Journal of Inflammatory Diseases
Year:2010 | Volume:14 | Issue:2 (55)|Papers Count:14

Background: Determining the prevalence of degenerative changes by MRI in patients with low back pain (LBP) and lumbar canal stenosis is valuable for better understanding of important LSS issue.Objective: This study was designed to determine the prevalence of disc degeneration changes through MRI images obtained from patients with low back pain and lumbar spinal stenosis.Methods: This was a cross sectional study in which 53 patients (selected through examining 200 MRI images from patients seeking medical care because of low back pain (LBP) and referred to our MRI imaging center) with MRI findings compatible with lumbar canal stenosis (LSS), were investigated between June 2003 to September 2004. Intervertebral disc conditions such as normal status, bulging, and herniation were evaluated in patient’s MRI images.Findings: In 53 patients with lumbar canal stenosis, 34% were women and 66% men (P<0.005). Degenerative disc disorders (especially herniation) were found in 51% of our patients and 49% shown to have isolated bony canal stenosis occasionally with bulging discs. The isolated or combined anteroposterior (AP) diameter narrowing between patients with LBP was 94.35% in the current study compared to the previous estimation in our imaging center (80%) found in 1998. There was 5.65% isolated LR narrowing and 7.5% AP and LR narrowing in our study.Conclusion: Based on our results, 51% of patients had degenerative disc disorder in the form of disc herniation associated with spinal canal stenosis 24.5% with no disc pathology, and 24.5% with bulging discs. Disc degeneration was more prevalent in stenotic group compared to non-stenotic group (51% versus 34% p>0.03).

Background: Infertility is a complex crisis in couple’s life and can produce severe psychological pressure on both partners. Depression, stress, low self-esteem, and marital sexual dissatisfaction are among the psychological outcomes of infertility.Objective: This study was aimed to determine the relation between infertility and sexual satisfaction.Methods: This was a cross sectional study in which depression and sexual satisfaction rate among 150 infertile versus 150 fertile couples (in Tabriz- in 2005) were investigated and further analyzed. Random Sampling was used to select study population. Data gathering was performed using a questionnaire consisting of 2 parts including a section on demographic characteristics, and also a Larson standard questionnaire for determining sexual Satisfaction). Data were analyzed using descriptive statistical methods, independent t-test, and X2.Findings: There was no significant difference associated with mean sexual satisfaction rate between infertile and fertile men and infertile and fertile women (p=0.707, t=0.377 in men p=0.370, t=0.898 in women). However, a statically significant relationship between sexual satisfaction score and duration of marriage, income status, number of unsuccessful treatment, length of time when infertility diagnosed, and performance of diagnostic tests was found.Conclusion: Considering the unpleasant effects of sexual dissatisfaction on physical and emotional health and also the occurrence of infertility-originated divorce, attempt has to be made for early diagnosis and treatment of undesirable situation in both partners.

Background: Breast cancer is the most common cancer and the leading cause of death in women between 40-45 years old. Recognition of highly significant risk factors of breast cancer is of vital importance in preventing the incidence of this type of malignancy.Objective: The objective of this study was to determine the risk factors of breast cancer.Methods: This was a descriptive-analytical case-control study. The study population consisted of patients with and without breast cancer living in two cities of Ramsar & Tonekabon who visited the hematology and oncology clinic during 2004-2007. A total of 120 individuals were selected based on pairs sampling method. The study tool was a researcher-designed questionnaire which could evaluate a number of variables. Data were analyzed using statistical tests including chi-square test, paired t-test, and logistic regression.Findings: There was a significant relationship between the breast cancer and the duration of breast feeding (p<0.02), family history of breast cancer (p<0.01), history of using oral contraceptive pill (p<0.000), condition of menopause (p<0.000), and history of abortion (p<0.001).Conclusion: Considering our data, periodic screening of women with one or more risk factors of breast cancer is recommended.

Background: Clomiphen citrate is the first choice to induce ovulation in patients with infertility. In resistant cases, an alternative such as tamoxifen is administered.Objective: To investigate the effect of tamoxifen on endometrial thickness and ovulation rate of infertile women with poor response to clomiphen citrate.Methods: This was a clinical trial performed at Kosar hospital, affiliated to Qazvin University of Medical Sciences, in 2007. Thirty four infertile women who were treated by a maximum of 150mg clomiphen citrate for 5 days but still with endometrial thickness below 7mm or absence of dominant follicle, considered as resistant cases. The resistant patients were treated with tamoxifen citrate 10 mg for 5 days from 5th to 9th day of menstruation. In case of inadequate response, reflected through the absence of dominant follicle during next periods, the dose of drug was increased to 10-20 mg/day. At the 16th day of menstruation, vaginal sonography was applied to investigate the number and diameter of dominant follicle and endometrial thickness. Data were analyzed using chi-square test and T. test.Findings: Using clomiphen citrate, 6 patients with improper endometrial thickness showed a distinct improvement (5±1.8 mm to 12.1±1 mm, P<0.002). Using 30 mg of tamoxifen, 8 patients (23.4%) were found to have dominant follicle (P=0.008) and 2 cases became pregnant.Conclusion: Tamoxifen may be a good alternative for clomiphen resistant patients in whom it improves the endometrial thickness and in the meantime accelerates the development of dominant follicle before treatment with HMG or surgery.

Background: Regarding the relatively high numbers of DDH in Iran and also avoiding the problems of early treatment, the patient follow up and delay in therapy seem to be necessary in evaluating the spontaneous improvement.Objective: To evaluate the spontaneous improvement of sonographic findings of untreated DDH of neonates within one month after birth at Qazvin Kosar hospital.Methods: This was a descriptive analytical study performed on 2791 neonates born at Qazvin Kosar hospital during April 2008 to April 2009. Following clinical examination, if the neonate was found positive for DDH, a sonography procedure applied. In case of positive sonography, the treatment was postponed for one month and the clinical examination and sonography re-checked at the end of one-month delay in therapy. Data were analyzed using SPSS v16 software and chi square test.Findings: Of total 2291 neonates, 103 cases were found positive for DDH following physical examination among those 23 excluded from the study. Out of 80 neonates positive for DDH upon clinical examination, 42 were found with normal sonography and 38 with positive sonography for DDH among those 35 neonates (92.1%) were revealed to have spontaneous improvement after one month. Female sex, breach presentation, and left hip involvement in clinical examination led to higher numbers of positive sonography. Neonates with DDH born from older mothers were demonstrated unlikely to have spontaneous improvement.Conclusion: Delay in DDH treatment led to spontaneous improvement in 92.1% of cases. This delay in therapy could prevent the occurrence of complications such as femoral head avascular necrosis while reducing the medical costs and emotional complications in young parents.

Background: Sore throat is a common complication after surgery. Application of 10% lidocaine spray on cuff of a tracheal tube maybe associated with decreased risk of postoperative sore throat.Objective: The purpose of this study was to determine the effect of 10% lidocaine spray on postoperative sore throat.Methods: This double-blind study was conducted at Rajaei Hospital in Qazvin during 2008-2009. Two hundred ASA I-III surgical patients (except the neck surgery) aged 9-81 years and without signs of common cold, were randomly divided into two groups. The subject group received aerosolized lidocaine (5 puffs) on cuff of the tracheal tube before tracheal intubation. The patients in control group received normal saline instead. Later, the patients underwent a standardized general anesthesia. These patients were interviewed when leaving the recovery room and re-questioned for the presence of sore throat the following day in the wards. Data were analyzed using the chi-square test and Fisher’s exact test.Findings: Sore throat was present in 29% of subject group and 22% of control group while in the recovery room. Sore throat decreased to 16% and 17% on the day after surgery. There was no significant difference in incidence of sore throat between two groups based on duration of surgery and the patient's sex when in the recovery room or wards.Conclusion: It seems that the application of aerosolized lidocaine on cuff of the tracheal tube before tracheal intubation fails to decrease the incidence of postoperative sore throat.

Background: There are several studies about the correlation of blood glucose level and prognosis in traumatic patients.Objective: To determine the relationship between the on-admission plasma glucose (G) level with the type and severity of trauma.Methods: In this analytical study, 270 patients who were admitted to the trauma center of Alzahra general hospital in 2006, evaluated for plasma G level, GCS, TS, and the type of trauma upon admission. In cases with plasma G (BS1) grater than 140 mg/dl on admission, the plasma G (BS2) was re-checked the next 24 hours. Data were analyzed using t-test and correlation ratio.Findings: The incidence of different types of trauma and their mean BS1 were as follows: head and neck trauma (45%, BS1=238±104 mg/dl), multiple trauma (28%, BS1=193±82 mg/dl), extremities trauma (16.1%, BS1=140±12 mg/dl), abdominal and chest trauma (7.4%, BS1=200±89 mg/dl), and pelvis trauma (2%, BS1=152±10 mg/dl). The Mean plasma G level in patients with TS=11-16, TS=6-10, and TS=1-5 was 130.74, 273.78, and 340 mg/dl, respectively.Conclusion: In the emergency stage of trauma, hyperglycemia is common. In addition, an increase in plasma G level has a direct correlation with severity of trauma and head injury.

Background: Acinetobacter is a gram-negative pathogenic bacterium and an important cause of nosocomial infections especially in immunocompromised patients in the intensive care units. Reports of multi-drug resistant isolates have increased during the last decade. As a result of extensive use of broad-spectrum antibiotics and high prevalence of ESBL producing bacteria especially in ICU ward, Acinetobacter infection is often difficult to treat.Objective: To determine the antibiotic resistance in Acinetobacter and detecting the prevalence of ESBL producing strains in ICU patients of Namazi Hospital in Shiraz (Iran).Methods: This study was carried our on 147 clinical isolates of Acinetobacter collected from ICU patients at Namazi Hospital during October to December (2008-2009). Antibiotic susceptibility test for isolated strains was performed using disk diffusion method. Also, isolation of ESBL Acinetobacter strains was accomplished using double disk synergy test.Findings: The highest antibiotic resistance among 147 Acinetobacter baumannii strains was found against ciprofloxacin, amikacin, and gentamicin. Regarding the results of initial screening tests, 44% of total samples were demonstrated to be ESBL positiveConclusion: Based on our data, the major reason for emergence of diverse ESBL strains was due to unjustified administration of broad spectrum cephalosporins. Accurate antibiotic susceptibility testing prior to administration of antibacterial agents for patients to reduce the high prevalence of ESBL strains is recommended.

Background: In the art of medicine, besides learning of background science, having professional skills is essential for a physician. Some studies show a feeling of dissatisfaction associated with learning professional skills in medicine graduates.Objective: This study was performed to assess the professional skills in general practitioners of health service centers in Qazvin province.Methods: In this descriptive study performed in 2008, the professional skills of all general practitioners working in Health Centers of Qazvin Province (I.R.Iran) including 33 medical, management and communicational skills were assessed through self-assessment method. The results were statistically analyzed, through chi square test and Phi, Cramer's V, comparison between two proportions, and contingency coefficient. P values less than 0.05 were considered as significant.Findings: Of 33 target skills in 91 general practitioners including 36 males and 55 females, lack of desirable professional skills in 16 items was found in at least half of the physicians. The skill of urinary catheterization in male and female patients, by male or female physicians, both showed significant difference (P=0.000). The relationship between the gender of physician and the skills of management of a normal vaginal delivery showed a significant difference (P=0.044) whereas such relationship between the gender and management of post delivery complications demonstrated an insignificant difference, statistically.Conclusion: Regarding the results, revision in the contents of clinical educational courses and based on real need, increasing skills training, collecting and strict execution of “Log Book” in all clinical internship courses, establishment of “OSCE” method for assessment of skills in intern trainees, and designation of re-educative workshops for training skills in graduate physicians, are suggested.

Background: With respect to the fact that the levels of prices and tariffs are determined out of the market procedure, the method of determination and estimation of a balanced price and the necessity of a transparent follow-up on outcomes of increased prices is of vital importance for the politicians of this section.Objective: To determine the effects of increasing hospital and medical services tariffs on price index in other economical sectors.Methods: In this applicable study, the input-output table of the year 2001 of the Iran Statistics Centres was used as the statistical basis. Using three scenarios associated with increased tariffs marked as “weak” (approved tariff), “moderate” (based on inflation rate), and “strong” (proposed by the Medical Council), the effects of increased tariffs on price index in other economical sectors were evaluated. Two open & close supply approaches were used to analyze the inputs.Findings: The first, second, and third scenarios in open approach for increase in tariffs indicated a range of effects on price index in economical sectors calculated at 0.00001-13.81%, 0.00001-15.31%, and 0.00003-50.43%, respectively. In closed approach, the increase in tariffs in the first, second, and third scenario showed a range of effects on price index in economical sectors calculated at 0.02-12.46%, 0.02-14.01%, and 0.06-46.14%, respectively. Finally, the agricultural section demonstrated the least positive sensitivity and the hospital and medical section the most positive sensitivity to increase in tariffs.Conclusion: The findings of present study indicated that changes in medical and hospital services tariffs have little effects in other sections and a small role in production process and economic integration. These sections fundamentally have marginal consumption nature. The results of open and close approaches in different scenarios showed that the tariffs of medical and hospital sections must be increased according to the inflation rate.

Background: Proper site selection, number of manpower and their composition, physical space, optimal allocation of resources, active beds etcare the most important factors affecting the cost of current construction, income and other financial institutions in hospitals.Objective: This study assesses economic relationship between physical spaces and the hospital costs and determines hospital scale efficiency in selected hospitals across the country.Methods: This is a descriptive study which was conducted in 1386 in 139 hospitals (out of 530) covered by the medical universities throughout the country. The sample hospitals selected and grouped based on a combination of factors such as be a teaching and non-teaching hospital, located in deprived and rich areas and also size of hospitals in terms of number of active beds.Information was collected using a questionnaire designed for the study and also through hospital websites. The collected Information included the number of employees, total hospital expenditures and income and information about the physical space of all wards in the hospitals.Findings: Out of total 650.4 hectares physical space of the hospitals, 240.5 hectares were developed (structured building), which 117.3 hectares allocated to treatment (clinical) and rest was administrative and supportive service.Conclusion: The results showed that the hospitals in the second and third groups had lower maintenance costs than the other groups, in a way that they could have more than 10.5% savings of scale through development of hospitals from first into third group.

Background: Chronic polyarticular presentation is not a common manifestation of gout and it may be confused especially with rheumatoid arthritis (RA).Objective: To evaluate the characteristics of patients with chronic polyarticular gout, important clues for differentiation from RA and its correlation with cardiovascular disease.Methods: This was a descriptive study on patients with chronic polyarticular gout who, for the first time, were admitted to Ghaem Hospital, Mashhad University of Medical Sciences during 1998-2006. Diagnosis was based on international criteria of gout. Patients with arthritis in less than four joints were excluded from the study.Findings: Eighteen patients were enrolled. In 8 patients (44.4%), the joint involvements were similar to RA and in two patients crystals of calcium pyrophosphate in synovial fluid (12.5%) also found. One patient had a pseudotumor on the tophus, and two with Achill’s tendinitis. Among patients, 61% suffered from cardiovascular disease. In these patients 39% had chronic renal failure, 22.2% had diabetes, and 50% had hypertriglyceridemia.Conclusion: It seems that chronic polyarticular gout is a kind of polyarthropathy that requires more attention to diagnosis.

Loud noise in the environment can result in many complications the most common of which is hearing impairment. The first part to be affected is the outer hair cells in cochlea. Soldiers in the military service are in close contact with loud noise produced by fire arm shots. The present descriptive study evaluated the hearing changes in a group of soldiers spending their term of military service in Qazvin 16 Armored Division. Soldiers with no previous hearing complications were checked for hearing threshold of both left and right ears at different frequencies before and after shooting by P.T.A and O.A.E devices. Comparing the results, a significant difference in hearing threshold of the left and right ears at 4000 and higher frequencies before and after shooting incident was revealed. However, no significant difference at lower frequencies was observed.