MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:- | Issue:55|Papers Count:15

Background and Objectives: Shivering is one of the complications usually seen after general anesthesia with volatile anesthetics including halotane. Shivering increases oxygen consumption and makes heart to work five to ten folds more when it becomes severe. In addition to increasing intraocular and intracranial pressure, it aggravates wound pain by stretching incisions too. The aim of this study was to present a pharmacological approach having least side effects and which could lessen or stop shivering during recovery phase after general anesthesia.Materials and Methods: This was an applied, double blind study performed in Nikoukari hospital to evaluate the effect of doxapram on cessation of shivering after general anesthesia in recovery room. Fifty patients were randomly selected and divided into two groups: 1mg/kg doxapram was administered to the patients of group I and to the patients of control group (group II) only normal saline was administered. Data was collected using a questionnaire. Results of this study were analyzed using Students t-test. Results: Results of this study revealed that 64% of patients were males and 36% were females. Average age of patients was 50 years old and average body weight was 62 kg. When shivering began, axillary body temperature was 35.98 C and 36.01 C in doxapram and normal saline group respectively. Mean period of shivering in group I was 2.63 minutes, while it was 10.34 minutes for placebo group (p<0.005).Conclusion: Shivering is a severe and dangerous complication since it increases oxygen consumption about one hundred percent. Shivering always needs administration of additional oxygen and if it persists acid-base balance and hemodynamic status deteriorates. If shivering could be stopped, patients will have a very smooth and calm recovery period, and they can be free of many complications related to anesthesia.

Background and Objectives: Respiratory Syncytial Virus (RSV) is the single most important cause of lower respiratory tract infection (LRTI) in infants and young children. The characteristic feature of RSV is severe infection in infants but mild in adults. RSV is found in all parts of the world and outbreaks in cold seasons are associated with an increase in hospitalization of children and deaths from LRTI, so the diagnosis of the virus at an early stage is very important specially in order to avoid improper drug therapy. The aim of our study was to evaluate LRTI caused by RSV in infants by using non-cultural method.Materials and Methods: In a retrospective study to evaluate the lower respiratory tract infections, 252 children with respiratory syndrome and sex matched 152 children without any respiratory symptoms were randomly selected as case and control group respectively, and were studied for the detection of RSV antigens by immunofluorescent method.Results: Sixty two samples (24.6%) from case group and single control group sample (0.65%) were positive for RSV antigens. Statistical analysis showed meaningful correlation between two groups (p<0.05). High prevalence of RSV infection was seen among children between 1 - 6 months age group and during the month of December. Results of this study showed that the most important clinical features in RSV positive patients were pneumonia (31%), bronchiolitis (55%), wheezing (41%), cyanosis (46%), signs of allergic skin disorders (8%) and conjunctivitis (9%). Statistical analysis didn’t show any meaningful correlation between the socio-economic status and education of these two groups. Conclusion: RS virus is significant in younger children because it may cause lower respiratory tract infection, and in the presence of certain disease and factors it has been known to cause respiratory failure. Lower respiratory tract infections caused by respiratory syncytial virus can be rapidly diagnosed by fluorescent antigen test.

Background and Objectives: Chlamydia species have been always considered as one of the most important causative agents of human diseases. With introduction of C. pneumoniae and C. pecorum as two new species to the group of bacteria, it has drawn more attention towards health concern. Routine laboratory methods are not able to identify these organisms because of them being obligate intracellular. Classic diagnostic procedure is their isolation in cell culture. However, low sensitivity, time-consumption and being expensive makes the method less accepted. Serological methods can be applied but they are less sensitive and are not been able to identify the causative agent of the disease in early stage of infection. Therefore, antigen detection methods and molecular techniques have gained more interest. In this study, fluorescent antibody test (FAT) and PCR were used to detect C. pneumoniae in clinical specimens and the results were compared.Materials and Methods: Fluorescent antibody test was carried out by the use of C.pneumoniae specific monoclonal antibody A3 and fluorescein-isothiocyanate-labeled anti-mouse immuno-globulin. PCR was applied to amplify 545 base pair of MOMP gene by CpnA and CpnB2 primers. These two methods were first optimized by pure DNA extracted from proliferated known C. pneumoniae strains: IOL-207, N16, VR1310. One hundred six throat swabs obtained from 30 HIV positive patients were tested to evaluate the sensitivity of these two methods.Results: Results with pure DNA showed detection limit was 10 chromosomal DNA and 10 ifu for the PCR and FAT respectively. Analysis of collected throat swabs indicated that 39 and 42 specimens were positive by PCR and FAT respectively.Conclusion: Examined specimens confirmed nearly same sensitivity for both methods, but PCR is more suitable for clinical laboratory with a lot of specimens, while application of FAT needs accurate observation in suitable time.

Background and Objectives: Systemic and topical antimicrobials are effective in the treatment of inflammatory acne vulgaris. Widespread use of these agents is increasingly associated with the emergence of resistant pathogens. Thus, it highlights the need for an alternative nonantimicrobial agents for the treatment of acne. Nicotinamide gel provides potent anti-inflammatory activity without the risk of inducing bacterial resistance.Materials and Methods: In this double blind investigation, the safety and efficacy of topically applied 4% Nicotinamide gel was compared to 1% Clindamycin gel for the treatment of 80 patients with moderate to severe inflammatory acne vulgaris. Out of these 80 patients, 30 were males and 50 females. Most of the patients were in 16-20 years age group. Forty patients were treated by 4% nicotinamide gel and other 40 were given 1% clindamycin gel. Patients were unaware of the name of medicine except the code A and B. Thus, a total of 80 patients were randomly assigned to apply either 1% clindamycin gel (N=40, Group A) or 4% nicotinamide gel (N=40, Group B) twice daily for 8 weeks. Efficacy was evaluated after 4 and 8 weeks using a physicians global evaluation, acne lesion count and an acne severity rating. Results: At the start of treatment, for patients under clindamycin or nicotinamide gel therapy, acne severity count median was 5.75 1.45 and 6.1 1.19 respectively. After 4 weeks therapy, acne severity count average for group A reached to 3.4 and for group B to 4.05. After 8 weeks treatment, acne severity count average in the first group reached to 2.05 1.72 and in second group it was 2.05 1.39 and p=1. After 8 weeks, both treatments produced comparable beneficial results in the physicians global evaluation of inflammatory acne.Conclusion: These results demonstrate that 4% nicotinamide gel is more efficient as compared to 1% clindamycin in the treatment of acne vulgaris. Because topical clindamycin like other antimicrobials is associated with emergence of resistant microorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.

Background and Objectives: The nutritional status of women prior to pregnancy as well as during gestational period influences maternal and fetal well - being. The objectives of this study were: assessment of weight gain during pregnancy, birth weight status and some effective factors in women who attended health centers of Marand district, Tabriz. Materials and Methods: A total of 91 pregnant women were studied in this longitudinal, descriptive-analytical survey by interviewing with subjects and athropometric measurments.Results: Mean pregnancy weight gain was 8.12 2.99 kg and mean birth weight of the newborns was 3350 46mg. From all subjects only 12% had pregnancy BMI lower than 19.8 and 73.63% of subjects had inadequate weight gain during pregnancy. Negative significant correlation was found between pregnancy weight gain and age of mothers (r=-0.31, p<0.002). Birth weight of newborns correlated positively and significantly with pregnancy weight and pregnancy BMI of mothers and sex (male) of new borns (r=0.39, p<0.0001, r=0.35, p<0.001, r=0.23, p<0.03, respectively). Based on stepwise multiple regression analysis, pregnancy weight of mothers was the most independent variable associated with the birth weight.Conclusion: These findings indicate the importance of the effect of pregnancy maternal weight on the newborn weight status. Therefore, nutritional interventions are emphasized to improve the nutritional status of women prior to pregnancy as well as during pregnancy.

Background and Objectives: Hematuria is one of the common problems of urinary tract in children, and an important finding in some of the common and serious diseases of children. Materials and Methods: A three years (from March 1996-March 1999) retrospective study of 100 children admitted with hematuria in Tabriz Pediatric Center was done to identify its etiological factors, which were determined with the consideration of clinical and paraclinical findings in the reports.Results: The first complain was change in urine color and the second most frequent complain was presence of edema. There was no significant difference regarding the sex of patients. Post Streptococcal Glomerulo-nephritis (PSGN), urinary tract infection (UTI) and nephrotic syndrome were observed in 80% of the cases and among these PSGN had the highest incidence. Regarding the age group, most of the cases were in 6-12 years of age. Type of hematuria (microscopic and macroscopic) had not much importance regarding the diagnosis and prognosis.Conclusion: Inquiring about the presence of history of sore throat, measuring the blood pressure and careful examination of the abdomen are of prime importance in children having hematuria. It is also necessary to request complete investigation required to identify the etiological factors for a proper management.

Background and Objectives: About 5 to 10 percent of all brain tumors develop hemorrhage. Hemorrhage is more common in metastatic tumors. The most important clinical presentation is rise in intracranial pressure. Computerized tomography (CT) scan and Magnetic Resonance Imaging (MRI) are the best evaluation methods. In the present study, patients with brain tumors were evaluated for intratumoral hemorrhage utilizing MRI and CT scan.Materials and Methods: All admitted patients were evaluated with axial view of CT scan and MRI after clinical observation and coagulation tests.Results: Out of 642 cases with brain tumors studied, 29 cases were found to have intratumoral hemorrhage. Glioblastoma multiform was the most common pathologic type and acute severe headache was the most frequent clinical presentation. Intratumoral hemorrhage was more commonly observed in patients which were in their fifth and sixth decade of age.Conclusion: Intratumoral hemorrhage is one of the most important differential diagnosis for acute increase in intracranial pressure in patients who have been investigated or operated earlier or are under radiotherapy treatment for brain tumors.

Background and Objectives: It is quite difficult to calculate the effect of illegal substance use on society. The effects are various and widespread and its cost to society is very high. Substance abuse appears to be one of the most serious psycho-social problems of urban communities. Most of the substance abusers have an additional diagnosis which influences in etiology, course and outcome of the disorder. This study was carried out to evaluate the comorbidity of opioid dependency and other psychiatric Axis I and Axis II disorders.Materials and Methods: A total of two hundred self referred addicts to Tabriz Welfare Center were selected randomly. Data collection instruments included an interview based on DSM IV criteria and a demographical assessment questionnaire. Results: The most frequent opioid abusers were in the age group of 25-34 years. In 80 percent of subjects the most frequently used substance was opium. Findings showed that 90 percent of all addicts met the DSM IV criteria for a psychiatric disorder in addition to opioid dependency. The most common disorder of Axis I were dysthymia (67%) and anxiety disorders (36%). Antisocial personality disorder (41%) was the most common disorder in Axis II.Conclusion: Psychopathology is a common finding in opioid addicts and has an important role in etiology, prognosis and treatment of substance dependence.

Background and Objectives: Chronic otitis media causes many complications and disability in hearing system that requires surgery. The efficacy of tympanomastoidectomy procedures for chronic otitis media (COM) on controlling infection was assessed in four hundred patients by means of four- point rating scale that incorporated both symptoms and signs, such as the presence or absence of otorrhea and granulation tissue.Materials and Methods: This study was retrospective review of the 400 procedures. Of these, 210 were performed for COM with cholesteatoma and 190 for active COM with granulation tissue but no cholesteatoma.Results: Of the four hundred surgical procedures performed, ninety percent were primary procedures, and 10% were revisions and patients were followed-up for 12 months. Infections were controlled in 364 (91%) of these 400 cases. Of the 26 cases (9%) that developed persistent infections, 16 were controlled with a combination of oral and topical antibiotics. Thus, overall satisfactory control of infection was achieved in 390 of 400 cases. Conclusion: Although, outcome of surgery was influenced by the diagnostic category of COM and COM with granulation tissue, it was not influenced by the following variables: primary versus revision surgery, canal wall-up versus canal wall-down surgery, and extent of disease.

Background and Objectives: Atherosclerosis is affected by some related causative factors, diseases or smoking habits. The aim of this study was to reveal atherosclerotic lesions in aorta, lower limb and pelvic arteries as well as to study some stenosing factors of these arteries, such as increase in cholesterol level of blood, smoking habits or diseases like diabetes.Materials and Methods: Two hundred and seven patients referred to the Department of Radiology, Imam Khomeini Hospital for angiography of the abdominal aorta and pelvic or lower limb arteries were enrolled in this study. These patients underwent angiography after being evaluated by their medical records for cardiopulmonary disorders. Arterial puncture was done via common femoral artery by using Branule needle, guide wire, contrast material and other arterial means. For aortic arteriography, the catheter was introduced in this artery and radiographies were taken after the contrast been injected. However, for lower limb arteriography purpose, the catheter was put into the common femoral artery and after injection of the contrast material, radiographies were taken including the whole limb, i.e. from the thigh up to the toes.Results: Out of 207 atherosclerotic patients referred for angiography, 129 cases had other contributing diseases such as diabetes. Of these, 12 patients were treated and others were not treated enough. During this study, patients were also involved by Buerger, and multiple myeloma. Patients with the history of surgical operations on the pelvis or lower limb were assessed as well.Conclusion: As this study reveals that almost all of the patients had high level of blood cholesterol, and 92 of these also had smoking habit, to decrease the number of patients involved by atherosclerosis it is suggested to reduce the causative factors such as high blood cholesterol level and prevent contributing diseases like diabetes and smoking habits.

Long term treatments are gaining more attention now a days with due attention to successful treatment associated with malignancy and survival of patient for a longer time. However, one of the incidental feature appearing during such treatment is secondary malignancy. In this report two cases are presented, aged 55 and 18 years, with breast cancer and abdominal large cell lymphoma respectively who were treated with CAF (Cyclophosphamide-Adriamycin-5-Fluorouracil) and CHOP (Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone) chemotherapy. Both the patients developed ANLL 11 and 18 months after treatment respectively. They were given 6 grams of cyclophosphamide and were followed up for 2 years. Since threshold level of cyclophosphamide induced leukemia is less than twenty grams, therefore interference of other factors such as cytogenetic abnormalities seems amenable.

In this report a case of 46 years old female patient with diagnosis of Precoarctation Aneurysm (PCA) is presented. She was earlier operated for a hydatid cyst of lung with left thoracotomy. After thoracotomy, as the mass was pulsatile, chest had been closed for further studies. Results of CT scan and angiography revealed the presence of aneurysm precoarctation in the distal arch of aorta. Surgery with mid sternotomy and trap door in left intercostal space with the aid of Cardio Pulmonary By pass (CPB) was performed. In surgery field there was precoarctation aneurysm with a small Patent Ducts Arteriosus (PDA) and also aortic coarctation existed. Aneurysmectomy, closure of PDA and repair of coarctation was done interpositionally with dacron graft No 27 mm. Patient was discharged from hospital a week later in a good condition.