits were the least commonly used between-meals in our study.Conclusion: Nutritional programs in school could effectively eliminate nutritional-related disorders in students. Our results have revealed that students should always be encouraged to have breakfast and appropriate between-meals and avoid disallowed foods in schools.

Background: Adequate dietary iodine is essential for the production of thyroid hormones. Breastfed infants are reliant on adequate maternal iodine intake. The aim of this study was to evaluate iodine sufficiency in lactating women in Iran. Materials and methods: The study population included 100 randomly selected lactating mothers referred to the Taleghani Hospital of Gorgan between April and June 2003. Subjects were within the 1st-6th month of their postpartum period. Goiter was graded according to WHO classification. Spot urine (2-3 ml) and breast-milk (5-10 ml) samples were collected for the measurement of iodine concentrations using acid digestion method. Urine iodine concentrations (UIC) of <100 and breast-milk iodine concentrations (MIC) of <50 µg/L were considered as iodine deficiency. Results: Mean (±SD) age of women was 25.6± 1.6 years. 43% and 8% had grade 1 and 2 goiters, respectively. The median (range; %95 CI) UIC was 259 µg/L (35-519; 226-275). UIC of <100 µg/L was detected in 16%, 50-99 in 13% and 20-49 µg/L in 3%. Grade 1 and 2 goiters were present in 8% and 8% of mothers with UIC <100 µg/L, respectively. The median (range; %95 CI) MIC was 93.5 µg/L (17-696; 97-137). MIC of <50 µg/L was reported in 19%, 35-49 in 13%, 20-34 in 3%, and <20 µg/L in 3%. Grade 1and 2 goiters were present in 11% and 8% of women with MIC<50 µg/L, respectively. MIC was significantly correlated with UIC levels (r=0.44, p<0.0001). Meanwhile, there was a significant association between iodine-deficiency and goiter (p<0.0001). Conclusion: UIC and MIC levels show sufficient iodine supplementation in Gorgan. However, some infants remain at risk for low iodine intake via breast milk.

Introduction: Hepatopulmonary syndrome (HPS) is one of the pulmonary complications of cirrhosis, which is manifested by reduction in arterial blood oxygen. The present study was conducted to evaluate the frequency, clinical and para clinical features of HPS, and to determine their predictive values in diagnosis in a group of Iranian patients.Materials and methods: This case series study was performed on 54 cirrhotic patients referred consecutively to the gastroenterology department of Taleghani Hospital between 2003 and 2004. Patients underwent pulmonary echo-contrast to detect intra-pulmonary and intra-cardiac shunts. Arterial blood oxygen, 02 gradient (A-a) and orthodoxy were measured in these patients by ABG. All patients underwent endoscopy for possible esophageal varices. Patients who met the following three diagnostic criteria including hepatic cirrhosis, arterial blood deoxygenation (P02<80mmHg) and intrapulmonary arterial dilation were classified as clinical HPS while those manifested solely with intrapulmonary arterial dilation were defined as subclinical HPS.Results: Of 54 patients, 10 (18.5%) fulfilled clinical and 7 (13%) subclinical HPS criteria. Patients aged 71-80 years were more commonly affected. Hepatitis B was the most common etiologic factor. Dyspnea (100%) and cyanosis (90%) were the most prevalent clinical features. Dyspnea and clubbing were the most sensitive and specific clinical features, respectively. Pao2<70mmHg and arterial-alveolar gradient had the highest sensitivity for HPS diagnosis. Conclusion: Clubbing with the highest positive predictive value (75%) and dyspnea whit the highest negative predictive value (100%) were the best clinical features to diagnose HPS. PaO2<70mmHg and P(A-a)02>30 and their sum, have the highest positive and negative predictive values in HPS diagnosis.

Background: Increment in childhood and adolescence obesity prevalence during the recent years has made many investigators to achieve studies in this regard. Factors related to fetal and early infancy as well as behavioral factors are studied in many of these studies worldwide. This study was aimed to determine some of these factors in Ahwaz primary school students.Materials and methods: Using two stage cluster sampling from 35 Ahwaz primary schools, all 10-11 years old students who had a BMI ≥95th percentile of Iranian reference were identified as obese (n=150) and 150 age - and gender-matched students (BMI<85th percentile) were selected as controls. A demographic questionnaire was completed and physical activity was assessed by Baeck Physical Activity Questionnaire. Results: Results have indicated that obese students had significantly higher birth weight as compared to non-obese ones; meanwhile, BMI was inversely correlated with the age of supplementary feeding introduction in obese students. Duration of watching TV and playing computer was associated with BMI in this group. Obese students had significantly less physical activity and sleeping duration. Race, gestational age, season of birth, birth order, breast-feeding duration, and sleeping regularity were not significantly differed between obese and non-obese students.Conclusion: High birth weight, early introduction of supplementary feeding, long time TV watching and playing computer, low sleep duration and low physical activity were associated with obesity among Ahwaz primary school children.

Background: Paying further attention to the professional performance of head nurses is associated with further hospital success and productivity as well as improving social health status. The present study was conducted to evaluate head-nurses and matrons attitude towards the concept of "evaluating head-nurses performance" and introducing a propositional model for this purpose.Materials and methods: For this descriptive-comparative study, the attitude of 34 matrons and 108 head-nurses about the current and ideal head nurses performance appraisal was evaluated. Data analysis was achieved by t-test, Kruskal Wallis and Mann Whitney U test, when appropriate.Results: Results have revealed that matrons had more positive attitude towards current head nurses appraisal when compared with head nurses (p<0.002). Totally, 97.1% of matrons and 95.1% of head nurses were agreed completely (mean score of 4-5 from 5) with the necessity of introducing an ideal head nurses performance appraisal model. Matrons (mean score of 4.81) and head nurses (mean score of 4.75) agreed with suggested features of the way to appraise head nurses. Finally, the propositional model for head nurses performance appraisal was introduced in 2 major categories of executive and educational-research management. Conclusion: The propositional model requires to be revised for pilot studies, of course, after acquiring agreement of sovereign ministry. Needless to say, appraise head nurses performance correctly would promote nursing service quality.