Medical Journal of Tabriz University of Medical Sciences
Year:2002 | Volume:- | Issue:56|Papers Count:17

Background and Objectives: Failure to thrive in early years of life increases risk of physical growth retardation and probability of behavioral, emotional and cognitive problems in later period of life. Therefore it is considered to be one of the major concerns of child health. The objective of this cross-sectional study was to determine the prevalence of failure to thrive in 6-36 months old children at health and medical centers affiliated to Asadabadi region of Tabriz. Materials and Methods: In this cross-sectional study, implemented in February and March, 2000, a total of 1559 children (781 males, 778 females) were randomly selected using family folder numbers and their weight and height were measured. Percent of weight and height for age was calculated in proportion to ideal body weight, height (50th percentile on WHO/NCHS-World Health organization / National Center for Health Statistics - growth chart) for their age and sex. More than 90% was considered as normal, between 90-75% mild, 75-60% moderate, less than 60% as severe growth failures. Results: On the basis of weight for age parameter and comparing with NCHS growth chart 1.5% of children (1.4% males, 1.6% females) had severe to moderate, and 16.4% (14.5% males, 18.5% females) showed mild failure to thrive. Comparing with common growth chart for girls and boys, severe and moderate failure to thrive were observed in 1.7% of children (1% males, 2.3% females), while mild in 17.7% children (10.2% males, 25.3% females). Percentage of girls and boys found above 50th percentile was 57% and 55% respectively.Conclusion: Considering the results of this study, usage of separate growth chart for girls and boys are recommended.

Background and Objectives: There has not been adequate research on the epidemiology of attempted suicides in Iran. Thus, we decided to investigate the epidemiological data concerning suicide among patients who were admitted in the psychiatric emergency ward of Ebnecina hospital (Fars Province, Shiraz) for a period of one year (1997- 1998). Materials and Methods: Among 697 patients hospitalized in emergency wards , 80 were found to have committed suicide due to suicidal thoughts and attempts. They were studied by clinical interview and demographic questionnaire. Results: Of the 697patients who were hospitalized, 80 (5%) were admitted with respect to suicide. Among them 48 (60%) were males and 32 (40%) were females, the mean age of them being 28.8 years. Of the above patients 43 (53.8%) were single and 34 (42.5%) married, only 3 (3.7%) were divorced or widow. Most of them had low educational level and low socioeconomic position, and lived in urban areas. The majority of them gave history of previous suicidal attempts (75%), mental disorders (60%) and a significant number of them also had physical illness. The most common suicidal causes were hopelessness (45%) and in most of the cases drugs and poisons were the most important means of suicide (41.3%). Depression was the most dominant psychiatric disorder in population of our study (63.8%). Conclusion: It is suggested that the findings of this research can be applied efficiently in the prospective, preventive and therapeutic programs.

Background and Objectives: It is estimated that cardiovascular disorders especially coronary artery diseases are the leading causes of mortality in Iran. The most common complication of cardiovascular diseases is myocardial infarction and its consequences. The critical time for a patient with acute myocardial infarction is first 24 hours after acute chest pain. Depending on cultural and social knowledge of patients about chest pain, it seems that some patients use self - treatment by traditional therapeutics instead of seeking medical assistance. In this study, we analyzed the effect of delay in time from onset of acute chest pain to admission in coronary care unit (CCU) in patients with acute myocardial infarction. Materials and Methods: This cross sectional study was performed in Shahid Madani heart hospital, Tabriz Iran. One hundred patients of both sexes were consecutively enrolled and studied. All patients were admitted in CCU due to confirmed diagnosis of acute myocardial infarction. They were asked to fill up the questionnaire which included 27 questions about location and duration of pain, concept of chest pain, first decision made by the patient about onset of acute chest pain and the time interval from onset of pain till his/her admission in CCU. Results: Results revealed that the mean delay in time from onset of pain, help seeking and going to the nearest clinic (patient delays) was 162 minutes and from first clinic to emergency ward of hospital (clinic and transfer delays) was 154 minutes. It took 91 minutes to move patient from emergency ward to admission in CCU (hospital delay). Totally, mean time from onset of acute chest pain to admission in CCU was 407 minutes. Conclusion: Intervention aimed at reducing the delay in acute myocardial infarction treatment should focus on the three periods especially on the help - seeking behavior of patients.

Background and Objectives: Infectious endocarditis is a disease caused by microbial infection of the endothelium which covers the heart. Its special is microbial vegetation which usually appear on the valves and sometimes it may be seen in the interior layers of the heart. Different studies in advanced countries have reported the outbreak of the disease from 1.6 to 6 in 100,000 patients. The present study was conducted on cardiac patients to diagnose those suffering from native valve endocarditis and to assess them clinically as well as bacteriologically. Materials and Methods: This retrospective analysis was conducted in Shahid Madani Hospital of Tabriz, during the year 1995 - 1999. The patients who lacked diagnostic symptom of endocarditis, and those who were diagnosed only on the basis of clinical signs, were excluded from the study and finally 20 patients who had endocarditis of native valve were studied. The information was collected by filling a questionnaire including demographic information, blood samplings, pathologic results, reports of echocardiography and radiology, feverish syndrome, the records of using antibiotics and the signs of disease. These informations were analyzed by the statistical program of SPSS WIN. Results: In total 20 patients with average age of 34 years, having native valve endocarditis were selected for the study. Of these patients 65% were male and 35% were female. Out of twenty patients, 17 had complete results of their blood culture test. Staphylococcus aureus was obtained in 11.67% cases and two cases were positive for beta-hemolytic Streptococcus (11.72%). In the analysis of cardiac complication none of them had myocardial infarction and angina, 6 cases had embolism, 10% had arrhythmias and other 10% patients had heart block, 3 of the patients had neurologic lesions and radiological findings in 9 cases were abnormal. Out of 20 , 11 patients underwent open heart surgery. The patients were treated with ampicillin and gentamicin postoperatively. The minimum duration of confinement to bed was 6 days and the maximum 9 days. In this study 80% of the patients recovered while 20% died. Three patients had Brucella sp. endocarditis which was recognized by the Wright test. The most common site of the infection was aorta. Conclusion: Rheumatic fever is a universal disease, the outbreak of which is very high in the countries which have poor economical conditions, are overpopulated and having substandard living conditions. These conditions cause the rapid transmission of rheumatogenic streptococcus. Improving these conditions and usage of proper and timely antimicrobial treatment can decrease prevalence of rheumatic fever and endocarditis too.

Background and Objectives: Overweight and obesity are among the most prevalent nutritional problems in developed and developing countries. They are risk factors for various diseases and responsible for increasing mortality and morbidity rates. In adolescents these conditions are associated with overweight and obesity in the future years of life. In this study we attempted to determine the prevalence of overweight and obesity by using Body Mass Index (B.M.I). Materials and Methods: In this descriptive study, 1518 high school girls aged 14-18 years were selected by stepwise random sampling from 5 districts of Tabriz. Overweight and obesity were defined as: 85th BMI<95th and BMI 95th percentiles according to the First National Health and Nutrition Examination Survey (NHANES I) respectively. Results: In total 14.6% (with a 95% confidence interval: 12.8-16.4%) of the subjects were observed overweight or obese. Overweight and obesity was seen in 11.1%( confidence interval with 95%: 9.5-12.7%) and 3.6% ( confidence interval with 95%: 2.6-4.5%) of students respectively. In studied subjects 8% ( confidence interval with 95%: 6.6-9.4%) had BMI below than 15th percentile. Conclusion: It seems that overweight and obesity in Tabriz high-school girls are more than other parts of Iran, and less than that reported in U.S studies as well as those from some neighbouring countries. In this age group in addition to overweight and obesity, problem of being underweight (BMI<15 th ) should also be noticed.

Background and Objectives: Bloodstream infections (septicemia and fungemia) represent a significant medical problem of considerable magnitude. It has been estimated that the mortality of these infections exceeds 100,000 cases annually in the world. This study was conducted to analyze laboratory findings in septicemic patients admitted to Imam Khomeini Hospital, Tabriz. Materials and Methods: This study was carried out to analyze positive blood cultures received in the laboratory of Microbiology, Imam Khomeini Medical Centre, Tabriz in years 1995-1997 in order to determine microorganisms associated with sepsis and their antibiotic sensitivities. Our study was extended to year 1998 with the above mentioned aims as well as to evaluate other factors such as age group, body temperature, number of WBC in peripheral blood and risk factors associated with septicemic patients. Thus, in our retrospective part of the study 6,889 blood cultures taken from 3,045 patients were analyzed, while in the other part of the study 1886 blood culture bottles taken from 900 patients were evaluated. Results: Prevalence of blood infection was found as 10.4%, 11.5%, 11.4% and 11.3% for year 1995, 1996, 1997 and 1998 respectively. Polymicrobic sepsis cases approached to 1.4%, 3%, 4.5% and 6.9% respectively in the above mentioned years. In the first part of study (1995-97), Gram- positive bacteria were isolated from 36.1%, while Gram-negative bacteria were recovered from 63.1% of blood cultures. Results of our prospective study in 1998 showed 56.4% and 43.6% of Gram-positive and Gram-negative bacteria respectively were responsible for septicemia. Highest percentage of positive blood cultures were obtained from the patients in 50 - 59 years Of age of these positive blood culture patients 11.5% were males and 11.1% females. Our results indicated that when three bottles of blood culture were taken from the same patient it resulted in the highest recovery of microorganisms (p<0.05). Conclusion: Results of this study showed the various types of bacteria involved in septicemic patients. Septicemia continues to be a severe and life-threatening disease, its mortality rate being very high (45.1%). Thus, extensive care is needed to control and treat septicemic patients.

Background and Objectives: Intussusception is a major cause of intestinal obstruction in infancy and childhood. The increased use of ultrasound (US) in its diagnosis and reduction with normal saline has resulted in better outcome in patients. Materials and Methods: In this prospective study we evaluated the efficacy of ultrasound in diagnosis and treatment of intussusception in 21 children referred to Tabriz Childrens Medical Center from 21st June 1996 until 21st June 1997. Results: When ultrasound was performed on 21 patients for diagnosis of intussusception, 19 of these patients showed typical ftindings. Male to female ratio was 1.8 to 1. On ultrasound, none of the cases were detected as false negatives, however three false positives were noticed giving a sensitivity of 100% and specificity of 40%. When real-time ultrasound guided saline enema was perfomed in 17 patients, enema reduction was successful in 16 cases thus, achieving approximately an overall success rate. Contraindications for US- guided enema reduction were: bowel wall thickness greater than 11 mm, perforation, peritonitis and recurrent intussusception more than three episodes. Conclusion: Absence of radiation exposure, easy observation of the patients condition during the procedure as well as high success rate of US- guided saline enema makes ultrasound detection, one of the most promising methods for nonoperative treatment of intussusception. In this procedure there is no need for surgery and anaesthesia, thus it reduces surgical risks and even hospitalization cost too.

Background and Objectives: Reports are available which suggest depression of carotid baroreflex in myocardial infarcted (MI) patients. These patients are more subject to sudden death. The aim of the work presented here was to investigate carotid baroreflex sensitivity in male patients after myocardial infarction. Thus, in this study we examined relation between decrease in baroreflex sensitivity (BRS) and duration of cardiac cycle in male MI patients. Materials and Methods: The study was perfomed on 15 infarcted male patients in the range of 40 - 70 years with the first cardiac attack and the same number of age matched healthy persons without any cardiac or pulmonary diseases The study was performed in both supine and seated positions. In order to estimate carotid baroreflex Neck Suction Device (Eckberg model) was used and electrocardiogram was recorded continuously. Intensity of stimulation and duration of stimulation were - 30 mm Hg and 30 seconds respectively. Results: Duration of basic cardiac cycle in normal group in supine and seated positions was 0.8616±0.13 SD seconds and 0.8619±0.141 SD seconds respectively that increased to 0.9529±0.12 SD seconds and 0.9436±0.9436 SD seconds after stimulation(p<0.001). Duration of basic cardiac cycle in patient group in supine and seated positions was 0.8717±0.127 SD seconds and 0.8215±0.11 SD seconds respectively that increased to 0.9124±0.153 SD seconds and 0.8767±0.15 SD seconds after stimulation(p<0.05). When duration of basic cardiac cycle in supine and seated positions in patients was compared to healthy group, a difference of 0.0511±0.011 SD (p<0.001) in supine position and 0.032±0.011 SD (p<0.001) in seated position was observed. Baroreflex sensitivity significantly increased with age (r=0.736; p<0.001 for control group, r= 0.66; p<0.05 for patient group) in both the groups and the differences were statistically significant. Adaptation in patients group was less compared to control group (r= 0.9, p<0.001 for control group and r=0.673, p<0.01 for patient group). Conclusion: This clinical study suggest that analysis of baroreflex sensitivity in patients after MI can be important for prognosis.

Background and Objectives: Proper dietary program in the patients undergoing hemodialysis not only can affect number of dialysis sessions but also postpone the need for transplantation as well as prevent its complications. Therefore, nutritional knowledge, attitude and practice of patient with renal failure undergoing hemodialysis were assessed . Materials and Methods: For this cross-sectional study, 70 patients (33 males and 37 females ,15-80 years old age) undergoing hemodialysis in Sina hospital, Tabriz were selected by simple sampling methods and data was collected by face to face interview using questionnaire. Results: The findings of this study showed that nutritional knowledge, attitude and practice were good in 47.10%, 74.3%, 62.9% patients respectively. Direct significant correlation was found between knowledge with attitude, attitude with practice and knowledge with education. Conclusion: On the basis of our findings, if increase in nutritional knowledge could result in changing attitude, it would be able to produce practical changes.

Background and Objectives: There are two distinct types of primary dysmenorrhea (Spasmodic and Congestive) which differ with each other in timing, quality of pain and other symptoms. The main purpose of this study was to determine the effectiveness of relaxation techniques (progressive muscle relaxation) in these two types of dysmenorrhea. Materials and Methods: Data was collected in the form of questionnaire, interview and clinical examination of sufferers. Target community of our study consisted of the students, which were residents in the two dormitories of Tabriz University of Medical Sciences, and had menstrual pain. Eighty - eight subjects (44 subjects with spasmodic and 44 subjects with congestive dysmenorrhea) were selected randomly from these two dormitories. In the next step, the students from one of these dormitories were assigned as experimental group, while students from the other dormitory were assigned as control group, so that study should not be affected. Relaxation exercises were trained only to the experimental group and the control group did not receive any interventions. Finally 75 students completed the study (35 spasmodic and 40 congestive subjects). Results: The study demonstrated that relaxation techniques were very effective in treating the subjects with spasmodic dysmenorrhea. It resulted in a significant reduction in SSS score, resting time and the amount of analgesic use in post treatment period in comparison with pretreatment period and control group. In congestive group relaxation was effective as compared to the spasmodic group but the amount of analgesic use and resting time did not reduce significantly. Conclusion: Relaxation techniques were effective in treating both spasmodic and congestive dysmenorrhea, however effectiveness observed in congestive cases was less than that seen spasmodic cases.

Background and Objectives: Infections resulting from Salmonella typhi and non-typhi Salmonella are still of special significance in many parts of the world especially in developing countries. Different types of salmonella have increasingly become resistant to the common antibiotics used in therapy. Our main objective was to study in vitro effects of five third - generation cephalosporins on 413 Salmonella strains which had been isolated from different clinical samples in Tabriz Childrens Medical Center. The results were compared with routine antibiotics (chloramphenicol,ampicillin, trimethoprim - sulfamethaxazole) prescribed in salmonella infections, so that effective measures could be taken for its treatment. Materials and Methods: Four hundred and thirteen salmonella strains isolated from different clinical samples including feces, blood, cerebrospinal fluid (CSF), wound, sputum and urine were studied. The clinical samples were cultured on to selective and differential media including SS agar, EMB, KIA, , blood agar , nutrient agar, and into trypticase soy broth as well as enrichment medium (selenite broth). The strains were identified using biochemical tests and antisera (bioMerieux). Sensitivity test on the isolated strains was carried out using the disk-agar diffusion (Kirby - Bauer) method. Results: Out of 413 salmonella strains two hundred and eighty eight strains (70%) were isolated from stool and 95(23%) strains from blood, while 10 (2.2%), 9 (2.1%), 8 (2%) and 3 (0.7%) strains were isolated from CSF, wound, urine and sputum samples respectively. The isolated organisms were identified using biochemical and serological tests and were arranged in the order of frequency of occurrence as: 292 (70%) serogroup B strains, 58 (14%) serogroup A strains, 39 (9.4%) serogroup C strains, and 24 (5.8%) Salmonella typhi strains. Thus, 93.4% of the collected salmonella strains were identified as non-typhi salmonella and 5.8% as S.typhi. All of the salmonella strains were sensitive to cefotaxime, ceftriaxone, ceftazidime, cephaperazone and the only resistance encountered belonged to non-typhi group in which 82 (21%) strains were resistant to cephaperazone. Non-typhi salmonella strains were also found resistant to ampicillin (98.7%), chloramphenicol (87.2%) and trimethoprim-sulfamethaxazole (58.6%), while S.typhi isolates revealed resistance of 4%, 1.3% and 4% against the mentioned antibiotics respectively.53.2% of the studied non-typhi salmonella strains showed resistance pattern of ampicillin + chloramphenicol + trimethoprim - sulfamethaxazole and 32.7% of them were resistant to ampicillin + chloramphenicol, while only 4.2% of the S.typhi strains showed resistance pattern of ampicillin + trimethoprim - sulfamethaxazole and other 4.2% strains were found resistant to ampicillin + chloramphenicol. Conclusion: The prevalent salmonella strains isolated in this study belonged to serogroupB, serogroupA, serogroupC and Salmonella typhi with pronounced presence of non-typhi groups. All Salmonella typhi and non-typhi salmonella were sensitive to the third generation cephalosporins tested in this study and the only resistance encountered concerning the third generation cephalosporins was that of non-typhi salmonella against cephoperazone (21%), underlining their importance in therapy of salmonella infections. Single resistance and multiple resistance against routine antibiotics used in treatment of salmonella infections were encountered both in Salmonella typhi and non-typhi salmonella.

Background and Objectives: Few studies have been carried out about treatment outcome of obsessive compulsive disorder (OCD). In this study the role of age, sex, duration of disorder, family history and comorbidity in treatment outcome of obseseive-compulsive disorder were investigated. Materials and Methods: One hundred patients (47 males, 53 females) were treated with anti- obsessive compulsive drugs (Clomipramine-fluoxetine) for one year. The age of patients ranged between 12 and 69 years. The severity of the disease and the course of improvement in the begining and end of the study were evaluated with psychiatric clinical examinations. Fourteen patients were dropped out. Forty nine females and 37 males completed the study. Results: Significant improvement was related with the age of patient (significant improvement was noted in 62% of patients under 21 years old, 41% of patients 22-31 years old, and 25% of 32-41 years old patients). Sex had significant importance in the course of improvement (51% males improved better as compared to 49% females) (p<0.05). Duration of the disease was reversely related to significant improvement. Significant improvement was noticed in 60% of cases with duration less than one year, 55% of cases between 1 and 5 years, and 41.5% of cases between 6-10 years. Family history of the presence or absence of disorder was not significant in treatment outcome. Patients with compulsion (only) had the best outcome. Comorbidity had no significant effect on the course of the disorder. Conclusion: Finally, it can be assumed that early treatment of the disorder has significant importance in the prognosis of obsessive - compulsive disorder.

Background and Objectives: A high intensity of deep vein thrombosis (DVT) has been observed in the deep veins of lower limb. The objective of this study was to locate the site of deep vein involvement, its intensity, and the resulting complications in order to provide needed contribution for their management. Materials and Methods: This study was done on 206 patients referred for angiography in the Department of Radiology, Imam Khomeini Hospital with the preliminary diagnosis of deep vein involvement, particularly their occlusion. Phlebography was performed for the diagnosis. After surveying patients history for cardiopulmonary diseases and preceding preparation, according to the age of the patient a needle of 20-23 gauge was introduced in one of the superficial veins of the dorsum of the foot. Tourniquet was applied above the ankle with the 30-mmHg pressure. Contrast material, up to 20 to 30 ml was injected from the leg and several radiographies were taken. Overall volume of the contrast medium corresponding to 80-100ml was used to study the femoral and pelvic veins. Results: The occlusion of the deep veins and their degree of the occlusion was revealed and formed varices were observed. Conclusion: DVT is mostly located in deep veins of leg and its sites, and less found in pelvic veins. It is observed that the highest intensity of DVT also occurs in deep veins of leg. The main resulting complications involve pain and disability of lower limb. This study elucidated the causative factors of this disorder and the necessary recommendations are presented for the patients in order to prevent the recurrence.

Alveolar proteinosis is a rare lung disease of unknown cause presenting with dyspnea and acinar pulmonary infiltrates due to lipoprotein - filled airspaces. A 34 aged man with cough and severe dyspnea was admitted with a diagnosis of pulmonary alveolar proteinosis. He underwent bronchopulmonary lavage under general anesthesia. Before lavage he had obvious clinical and laboratory signs of respiratory failure including tachypnea, resting dyspnea, cyanosis, polycytemia (Hct=65%, Hb=18.3), hypoxia (Pao2=47mmg , Sao2=79%) and hypercarbia (Paco2=50mmHg). After preoperative assessment such as twice phlebotomy performed within 72 hours interval and preparation under general anesthesia first right lung and then after 4 days left lung was lavaged with 21 and 17 liters of normal saline solution respectively. After lavage of both lungs significant improvement in clinical and paraclinical signs was achieved. In arterial blood gas analysis Pao2 increased to 86 mmHg, Sao2 was 91% and Paco2 decreased to 38 mmHg. A significant resolution of airspace consolidation in chest X- Ray was observed.