Research in Medicine
Year:2003 | Volume:27 | Issue:3|Papers Count:13

Background: Cardiovascular disease (CVD) is one of the major health problems in our country. The aim of this study is to determine the predictors of CVD risk factors in adolescents residing in distinct-13 of Tehran. Materials and methods: Dietary intake assessment was undertaken with 2-day 24-hour recall in 420 adolescents, 11-18 years old, from a total of 15005 subjects participating in Tehran Lipid and Glucose study After excluding the under- and over- reporters 290 adolescents remained in the study. Data related to cigarette smoking was collected. Height and weight was assessed and BMI was calculated. Blood pressure was measured two times separately in sitting position. Serum cholesterol, Triglyceride, and HDL were measured in a blood sample after a 12-hour fast. To determine the predictors of CVD risk factors stepwise linear regression was used.Results: Results showed a strong positive correlation between BMI and systolic blood (pressure in girls (p<0.001, b=1.8) and boys (b=0.04, p<0.001), as well as diastolic blood pressure in girls b=0.8, p<0.001) and boys (b0.05, p<0.01). There was an inverse association between calcium intake and systolic (b=0.16, p<0.05) and diastolic blood pressure in boys (b=0.36, p<0.01), as well as an inverse association between calcium intake and systolic (b=-1.2, p<0.05) and diastolic blood pressure (b=0.05, p<0.05) and serum triglyceride (b=-0.1, p<0.01) in girls. Positive correlations were found between BMI and cholesterol in girls (b=0.2, p<0.01) and boys (b=0.31, p<0.01).Conclusion: Low dietary calcium intake, high blood cholesterol, and above average BMI is associated with elevated levels of systolic and diastolic blood pressure in adolescent boys and girls in Tehran, thus predicting a higher risk for CVD.

Background: Opiates and other related materials may inhibit the physiologic secretion of adrenocorticotropin. The aim of the present study is to determine the association between the cortisol level and adrenal insufficiency in addicted patients.Materials and methods: For this clinical trial, 100 patients who had elective abdominal surgery or inguinal hernial repairs were selected randomly. They were distributed in two groups: opium addicts (cases), and nonaddicts (controls). One day before surgery cortisol was measured by radio immunoassay (RIA).Results: Of 50 addicted patients, 17 revealed to have lower than normal cortisol levels whereas 5 had higher levels. There exists a non-significant association between the cortisol level and duration of addiction, and also cortisol level and the degree of dependency. Cortisol levels were within normal range in all controls. Post-anesthetic complications and withdrawal syndrome, especially pain and shivering in recovery room, were more obvious among addicted patients as compared to controls and the difference was statistically significant. (P<0.0001) The duration of recovery was much shorter among addicted patients as compared to the controls, (p<0.00001).Conclusion: Addicts should be considered as high risk patients for elective surgery. Adrenal insufficiency and post-anesthetic complications deserve special attention in this group.

Background: The third stage of labor is of utmost importance. Prior investigators have proposed different approaches to shorten this stage. The present study was aimed at determining the efficacy of syntometrine, syntocinon and the physiologic approach in the management of the third stage of labor.Materials and methods: Ninety parturients enrolled for this clinical trial. They were randomly distributed in one of the 3 groups; physiologic, syntometrine, and syntocinon. Along with the anterior shoulder appearance, 10 units of oxytocin, or 5 units of oxytocin plus 0.5mg ergometrin was intramuscularly injected in the syntocinon and syntometrine group, respectively. Then the umbilical cord was clamped and cut immediately and finally the placenta was delivered. On the other hand, patients in the physiologic group were not given oxytocic drugs, and umbilical cord was not cut unless the pulse completely disappeared. The efficacy of these approaches was determined on the duration of the third stage of labor and its complications (bleeding during the first 2 hours, hemoglobin, hematocrit, further requirement of oxytocic drugs). Drugs-related side effects were also determined. Results: The mean duration of the third stage of labor was 7.4±2.4, 5.5±2.5, and 5.1±2.4 minutes in the physiologic, syntocinon and syntometrine groups, respectively (p<0.001). The amount of bleeding during the first 2 hours were 230±95.2, 217±113, and 176±83.2 ml in the groups, respectively (p<0.05). Hematocrit was 33.3±4.1, 34.7±4, and 36.4±4% in the groups (p<0.05). Further demand for oxytocic drugs was reported in 16.7% of patients in the physiologic group and 13.3% of patients in the syntocinon group, whereas, there was no demand among patients who receive syntometrine (p<0.05). Mild pain was reported in 16.7, 20 and 43.3% of patients in the physiologic, syntocinon and syntometrine groups, respectively (p<0.05).Conclusion: In order to manage the third stage of labor, syntometrine is better than syntocinon and syntocinon is better than the physiologic approach.

Background: Controversies exist regarding the role of helicobacter pylori infection in NSAIDs-induced GI bleeding. Thus, the present study was conducted to compare the frequency, risk factors and signs and symptoms of NSAIDs-induced GI bleeding among infected and non-infected subjects with H. pylori.Materials and methods: In a cross sectional study, all 256 cases of GI bleeding following NSAIDs usage were enrolled. They undertook endoscopy. H. pylori infection was evaluated by urease test.Results: The study population included 94 males and 162 female with the mean (±SD) age of 55.3±10.9 years. Among these, 190 had positive urease test and the remaining 66 were negative (p<0.05). Female gender, smoking, and alcohol consumption were significantly more common among H pylori-infected individuals.Conclusion: Our study revealed that H pylori infection is common in patients who develop NSAIDs-induced gastro-intestinal bleeding and may increase the risk of bleeding following NSAIDs usage.

Background: Diabetes mellitus is a common chronic metabolic disease. Optimal management of psychiatric problems, especially depression, may lead to better control of blood glucose levels in diabetics. Unfortunately, depression is usually neglected in medical diseases. We evaluated the prevalence of depression using a simple test, (Beck test), to screen for depression in diabetics.Material and methods: One hundred known diabetic patients were evaluated for the presence of symptoms of depression using the Beck Questionnaire. Age, marital status, sex, duration of diabetes, type of diabetes, and history of taking antidepressants were recorded.Results: Based on Beck test, depression was discovered in seventy eight percent of diabetics. There were significant differences between depressed and non-depressed individuals regarding sex, complications of disease, duration of diabetes and age (p<0.005, p<0.001, p<0.05, p<0.005, respectively).Conclusion: Our findings revealed high prevalence of depression symptoms among diabetic patients.Considering the conventional simple therapies for depression, proper screening among diabetics seems to be necessary.

Background: Patients make their first contact with the health services of a hospital in the outpatient clinics; therefore, the administration of this unit has especial effects on patients' attitude towards the hospital. We conducted a study in order to evaluate the demographic features and the opinions of patients about an out-patient service in a university hospital.Materials and Methods: We performed a descriptive study on out-patients referring to Taleghani hospital by a structured questionnaire through a face-to-face interview during an academic year, 2001 to 2002.Results: 1098 patients (42.9% male, 57.1% female) with a mean age of 31±16.8 years were enrolled for this study. 85% of cases were residing in Tehran province. The most crowded clinics were as follows: Orthopedic (14.3%), Faciomaxillar surgery (12.5%), and Obstetrics and Gynecology (11.6%). Waiting duration to visit a doctor ranged from 15 to 360 minutes with a mean of 103±66 minutes. 74.5% were satisfied with personnel, 74.1% with official staff, and 53.8% with physicians. Delay in coming and absence of specialists were the most common complaints of patients. As far as the public health services were concerned, 85.5% and 82.4% were completely satisfied with the facilities offered by vaccination and family planning clinics, respectively.Conclusion: By the help of an integrated program the majority of reported insufficiencies are correctable. The regular presence of specialists in clinics, the availability of pharmacy for providing prescribed medication, and provision of easily available primary care facilities are major factors for patient satisfaction.

Background: The hidden curriculum has great impact on students learning, the present study was conducted on Nursing and Midwifery students to determine their experience with the hidden curriculum. Materials and methods: It was a combined survey achieved in two stages on Nursing and Midwifery students. During the first stage, a free interview was carried out to determine their attitudes towards, experiences with, and references of the hidden curriculum. These interviews were analyzed using Streubert technique. During the second stage, a questionnaire was completed and finally analyzed.Results: All students have experienced the hidden curriculum and usually found it to be more effective than their routine learning program. This learning modality was associated with more stabilized behaviors among them. Meanwhile, most of their learning objectives, including positive and negative or group and individual learning were achieved through the hidden curriculum. They have pointed out that faculty professor, nursing and midwifery staff, other students, patients and mass media were their main source of reference, however, nursing and midwifery staff augmented the training impact.Conclusion: Students believed that the hidden curriculum is an effective modality for learning.

Background: Evidence indicates that the orbitofrontal cortex (OFC) in the brain is probably involved in emotional learning. The aim of the present study is to evaluate the role of OFC on spatial memory in dark and light area in rotation arena in place avoidance learning model.Material and methods: Long-Evans strain rats (280-300gr) were surgically implanted bilaterally with cannulae aimed at the OFC and were trained to avoid a 60 degree segment of the arena entering which was punished by mild foot shock. The punished sector was defined by room cues during rotation in the light and by the floor cues in the dark. Place avoidance training occurred in a single 30- min session and the avoidance memory was assessed during a 30-min extinction trial 24 h later. The time to the first entry and the number of entrances into the punished sector during extinction were used to measure the place avoidance memory. Bilateral injections of Tetrodotoxin (5ng/ml per side) was used to inactivate the OFC 60 min prior to acquisition, immediately after training, or 60 min before the retrieval test. Control rats received saline with the same volume that was injected at the same time.Results: The results indicated that acquisition and consolidation of spatial memory in dark and light area was impaired (p<0.01). But retrieval was not impaired in either task (p>0.05).Conclusion: We conclude that the OFC modulates spatial memories formed within representations of space that depend upon dark and light information.

Background: Mustard gas may cause acute (early) and chronic (late) lesions. Acute lesions include disseminated bullous lesions on skin, respiratory, and GI disorders; chronic complications are chronic bronchitis, severe asthma, and malignancies. B cells are active part of humoral immunity that secrete antibodies to defend our body.Materials and methods: We have evaluated 3 groups of patients, each including 25 patients as well as 10 control subjects. Complete blood count, morphological and flowcytometric studies were carried out. For flowcytometric studies 4 markers of CD45, CD19, HLA-DR, and CD25 were assessed on surface of B cells with CD45/CD19/HLA-DR phenotype. Their performance was investigated with CD25.Results: Our findings have revealed a significant decrease in CD25 on B cells' surface that is associated with recurrent microbial infections, in patients exposed to mustard gas.Conclusion: Genetic changes in B cells, due to mustard gas inhalation may predispose individuals to recurrent infections such as pneumonia.

Background: Cancer is the second most common cause of death in developed countries. The incidence of the different histological types of cancer varies greatly between different populations and it is attributed to occupational, social. cultural, racial, (possibly hereditary), and geographic influences. The objective of this study was to determine the pattern of age distribution and the frequency of different cancers, registered in different diagnostic centers in Babol during the year 2001.Materials and methods: In a cross-sectional study, characteristics of all registered malignancies were obtained from special records in different diagnostic centers in Babol using the International Classification of Disease (ICD). The data were analyzed using SPSS software.Results: Among 632 cases, 57.9% were males and 42.1% were females. 53.3% of malignancies occurred after 60 years old and 46.7% before 60 years. The mean age at diagnosis was significantly higher among males (59 years) than females (51 years), (p<0.001). The 10 most common malignancies among males were: stomach (24.9%), skin (10.7%), esophagus (10.1%), urinary bladder (8.2%), prostate (6.6%), colon and rectum (6.6%), hematopoietic system (4.9%), lymphatic system (4.6%), testes (3.8%) and connective tissue (2.7%). Meanwhile, the 10 most common malignancies among females were: breast (21 .4%), stomach (12.4%), esophagus (12%), colon and rectum (9%), hematopoietic system (7.9%), skin (7.5%), lymphatic system (3.8%), cervix (3%), ovary (2.6%) and thyroid gland (1.5%).Conclusions: With increasing age, the frequency of different cancers increases and our results indicate that more than half of the cases are 60 years or above. Stomach cancer is the most common malignancy of this region and occurs most frequently during 7th and 8th decades of life. The most common malignancy among females is breast cancer and occurs most frequently during the 4th-6th decades of life.

Primary rhabdomyosarcoma is a rare entity. To date, only 29 cases have been reported in the world literature. The current article presents another case of this disease, in which a 3-year-old boy was referred to our service with a one-week history of productive cough and fever. Imaging studies revealed a huge mass on the right lung as well as plural effusion. He underwent a right posterolateral thoracotomy and lobectomy. Pathologic studies revealed a primary pulmonary rhabdomyosarcoma of embryonic type. He has no other symptoms of disease on a 6-month follow-up.

Varicella Zoster Virus (VZV) causes two distinct clinical entities, varicella that is an acute and generally benign illness in children resulting from primary infection with VZV, and zoster which results from reactivation of latent VZV and usually occurs in adults. Zoster is uncommon before 10 years of age. Occurrence of herpes zoster during varicella infection is exceptional. Here, I report an unusual and rare case of herpes zoster that occurred during varicella in a healthy 10-year-old child.

Ovarian carcinoma of transitional cell type are rare, however, their simultaneous occurrence with bladder carcinoma of the same type is even a rarer condition. To our knowledge, 3 cases of this uncommon event have been reported in the literature.We present an 87-year-old female who had a previous history of bladder carcinoma of transitional type twelve years ago. She had ovarian carcinoma of the same type. She had undergone TUR several times; optimal cystoreductive surgery was performed for ovarian carcinoma. Chemotherapy was given following surgery and in a 6-month follow up there were no signs of a residual tumor.