Journal of Inflammatory Diseases
Year:2007 | Volume:11 | Issue:3 (44)|Papers Count:19

Background: Bacterial sepsis is one of the most common diagnostic challenges in newborn medicine and is considered as a leading cause of neonatal mortality and morbidity.Objective: To study the role of C-reactive protein (CRP) in diagnosis of neonatal early-onset sepsis.Method: This was a cross-sectional analytical study in which 100 newborn babies admitted to NICU were investigated. C-reactive protein was measured before and 24 hours after the beginning of therapy. Continuation or cessation of antibiotic treatment depended upon the results of CRP and blood culture. The data were analyzed statistically using chi-square and fisher exact tests.Findings: Sensitivity of the first measurement of CRP compared with the result of blood culture was unmeasurable, but the negative predictive value was 97%. The sensitivity of CRP in second measurement and the negative predictive value were 100%.Conclusion: Our findings revealed that the first CRP result bear little sensitivity in diagnosing sepsis, however, the second CRP result produced higher sensitivity and negative predictive value (100%) for detection of early-onset sepsis. CRP negativity 24 hours after the onset of symptoms could rule out the presence of sepsis with further antibiotic cessation. On the other hand, a positive CRP with sensitivity of 100% is suggestive of sepsis.

Background: Peripheral intravenous catheters are increasingly used in neonatal intensive care unit (NICU) to administer intravenous fluids, blood products, drugs and nutrition. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay.Objective: To determine colonization rate of intravascular (IV) catheters and catheter related bacteremia in NICU of Qods hospital.Methods: This was a descriptive study carried out on 100 infants whose catheters were removed for any reason. A length of 3 cm from the catheter tip was cut aseptically and placed in thioglycolate media. In case of any growth within the next 7 days, subcultures on blood agar and MC agar media were performed followed by bacterial identification. Drug susceptibility profiles of isolated bacteria were detected according to standard methods. Before catheter removal, blood sample from each infant, was taken for culture, microbiological identification and susceptibility assay.Findings: Of 100 catheter tips, 35 (35%) samples produced positive cultures among those 19 cases (52%) identified as coagulase negative staphylococci (CNS). Positive blood cultures were found in samples of 7 patients (7%), all from catheters colonized with bacteria, and identified as CNS (4 samples) and coagulase positive staphylococcus (3 samples). Among the CNS isolated from catheters, the highest resistance (100%) was related to ampicillin and Oxicillin and the lowest (18%) resistance associated with vancomycin.Conclusion: Application of intravascular catheters in neonates should be accompanied with great attention in making a balance between the need for vascular access and the risk of bacteremia and thus, adequate control and rigorous preventive measures must be established when a vascular access is a necessity.

Background: Prolonged jaundice is defined as a type of icterus lasting over 14 days in term neonates or over 21 days in preterm neonates. Various pathologic causes such as urinary tract infection may induce prolonged jaundice.Objective: To determine the prevalence of urinary tract infection in neonates with prolonged jaundice.Methods: This was a cross sectional study carried out at Aliasghar hospital in Zahedan (Iran) during 2005. A total of 230 neonates with prolonged jaundice were investigated, conveniently. Using a urine bag, single sample was collected from all patients followed by culture. In case of a positive urine culture (>105 CFU/ml of a single pathogen), a second urine sample was taken by suprapubic method and cultured again. The reappearance of previously identified single pathogen was indicative of the presence of urinary tract infection. The data were analyzed using Chi2 statistical test.Findings: Out of 230 neonates, 138 (60%) were males and 92 (40%) females. Positive urine culture was identified in 17 (7.4%) samples while the majority of samples (213) produced negative results. The organisms isolated in urine cultures were E coli in 13 samples (76.5%), Klebsiella in 3 cases (17.6%) and Staphylococcus aureus in 1 sample (5.9%). Regarding the gender, no statistically significant difference between the prevalence of urinary tract infection and the types of pathogens was found.Conclusion: Based on our data, a urine culture should be considered while bilirubin work-up of infants with unknown etiology of prolonged jaundice is carried out.

Background: Low birth weight is one of the risk factors associated with neonatal morbidity and mortality. The relationship between stressful life events and low birth weight is not well documented.Objective: To determine the association between low birth weight and stressful life events.Methods: This was a correlational study with a continuous sampling method. A total of 1182 mothers with singleton pregnancy, between 37 to 42 weeks of gestation with no pregnancy complications/or known physical or psychological disorders and with low birth weight babies were investigated. Data were collected using SRRS questionnaires combined with interviews at two state run delivery rooms in Qum, southeast of Tehran, Iran. Statistically, chi square test, exact Fisher test, Mantel-Haenszel and stepwise logistics regression were used in analyzing the data.Findings: Our findings were indicative of the presence of a statistically significant correlation between low birth weight and change in frequency of domestic arguments (p=0.003), beginning or ending of school course (p=0.000), and also school change (p=0.02). No significant association between the low birth weigh and the number and intensity of stresses was established.Conclusion: Based on data found in present study, educational and counseling programs for pregnant women to ease their hardships in facing unpleasant events and also improving their coping abilities against stressful situations is suggested.

Background: Breastfeeding is proved to be both important and useful for children, mothers and community.Objective: To assess the breastfeeding problems and also mothers' expectations of their husbands, work places and health centers.Methods: This was a cross-sectional study carried out on 288 mothers with a two-year old child in 2004. The data were collected using a questionnaire and analyzed by k 2 test, statistically.Findings: Of a total of 288 mothers, 45.2% were illiterate or poorly literate and only 9% with education at university level. Most mothers (86.1%) were housewives and the rest with a job. Nearly half of the children were exclusively breastfed for six months and in total, 80% with breastfeeding duration of 22-23 months. There was a significant correlation between literacy and the duration of breastfeeding. A negative relationship was shown between breastfeeding duration and having a job.The important causes for terminating breastfeeding were mother’s belief towards the sufficiency of breastfeeding (18.9%), lack of milk in mother's breasts (18.9%), and Child’s avoidance (17%). Approximately, 30.3% of mothers were found with no support from their husbands. Full supports by health centers were given only to 39.7% of mothers whereas 57.1% received relative supports. There was a positive correlation between the degree of support and the duration of breastfeeding. Among the mothers, 43.6% expected cooperation from their husbands and 68.8% of mothers with a job, insisted on extension of pregnancy leave. Also, 18.2% of mothers expected more proper behavior from the health center personnel.Conclusion: Regarding the data found in present study, the most important causes of early breastfeeding termination were mother’s mentality, lack of milk, and child's avoidance. It seems that good consultation could provide mothers with increased self-reliance. Additionally, the extension of pregnancy leave and also educating fathers on the quality of support given to mothers are recommended.

Background: The improved uterine bleeding profile in postmenopausal women receiving hormone therapy likely enhance compliance with hormone replacement therapy.Objective: To compare the bleeding patterns in post menopausal women receiving continuous or sequential hormone therapy.Methods: This quasi-experimental clinical trail was performed on 44 healthy postmenopausal women < 65 years old with intact uterus who were presented for gynecologic examination at Bouali hospital in Tehran (Iran) during 2001-2002. The patients were divided into two groups marked as group I including postmenopausal women on oral replacement with estrogen conjugate 0.625 mg and medroxyprogesterone 2.5 mg daily, in a continuous combined fashion, and group II composed of post menopausal women on oral replacement with estrogen conjugate 0.625 mg daily and medroxyprogesterone 5 mg during the last 14 days of each month. The patients were followed up for one year. The data on bleeding patterns and their relationship with duration of menopause and body mass index were analyzed statistically using k2 and Fisher exact tests.Findings: The mean menopause age was 53±4.7 and 45.2±2.2 years in group I and II, respectively. There was a significant difference between two groups, statistically (p<0.001). The mean menopause duration was 3.8±2.8 years in group I and 1.1±0.8 in group II with a statistically significant difference between two groups (p=0.01). The difference in body mass index between two groups was insignificant, statistically. All women in group I (22/100%) were found to have amenorrhea after one year. Among the patients in group II, one (14.3 %) suffered spotting, 5 (71.4%) with regular bleeding and 1 (14.3%) with amenorrhea following the same time period. The difference in bleeding patterns between two groups was shown to be statistically significant (p=0.000).Conclusion: While unexpected vaginal bleeding in women using continuous combined HRT decreased after 1 year, the degree of bleeding among those using cyclic HRT remained unchanged.

Background: Genital tract infections are among the most common causes of patient referral to obstetric clinics and vulvovaginal candidiasis is a common complication of women. Nearly 75% of adult women suffer genital yeast infection at least once in their lifetime.Objective: To determine the agents associated with candidal infection in patients referred to Qazvin public health centers in 2005.Methods: This was an experimental study in which a total of 128 patients with abnormal vaginal discharge, genitalia pruritus, and disparonia were examined using vaginal swab sampling and direct microscopy of smears for candida followed by culture on Sabouraud dextrose agar. The data such as age, method of contraception, erythema of vulva, itching, burning, and white vaginal discharge were collected using a questionnaire. Statistical analysis was performed by means of c2 and Fisher exact test.Findings: Our results indicated that 39 (30.5%) patients suffered candidal infection by direct smear method, however, 59 (46%) were positive by culture results .Among the vaginal symptoms, erythema of vulva, itching , burning and white vaginal discharge were shown to be significantly associated with vaginal candidiasis (p<0.05). Candida albicans was the leading (83%) agent among the yeast isolates followed by other species of Candida with lower frequency.Conclusion: Diagnostically, the culture technique is more sensitive than direct smear for detection of vulvovaginal candidiasis

Background: Biological effects of microwave radiation on living creatures have been the focus of many investigations over the last decade and the influence of different wave parameters_such as frequency, power, exposure time, and modulation has been elucidated.Objective: The main purpose of the present study was to investigate the effect of microwave radiation on alterations of micronucleus induction and nuclear divisions index under different conditions.Methods: A total of 48Balb/c mice divided in eight groups (7 as cases and 1 as control) were exposed to microwave generator while restrained in specially designed Plexiglas chamber. Later, the frequency of micronucleus in binucleated lymphocytes and NDI was evaluated using micronucleus assay on mouse lymphocytes.Findings: Microwave radiation at different conditions (frequency, power, modulation and exposure time) showed no significant effect on frequency of micronucleus, however, the nuclear division index was significantly decreased under such conditions.Conclusion: Based on data found in our study, the microwave radiation as we used during the present work, caused significant effect on nuclear division index in mouse lymphocytes.

Background: Early diagnosis of CAD could lead to proper treatment of patients and coronary artery calcification is considered to be a valuable index in detecting coronary artery disease using a noninvasive technique.Objective: To evaluate the relation between calcification and stenosis of coronary artery.Methods: This was a cross sectional study in which 760 patients suffering from typical chest pain and as candidates for coronary angiography were evaluated for calcification of coronary artery by fluoroscopy. All patients signed a consent form while the whole procedures were fully explained in a comprehensible language. Following fluoroscopy and angiography, the results were reviewed by two different cardiologists, separately. The presence of any significant stenosis greater than 75% was considered as a sign for severe CAD. The data were analyzed by X2 followed by determination of sensitivity and specificity.Findings: Abnormal angiogram was found in 402 cases of our patients. In general, the positive and negative predictive values for calcification were 81.8% and 26%, respectively. The positive and negative predictive values were 87.1% and 63.4% in females and 79.7 and 47.3% in males respectively. The highest predictive value was seen in patients below 40 years old (100%). Coronary calcification in patients with abnormal coronary angiogram was found to be 5.4 times higher than those with normal angiogram.Conclusion: According to our results, the noninvasive fluoroscopic technique for detection of coronary artery calcification could be regarded as a screening tool to reveal significant coronary involvement.

Background: Type 1 diabetes mellitus is frequently associated with autoimmune thyroid disease.Genetic susceptibility to autoantibody formation in association with autoimmune thyroid disease and type 1 diabetes mellitus has been described with varying frequencies.Objective: To investigate the prevalence of anti-thyroid peroxidase (anti-TPO) and also the overt and subclinical hypothyroidism in type 1 diabetic patients.Methods: In this case-control study, 65 subjects with type 1 diabetes mellitus and 65 unrelated normal controls were recruited for detection of anti-TPO and thyroid-stimulating hormone (TSH). Radioimmunoassay (RIA) was used for anti-TPO and TSH detection.Findings: Out of 65 type 1 diabetic patients, 18 (27.7%) were positive for anti-TPO and 18 (27.7%) with abnormal serum TSH level. Among the patient group, 11 (16%) were found to have overt hypothyroidism and 7 (10.8%) with subclinical hypothyroidism. The mean anti-TPO levels were higher in patients with overt hypothyroidism (238.18±223.69 U/ml) than in patients with subclinical hypothyroidism (36.38±22.46 U/ml). Of a total of 11 patients with overt hypothyroidism, 9 (81.1%) showed abnormal anti-TPO levels, whereas positive anti-TPO was detected in 57% (4 out of 7) of patients with subclinical hypothyroidism.Conclusion: The presence of anti-TPO in 27.7% of type 1 diabetic patients confirmed a strong association between autoimmune thyroid disease and type 1 diabetes mellitus. Thus, for early detection of autoimmune thyroid disease in patients with type 1 diabetes mellitus, the measurement of anti-TPO and TSH, preferably at the onset of disease, is recommended.

Background: Opium abuse and addiction is a worldwide problem and application of a method, both cost effective and with less side effect, to shorten the opioid detoxification period is on increasing demand.Objective: To compare the efficacy of Buprenorphine and Clonidine in treatment of opium withdrawal. Methods: This study was a randomized, double blind, parallel group, clinical trial performed on outpatients referred to either psychiatric ward at Amirkabir hospital or private clinics in 2005. The patients, initially divided into two groups of 38 members, were assessed for both the efficacy and side effects. Statistical analysis was performed using descriptive statistical tests, k2 test, and also the correlation severity by relative risk analysis (R.R.) Findings: Thirty six (94.8%) subjects in Buprenorphine group and 32 (84.3%) in Clonidine group completed the detoxification program, successfully. Relapses were observed in 2 and 6 cases of Buprenorphine and Clonidine groups, respectively. The difference was statistically insignificant (p=0.13). The side effects including hypotension, headache, sedation, dizziness, dry mouth, nausea, and constipation during the 10-day detoxification periods in Clonidine group was more severe and intolerable than in Buprenorphine group. Conversely, the sweating, as another side effect, was found to be more pronounced in Buprenorphine group than in Clonidine group.Conclusion: Buprenorphine and Clonidine showed similar effects in managing opium withdrawal, yet the withdrawal symptoms of opium was found to be more tolerable with Buprenorphine than Clonidine. Also, less side effects were observed with Buprenorphine.

Background: Currently, increased knowledge of patients over their rights has been accompanied with greater demands and expectations and thus, it is of prime necessity to all members of medical care including hospital managers, to be fully aware of such rights.Objective: To comparatively determine the managers' knowledge on patient rights in Tehran public and private hospitals.Methods: This was a cross-sectional study carried out in 2004. All managers of public and private hospitals in Tehran were included (n=70). Data were collected using a 36-question questionnaire and further analyzed by SPSS. Fisher and c2 tests were used for statistical analysis.Findings: Among the public hospitals managers, 34.5% were found with good level of knowledge on patient rights, 48.5% with medium and 17% with poor knowledge. In the same way, 23% of private hospitals managers were shown to have good level of knowledge, 54% with medium and 23% with poor knowledge on patient rights. There was no meaningful difference between the levels of knowledge among two groups.Conclusion: Based on data found in our study, lack of good knowledge on patient rights was obvious among the managers of both public and private hospitals. Since the knowledge is considered as a solid base for appropriate functionality, it could be predicted that the performance of hospital managers on patient rights to be in parallel with the extent of their knowledge. Thus, a comprehensive series of training courses on “patient’s bill of rights” for health care members including hospital managers is suggested.

Geographical epidemiology can be defined as description of spatial patterns of disease incidence and mortality. It forms part of the descriptive epidemiology which is generally more concerned with producing hypothesis for the etiology of diseases, injuries or mortalities. Among the different fields of geographical epidemiology, the field of disease mapping has developed rapidly during the recent decades As the researchers apply different kinds of maps in visualizing the health data, it is of prime necessity for health care specialists to get familiar with all those different maps and also their pros and cons. This article therefore, reviews the most important ways of mapping health data, how to design and where to apply them.

The aim of this study was to evaluate the communication skills of 110 medical interns of Qums teaching hospitals in 2004. Through structured questionnaire the interns and their 110 patients were surveyed. Out of 110 medical interns, 38.18% always said "greetings" to the patients and asked about their conditions whereas only 1.82% introduced themselves to patients. Showing sympathy and sensitivity for patients was found only in 21.82% of the interns and 10.41% used to discharge the patients from uncertainty. Asking any type of questions was allowed by only 23.64% of medical interns however, none of the patients asked about treatment protocol. From the patients’ point of view, 49.09% were fully aware of their problems, 52.73% could ask any question and 61.82% felt a good sense of empathy and sensitivity shown by the interns. It is suggestible that the communication skills of the interns should be empowered.

Through a checklist 68 proposals and 28 reports of students' researches submitted to student research committee of QUMS (from 2004 to 2006) were assessed. Most of the researchers (48.5%) were medical students. Most of the teachers (72.1%) were from Faculty of Medicine; of these 17.6% were pharmacologist and 11.8% anatomist. Most of the researches (35.5%) were experimental studies. Only 13.2% of their results were published in journals or seminars. The most weakness of the proposals was in "sampling" and "objectives and hypothesis". The weakness of the reports was evident in "abstract". It seems that teachers must advise their students in writing proposals and reports more than before.