Razi Journal of Medical Sciences
Year:2009 | Volume:16 | Issue:66|Papers Count:8

Background and Aim: Nephrotoxicity is the most important and the most frequent adverse effect of Aminoglycosides, which restricts its usage despite its availability and effectiveness. It seems thatL-carnitine with an inhibitory effect on free radical production and some antioxidant effect, may have a supportive role against the potential renal damage due to ischemia. The recent study was designed to compare the serum ACE and serum and urine NAG activities in patients on L-carnitine and Gentamicin treatment with the control group.Materials and Methods: The recent study is a randomized clinical trial conducted on patients admitted in the Orthopedic ward of Hazrat-e-Rasool Akram hospital in 2006. Sixty-four patients were allocated randomly to the case and control groups. The control group received 80 mg of intravenous (IV) Gentamicin, three times a day for 3 days. The case group was under the same treatment plus 1 gram of oral L-carnitine, for 3 days, three times a day. Serum ACE and serum and urine NAG activities were compared within the two groups. Data were analyzed using SPSS V.11.05 software , Paired sample t-test, Independent sample t-test and ANOVA.Results: Serum and urine NAG activity on the first day showed no significant difference among the two groups, but there were significant differences at the end of the treatment period (4th day). Serum ACE activity in both the case and control groups showed no significant differences prior and after the treatment period.Conclusion: The results of the recent study showed significant changes in serum and urine NAG activity during the short course of the treatment. These may show early renal tubular injury prior to any BUN and creatinine changes. On the other hand, although urine NAG activity in patients receiving Lcarnitine showed an increase on the fourth day of treatment, but the increase is less than the control group. The above findings may support the supportive role of L-carnitine in tubular damages.

Introduction: Cancers are the most prevalent causes of exudative pleural effusions after parapneumonic pleural effusions. Despite the combination of the pleural fluid cytological studies and pleural biopsy, diagnosis could not be reached in an important number of cases. In an attempt to improve the value of pleural fluid analysis in the diagnosis of malignant pleural effusion, some studies have focused on the evaluation of different tumor markers. In this study we decided to determine diagnostic value of tumor marker assay in pleural effusions versus cytology and biopsy.Materials and Methods: This analytical cross-sectional study was performed in Hazrat-e-Rasool Akram Hospital. Forty patients with lymphocyte dominant pleural effusion and negative pleural fluid smears and cultures for tuberculosis were enrolled in this study. Cytology, biopsy and thoracoscopy (if needed) were done. Levels of the six selected tumor markers (aFP, CEA, CA 19-9, CA 15-3, CA 125 and b-hCG) were measured in the pleural fluid. Sensitivity, specificity, positive and negative predictive values were calculated regarding the results of cytology, biopsy and thoracoscopy. Also, t-test and Chi2 were used in data analyses.Results: The sensitivity of the six measured tumor markers in pleural effusion was: 4% AFP, 52% ßhCG, 35% CA 19-9, 65% CEA, 95% CA 125 and 65% CA 15-3. The specificity of all tumor markers was 100%, except CA 125 which was calculated as 25%. The combination of markers including CA15-3, CA 19-9, CEA and b-hCG had sensitivity and specificity of 95.6% and 100%; and PPV and NPV of 100% and 80%, respectively.Conclusion: Using tumor markers could possibly be a suitable substitute for invasive and expensive methods such as thoracoscopy and thoracotomy. It seems that applying the combination of umerous tumor markers increases the sensitivity and helps us to make better differential diagnoses.

Background and Aim: Clonidine has been found to decrease the tourniquet pain and enhance analgesia, when added to lidocaine in Intravenous Regional Anesthesia (IVRA) for upper extremity surgery. Our study evaluates the efficacy of oral clonidine as premedication before IVRA with that of lidocaine for upper extremity surgery and compares it to that of clonidine added as adjunct to lidocaine solution for IVRA. Patients and Materials: We conducted a prospective randomized double-blinded study on 60 patients undergoing upper extremity surgery under IVRA. Patients were randomized to receive plain lidocaine, 200 mg in 41 ml for IVRA(group IVRA), lidocaine 200 mg in 40 ml plus clonidine 2 mg/kg in 1 ml (group IVRA–C), or plain lidocaine, 200 mg in 41 ml for IVRA plus oral clonidine 2mg as premedication 1.5 hrs before surgery (group IVRA-OC). Patients in the first two groups received a placebo as premedication. Times of proximal tourniquet deflation and distal tourniquet inflation (T1), time of first intraoperative request for analgesics (T2) , time of first postoperative request for analgesics(T3), and the total analgesic consumption were recorded.SPSS V. 13 was used for statistical analysis. Quantitative data are shown as mean+/- SD and qualitative data are presented with frequency. Chi square and ANOVA tests were used for data analysis. p<0.05 was considered as significant.Results: In this study 60 patients were divided in to three groups of 20 each. The groups were IVRA, IVRA-C and IVRA–OC. There were no significant differences among the three groups in regard to the demographic characteristics and the duration of surgery. Time duration of proximal cuff deflation and distal cuff inflation was 49.5 +/¾ 10.5 minutes in group IVRA–C, which was almost twice that of the other two groups (p= 0.0001). Time for first intraoperative request for analgesics was significantly different (longer) in group IVRA–C as compared to group IVRA p= 0.01). Time for first postoperative request for analgesics and the total analgesic consumption were significantly longer and lower, respectively in group IVRA-OC (p = 0.0001).Conclusion: The addition of clonidine to lidocaine for IVRA, delays the onset of tourniquet pain and decreases analgesic consumption for tourniquet pain relief intraoperatively. Oral clonidine, on the other hand, is mostly effective in postoperative pain relief.

Background and Aim: Many studies have shown the neuroprotective effect of systemic hypothermia in the treatment of spinal cord injury. But the effect of delay hypothermia is not known. The goal of this study was to evaluate the effects of Methylprednisolone on the therapeutic window of hypothermia treatment following experimental Spinal Cord Injury (SCI) by measuring the accumulation of Polymorphonuclear leukocytes(PMN) at the traumatic site.Materials and Methods : In an experimental study, twenty-four Wistar albino rats (260–300 g) were divided in to six groups of four each: A(only laminectomy), B(Trauma; laminectomy + cord injury), C (methylprednisolone; laminectomy + cord injury + methylprednisolone), D(early hypothermia; laminectomy + cord injury + early hypothermia), E(late hypothermia; laminectomy + cord injury + late hypothermia), and F(late hypothermia + Methylprednisolone; laminectomy + cord injury + late hypothermia +MP). Traumatic spinal cord injury (SCI) was induced by using Weight drop method (30 g.cm) on the anesthetized animals at T9 level. Tissue samples from the spinal cord were harvested 7 hours after laminectomy. PMNs counting were performed by light microscope and the data were analyzed using One-way ANOVA.Results: Early hypothermia and methylprednisolone inhibited PMN accumulation, but late hypothermia (induced 3 hours after trauma) did not show significant effect on PMN count. Delay hypothermia and Methylprednisolone decreased the number of PMN, but it seemes that this effect was related to methylprednisolone. Adding methylprednisolone to delay hypothermia did have significant beneficial effect, but it was not more than "methylprednisolone alone" group.Conclusion: Methylprednisolone cannot extend the Therapeutic window of systemic moderate hypothermia for the treatment of experimental mild traumatic spinal cord injury in rat.

Background and Aim: Dermatophytes are the group of keratinophilic fungi that can cause diseases and infection in skin and other keratinized parts such as nail and hairs. The most important genus among keratinophilic fungi is Trichophyton which can be the most probable cause of tinea pedis in the world. There are 24 recognized species of this genus. Additionally, molecular strain typing of Trichophyton mentagrophytes isolates within skin specimens from patients with dermatophytosis indicates involvement of multiple strains. The aim of this study was the determination of strains of Trichophyton mentagrophytes in order to prevent the dissemination of infection, which is very important epidemiologically.Materials and Methods: The study was of descriptive – analytic type. Skin specimens from 100 patients who had dermatophytosis by Trichophyton mentagrophytes were cultured and plates which had 5 colonies were selected. Deoxyribonucleic acid (DNA) was extracted from the isolates. According to PCRbased typing method that analysed variations in the numbers of repeats in the non-transcribed spacer (NTS) region of the ribosomal ribonucleic acid (rRNA) gene repeats, data were described. All the results were analyzed by (±SD), Chi –square and t-student tests.Results: In 20 out of 100 specimens of Trichophyton mentagrophytes , there were 2 or more strain types in a variety of Trichophyton mentagrophytes. Conclusion: These results suggest that in the most cases of fungal infections caused by Trichophyton mentagrophytes, multiple strains are involved. These results have important implications in epidemiological studies, treatment and drug resistance in fungal infection.

Background and Aim: There are increasing concerns regarding antimicrobial resistance in Iran. Data are limited on the prevalence and risk factors associated with resistant organisms, including Escherichia coli (E.coli) which is the most common cause of urinary tract infection (UTI). The aim of this study was to evaluate the prevalence of resistance and risk factors for resistance to gentamycin (GEN) , ceftriaxone (CFX) and a combination of both of them in E. coli strains isolated from hospitalized patients with acute UTIs in Tehran, Iran.Materials and Methods: We performed a prospective descriptive case –control study from March 2005 to March 2008 among all cases of UTI in children from 1 month up to 12 years of age who were admitted to Ali Asghar Childrens Hospital (a referral pediatric center in Iran). Positive urine cultures with E.coli were further classified to sensitive, intermediate and resistant strains according to standard NCCLS method. Evaluated risk factors were checked within case control groups and the results were analyzed first by Chi square and then Logistic regression tests using SSPS V.15 software. Results: A total of 125 E. coli were isolated. Resistance rates were 38.4% for CFX , 24% for GEN and 20% for CFX+GEN. Univariate analyses selected the following factors as being significantly associated with E. coli resistance: I) for resistance to GEN: prophylactic antibiotic (OR=3.5, p=0.006), urologic disorder (OR=2.4 , p=0.04), resistance to CFX (OR=15.7 , p=0.000), Vesicourethral reflux (VUR) (OR=2.7 , p=0.021) , with a trend toward significance for prior (1 year) urinary catheter (OR=2.5, p=0.052), and prior (6 months) hospitalization (OR=2.2 , p=0.055) ; II) for resistance to CFX: prior (1 year) UTI (OR=2.6 , p=0.012) , prophylactic antibiotic (OR=4.2 , p=0.001), urinary catheter (at present) (OR=4.8 , p=0.007) , prior (1 year) urinary catheter (OR=3.3 , p=0.006), urologic disorder (OR=2.7 , p=0.007) , prior (1 month) surgery (OR=8.8 , p=0.03) , prior (6 months) hospitalization (OR=4.2 , p=0.000) , resistance to GEN (OR=15.7 , p=0.000) , VUR (OR=2.2 , p=0.04) and NB (OR=3.9 , p=0.003) ; III) for resistance to CFX+GEN: age < 4 years (OR=3.9 , p=0.025) , prior (1 year) UTI(OR=2.5 , p=0.038) , prophylactic antibiotic (OR=4.1 , p=0.002) , prior (1 year) urinary catheter (OR=2.7 , p=0.036) , urologic disorder (OR=2.9 , p=0.02) , prior (6 months) hospitalization (OR=2.5 , p=0.037) , and VUR (OR=2.8 , p=0.022). We also used Logistic regression analyses for risk factors which had p<0.05 in univariate analyses. The results were: I) for resistance to GEN: resistance to CFX (Sig. = 0.000, EXP (B) = 13.5); II) for resistance to CFX: Prior (6 months) hospitalization (Sig.= 0.047, EXP (B) = 2.9) , resistance to GEN (Sig. = 0.000 , EXP (B) = 15.6); III) for resistance to CFX + GEN: age (<4 years) (Sig. = 0.040 , EXP (B) = 4.3).Conclusion: Recognized risk factors must be considered when deciding for empiric therapy in children especially in referral centers. We hope that our results will contribute to the development of strategies aimed at limiting the evolution of antimicrobial resistance in Iran.

Background and Aim: Acute appendicitis is a common cause of abdominal pain and it can be difficult to diagnose, especially during the early stages. The role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined. The aims of this prospective audit were to define the role of C-reactive protein and the other serum markers of inflammation, total white cell and neutrophil count in the diagnosis of acute appendicitis in adult.Patients and Methods: In a prospective analytic setting, 100 patients with the probable diagnosis of acute appendicitis (Alvarado score ≤5) that had referred to Tabriz Pediatric Hospital during 2007-08 were studied. The CRP, WBC count and neutrophil percentage were checked on admission in all patients and were compared between the patients with and without definite diagnosis of acute appendicitis according to the result of histopathologic study or follow up (as the gold standard methods) via Student t-test, Mann-Whitney U test, Chi-Square test and Fisher’s Exact test.Results: A total of 52 males and 48 females with the mean age of 20.6±4.1 years were recruited. Fifty four (54%) patients revealed to have definite acute appendicitis. Patients with final diagnosis of acute appendicitis had significantly greater values of inflammatory markers. Elevated CRP had sensitivity (62.7%), specificity (68.3%), positive predictive value (74%) and negative predictive value (56%) which is not enough for diagnosis. Only 2 patients with normal markers had acute appendicitis. Conclusion: This study showed that despite the elevation of these inflammatory markers in patients with acute appendicitis, mere reliance on laboratory findings in managing the patients with equivocal appendicitis would not make sense. Combination of the clinical suspicion with these laboratory data is recommended. Normal values of all of these markers are very unlikely in pathologically confirmed appendicitis in adult.

Introduction: Simultaneous anterior fracture-dislocation of the shoulder and fracture of the ipsilateral humeral shaft results from severe trauma and is very rare. In this report we present such an injury and its treatment.Case Report: A 48-year old man was brought to hospital after a motor bike accident with anterior dislocation of the shoulder and fracture of the ipsilateral humeral shaft and greater tuberosity. Both injuries were treated by open reduction and internal fixation.Conclusion: By timely diagnosis of this rare and disabling injury, full treatment can be given. Thus, performing an accurate examination and obtaining the essential x-rays are mandatory.