JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2009 | Volume:27 | Issue:94|Papers Count:10

Background: Some biochemical markers such as FFN (fetal fibronectin), IL1B (interleukin 1B), IL6, and IL8 in cervical mucus have been used to predict preterm delivery. The aim of this study was to assess the combination of two factors (cervical dilatation (1-2cm) with IL6 and IL8 levels) to predict preterm delivery.Methods: This was a prospective follow-up study. The study population consists of normal singleton pregnant women between 24-34 weeks of gestation. Patients divided in two groups: first group had 1-2 cm cervical dilatation and second group had no cervical dilatation. Cervical fluid was sampled from uterus external os and analyzed for IL6 and IL8 with ELIZA in both of groups. Preterm delivery and levels of IL6 and IL8 were assessed. The relation between IL6 and IL8 levels and cervical dilatation with preterm delivery was determined. Sensitivity, specificity, positive predictive value and negative predictive value of IL6 and IL8 and their relation with dilatation and preterm delivery were assessed.Findings: Data analyzed by SPSS-13 software and t-test. IL6 levels have more sensitivity and specificity for preterm delivery. Sensitivity and specificity of cervical dilatation (1-2 cm) and IL6 > 1.8 pg/ml for predicting preterm delivery were 50% and 65%, respectively. PPV and NPV were 28.6% and 82.4%, respectively. Conclusion: According to review articles, these two variables have not been used for preterm delivery prediction. Low cervical dilatation (1-2cm) had significant relationship with preterm delivery. Combination of cervical dilatation and IL6 can be used for predicting the preterm delivery.

Background: Congenital hypothyroidism (CH) is a relatively common congenital disorder in neonates. Recently, a considerable proportion of familial cases have been identified, and possible roles of autoimmune factors suggested. The aim of this study was to evaluate the abnormality of thyroid function tests in first degree relatives of CH neonates and compared it to normal population.Methods: From 2002-2007, thyroid function tests (T4 and TSH) of 194 randomly selected CH neonates borne in all 17 hospitals of the Isfahan, Iran and their first degree relatives were measured, and compared with thyroid function tests of first degree relatives of 350 normal neonates that randomly selected as sex, age and urban/rural status. Patients’ mothers and control groups were also evaluated for TPO antibody. Statistical analysis was performed by SPSS using Chi Square test used to compare two groups.Findings: Thyroid function tests was measured in the first degree relative of neonates with CH (361parents, 136 siblings) and compared with control groups (665 parents, 477 siblings). Thyroid function tests were abnormal in 85 patients of case group vs. 96 patients of control group. Hypothyroidism was found on 75 and 57 person in case and control groups, respectively. In 17.3% of CH neonates mothers and 32.5% of control groups mothers TPO antibody were positive. 31.4% of CH infants had parental consanguinity that 22.6% of them had abnormal thyroid function test in their family.Conclusion: Abnormal thyroid function tests were significantly more frequent in the first degree relatives of CH infants than normal population (P<0.005 for parents and P<0.0001 for siblings). Furthermore the proportion of affected infants mothers with positive TPO-Ab was significantly lower than control groups (P=0.005). Our study suggested that there is a possible familial and genetic component in inheritance of CH and maternal thyroid autoimmunity may not play an important role in development of CH in our area.

Background: One of the mostly used methods introduced for treatment of lateral epicondylitis which is local steroid injection. Flexing the wrist of involved hand strongly and suddenly, which is called "complete the lesion" is of methods used with local steroid injection and is not truly known.Methods: Through a double-blind clinical trial, 50 patients with lateral epicondylitis, visiting the orthopedic clinic of Ayatollah Kashani Hospital, Isfahan, were studied in two groups of 25. Case group received local steroid injection with "complete the lesion" maneuver and their hands were casted with a long plaster for 3 weeks. The control group received all above actions, except for "complete the lesion" maneuver. The  patients were evaluated based on Verhaar criteria in third, sixth, twelfth, and twenty fourth weeks and categorized in four groups of excellent, good, intermediate, and poor. During the follow up period, seven patients were excluded from the study. Data were analyzed with Friedman and Man-Whitney analytical tests.Findings: During the follow up period, there was no significant difference between case and control groups (Man-Whitney test, P>0.05). During the third week evaluation, the median of case group scores was a little higher than the control group ones (3.02 vs. 2.77). Also, we found that the treatments used for both groups had analytically significant effects (Friedman test, P<0.05).Conclusion: Patients in case group had more pain, rather than in control group, through the first three weeks. Treatments used for both groups showed acceptable results through the short-term (weeks 3 and 6) and longterm (weeks 12 and 24) evaluations. It seems that more studies in longer time periods, focusing on the factors affecting condition relapse, may be useful.

Background: Atherosclerosis has a high prevalence in systemic lupus erythematosus (SLE) patients and the vascular endothelial dysfunction is the earliest stage of the atherosclerosis. The aim of this study was to evaluate the prevalence of vascular endothelial dysfunction and its risk factors in SLE women and then to identify its correlation with the disease activity, duration and concomitant conditions in these patients.Methods: Eighty four female SLE patients and 18 healthy young female were included in the study. The vascular endothelial function was evaluated via ultrasonographic assessment of the brachial artery diameter to determine flow mediated dilation (FMD) and Post TNG dilation-FMD gap (PFG) indexes. The FMD index, one standard deviation lower than mean FMD of the control group was considered as impaired FMD and PFG index one standard deviation more than mean PFG of the control group was defined as impaired PFG.Findings: SLE patients had higher prevalence of impaired FMD than healthy subjects (48.8 vs. 5.5%). The prevalence of impaired PFG in SLE cases and healthy subjects was 25 and 5.5%, respectively. FMD and PFG impairment did not have any significant correlation with disease activity, duration, the presence of the anti-dsDNA, anticardiolipin antibodies, antiphospholipid syndrome, hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, history of lupus nephropathy, and history of receiving cyclophosphamid pulses.Conclusion: The vascular endothelial dysfunction is very prevalent in SLE patients and no specific factor alone can explain this finding.

Background: The effects of bupropion in control and treatment of Attention Deficit Hyperactivity Disorder (ADHD) patients is not cleared yet. The aim of this study was to check its effects on control of ADHD signs and symptoms.Methods: In a Randomized, double blind, placebo control clinical trial (which take 4 weeks), 40 ADHD children were divided into two groups. The control group received bupropion but the placebo group received placebo. Both of them took part in social skills sessions. Conner's questionnaires (teacher's and parent's) were filled before, two weeks, and 4 weeks of study. The social behavior questionnaires were filled before and after the study. The Psychiatrist followed the patients and evaluated the severity of the disease before, 2 weeks, and 4 weeks of the study. Findings: There were not any significant difference between the scores of Conner’s questionnaire (P=0.77, P=0.97, P=0.95) and social skills questionnaire (P=0.16, P=0.29, P=0.47). Impulsivity (P=0.41, P=0.28), accepted social behavior (P=0.87, P=0.24), peer relationship (P=0.28, P=0.78), and communication skills (P=0.61, P=0.91) at any time of the study. The only difference was between ADHD subscale of Conner’s questionnaire for teachers in the week 4 (P=0.048). There were not any statistical differences between the scores of severity before and week 2 (P=0.81, P=0.79). But at the week 4 the severity score was 0.6 greater in placebo than in control group (P=0.044). the side effects of the bupropion were nausea and vomiting in 3 patients, headache, irritability, rash, anorexia, tick, confusion, agitation in 2 patients, and tremor and night mare in one patient.Conclusion: Finally despite partially effects of bupropion on controlling the signs and symptoms of ADHD, more expanded trials are suggested.

Background: This trial aimed to determine the impact of high risk approach for primary prevention of cardiovascular diseases (CVD) in children of families at high risk for premature CVD.Methods: This trial was conducted as part of the Isfahan Healthy Heart Program, and comprised 105 adolescents, aged 12-18 years, whose parents were admitted because of premature CVD (<55 years) to the hospitals affiliated to Isfahan University of Medical Sciences. After physical examination, filling in questionnaires and blood sampling, oral and written information about healthy lifestyle especially for healthy nutrition, increasing physical activity and tobacco control were provided for children and their families. All assessments were repeated after one year.Findings: The mean value of all anthropometric indexes including weight, height, waist and hip circumferences as well as systolic and diastolic blood pressure and biochemical factors showed significant changes (P<0.01) after intervention. The mean body mass index decreased from 21.03±3.8 to 20.99±3.9 kg/m2. Serum triglycerides decreased from 100.31±41.4 to 95.48±40.6 mg/dl, total cholesterol decreased from 164.51±27.2 mg/dl to 158.44±30.5 and LDL-cholesterol from 99.37±23.5 to 93±24.9 mg/dl. HDL-cholesterol increased from 44.16±8.6 to 46.34±10.5 mg/dl. Changes in blood sugar and lipid profile was more favorable in boys than in girls, for instance total cholesterol decreased from 165.5±30.6 to 157.46±31.4 mg/dl in boys and 163.47±23.2 to 159.47±29.8 mg/dl in girls, respectively.Conclusion: In spite of the existing genetic tendency for CVD and its risk factors, education of healthy lifestyle can be effective in controlling CVD risk factors. This high risk approach had favorable results and should be considered in addition to the treatment of the CVD patients.

Purpose of this review paper is to provide an overview on the application of hyperthermia (HT) [the controlled increased of tumor temperature by 8-3oC] combined with conventional cancer treatment modalities. HT is applied with different methods e.g. superficial-HT, locoregional deep-HT, interstitial-HT, intracavity-HT, and whole body-HT. Studies show that addition of HT to radiotherapy, chemotherapy, or both, will result in better tumor response rate, local control, palliative effects and survival rate, without increasing toxicity, in different tumor sites such as breast cancer, melanoma, head and neck, cervix cancer and glioblastoma. In the recent years, due to the substantial technical improvements in achieving selected increase of temperatures in superficial and deep-seated tumors, thermometry, and treatment planning, HT is becoming more accepted clinically worldwide. HT, as an adjunctive cancer treatment modality, is certainly a promising approach, however, it is not well known yet.

Background: Behcet's disease is a multisystem disease and mainly classified as a vasculitis. In this disease many organs like skin, mucosa, eyes, joints, vessels, nervous system, gastrointestinal tract, testis, heart and lungs maybe involved.Case Report: This case is a rare presentation of Behcet's disease with multiple saccular aneurisms in a 33 year old man. A patient with a permanent pain in back and flanks with radiation to the testis without relationship with position and feeding was admitted in Al-Zahra Hospital, Isfahan. In the abdominopelvic ultrasonography, an abdominal aneurism with thick wall borders and 37 mm in total diameter and 15 mm in open lumen diameter was reported. In spiral CT-scan of abdomen and pelvis with contrast, aneurism of abdominal aorta (4×4.5 cm in diameter) beginning below the renal arteries was seen, that extended downwardly to the near of the aortic bifurcation. Finally in MRA multiple saccular aneurism of the abdominal aorta at the same places was reported. After repairing of aneurism by surgical operation. The patient was referred to the clinic of rheumatology. After taking of history and physical and laboratory examination, because of the recurrent oral aphthous, erythemnodosum, positive result on pathergy test and abdominal aorta aneurism, the diagnosis of behcet's disease was confirmed and the patient was treated with medical drugs.