Journal of Isfahan Medical School
Year:2011 | Volume:28 | Issue:113|Papers Count:18

Background: Circadian rhythm disorders (CRDs) are one of the manifestations of all types of sleep disorders in Multiple Sclerosis (MS) patients. Knowing about these problems and rationale approach to them can increase the health level and treat these patients. The aim of this study was to determine the frequency of circadian rhythm disorders in MS patients in compare with control group and ascertain its association with chronic fatigability.Methods: The case-control study was held on 120 Multiple sclerosis patients and 60 healthy people (as control group) in MS Clinic of Al-Zahra Hospital in Isfahan in 2009. The questionnaires of PSQI, FSS and EDSS was given to patients and for assessing the circadian rhythm disorders, the PSQI questionnaire was given to control group too. All the findings were analyzed in SPSS software.Finding: The amount of circadian rhythm disorders in MS patients was significantly higher than control group (P=0.002). In this manner, these kind of circadian rhythm disorders in patients with severe fatigue was significantly higher than patients with mild fatigue (P<0.05).Conclusion: This study showed that the rate of circadian rhythm disorders in MS patients with severe and mild fatigue was higher than control group. Increased distribution of these groups of disorders may empower the more susceptibility of biologic clock, which regulates the circadian rhythm, in the course of MS disease. More studies are required for confirmation of anatomic relationship between location of demyelinative plaque and types of sleep disorders.

Background: Shoulder pain is one of the most common complications after stroke. However, information about risk factors and prevalence of it is not enough. Surveying the association of shoulder pain with diabetes mellitus, hypertriglyceridemia and hypercholesterolemia was the aim of this study.Methods: This cross-sectional study was carried out at clinics affiliated to Shiraz University of Medical Sciences. From 191 referred patients, 152 patients were enrolled. Within a year, once every two months, shoulder pain assessed among them. In addition, diabetes, hypertriglyceridemia, and hypercholesterolemia were assessed in these patients.Finding: Among 152 patients with stroke, 103 patients did not develop shoulder pain and 49 developed it. Among participants with shoulder pain, 41 patients had diabetes mellitus, 10 had hypertriglyceridemia, and 39 had hypercholesterolemia. After analyzing data with logestic regression model, the relationship between diabetes and shoulder pain was significant, but the relationship between shoulder pain and hyperlipidemia was not.Conclusion: Shoulder pain is common after stroke and diabetes is a predictor it.

Background: Atopic dermatitis (AD) is a prevalent medical condition in infancy with the prevalency of near 10 to 25% in western countries. Current standard of care for atopic dermatitis can lead to many complications. There is a need for alternative treatments with lower risks of side effects. Recent studies have shown a positive effect of prebiotics in prevention and treatment of the disease. The main objective of this study was to determine whether consumption of prebiotics can reduce the severity of atopic dermatitis in 7-24 months old children in Isfahan.Methods: In a double blind controlled clinical trial study, 70 atopic dermatitis children were divided by simple random sampling into treated group receiving prebiotic (fructooligosaccharid+inulin) and control group receiving placebo (dextrin powder) for 3 months. At the beginning and at the end of intervention, SCORAD test questionnaire was completed for all children by a physician. The collected data were analyzed by SPSS software, using student-t and paired-t tests. P values less than 0.05 were considered statistically significant.Findings: The difference between total SCORAD indices before intervention in the treated and control groups was not statistically significant (53.9±23.6 and 43.4±20.9, respectively). After intervention, these values were reduced in the treated and control groups, but the difference between the means of the two groups was statistically significant (4.3±9.6 and 19.4±13.0, repectively; P<0.001).Conclusion: Prebiotic substances have positive roles in adjutant treatment of atopic dermatitis.

Background: Prediction of ventricular tachycardia (VT) inducibility through clinical and paraclinical predictors and ability of ventriculoatrial (VA) conduction can help to identify high risk patients easier.Methods: Fifty four patients suspicious for ventricular tachyarrhythmia underwent electrophysiologic study for basic measurements and programmed stimulation for ventricular tachycardia induction, electrocardiography and echocardiography during October 2007-October 2009.Finding: The mean age of participants was 59.4±13.9 years. Forty three patients (79.6%) were male and 39 patients (72.2%) had history of ischemic heart disease (IHD). Ventricular tachycardia was induced in 30 patients (55.6%). Ventriculoatrial conduction was recorded in 38.9% of patients (21/54). Ventricular tachycardia was induced in 52.4% of patients (11/21) with ventriculoatrial conduction versus 57.6% (19/33) in ventriculoatrial dissociate patients (P=0.3). Mean of ventriculoatrial Wenchebach point (VAWP) was 400±96.6 and 393±103.6 ms in ventricular tachycardia inducible and non inducible patients respectively (P=0.4). Presence of ischemic heart disease and lower left ventricular ejection fraction (LVEF) were associated with increased probability of ventricular tachycardia induction (P=0.008 and 0.04 respectively). Presence of ischemic heart disease predicts ventricular tachycardia inducibility independently. Patients with inducible ventricular tachycardia had slightly shorter atrial-His (AH) interval (97.33±30.4 and 112.1±42.6 ms, P=0.07).Conclusion: Ventricular tachycardia induction was very slightly more common in ventriculoatrial dissociate patients but we could not prove it. Presence of ischemic heart disease independently and lower left ventricular ejection fraction dependently could predict ventricular tachycardia inducibility.

Background: Advances in perinatal care have increased the number of premature babies who survive. We investigated the frequency of preterm delivery and its influence on the neonatal outcome in pregnancies at a perinatal center in Isfahan, Iran.Methods: This study was done among the preterm deliveries at a Shahid-Beheshti perinatal center in Isfahan, Iran. The data collected in checklists and were analyzed by Student-t, Mann-Whitneyt, and chi-square tests via SPSS software.Finding: In this study we evaluate 1402 delivery. There were 233 preterm deliveries (less than 37 weeks gestational age). Among 248 live preterm deliveries, 123 cases (49%) need NICU cares. The mean of NICU administration was 10.1 days. The rate of mortality in NICU was 25% (32 cases).Conclusion: Preterm deliveries are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs. In this study, our findings were in the range of other studies; but more attention to premature neonates is recommended.

Background: Ultrasound is a noninvasive and accurate method for measurement of liver size and the evaluation of hepatic size is a daily question in abdominal ultrasound, especially to determine the presence of hepatomegaly. This study investigated a new method of ultrasound for liver span measurement with probe in contrast with previous methods using a ruler for calculating the distance between upper and lower liver margins.Methods: Fifty nine patients with liver CT scan were evaluated with two ultrasound methods of probe and ruler liver span measurement and the findings were compared.Finding: Ultrasound measurement of liver span with new method with probe had accuracy of 64.4% in cut of point of 10 mm in contrast with CT scan.Conclusion: Probe method can be used as an accurate method instead of previous method of measurement with ruler.

Background: Recently it is suggested that local injection of tramadol can reduce postoperative pain; but it is controversial whether the intravenous injection is more perfect or subcutaneous. We conducted this study to compare the effect of these methods on postoperative pain.Methods: In a prospective randomized double blind clinical trial study, 75 patients undergoing abdominal surgery were allocated in three groups (n=25). In group A (subcutaneous), 1.5 mg/kg tramadol was injected subcutaneously and normal saline was injected intravenous in an equal volume of 10 cc; in group B (intravenous) 1.5 mg/kg tramadol was injected intravenous and normal saline was injected subcutaneously in an equal volume of 10 cc; and in group C (control) normal saline was injected subcutaneously and intravenous in an volume of 10 cc. The drugs were injected before incision of surgery in all groups. The severity of postoperative pain after surgery was evaluated by visual analogue scale and the time of first opioid analgesic used and total analgesic dose taken during the postoperative period was recorded.Finding: The total dose of used opioid analgesic was significantly less in subcutaneously injected tramadol group (P<0.01). The time of the first opioid analgesic consumption was significantly shorter in control group (P<0.01).Conclusion: According to results of this study, subcutaneous and intravenous injection of tramadol can reduce postoperative pain; subcutaneous injection was more effective, of course. Therefore, subcutaneous tramadol is suggested for control of postoperative pain.

Background: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized with chronic inflammation of mucosal surface of bowels. Genetic, immunologic, environmental and individual factors contribute disease have been identified in recent studies. This study was done to investigate the effect of stressors on the incidence or relapsing of this disease.Methods: This was a case-control study on the patients with ulcerative colitis. In this study, 75 patients (45 patients with ulcerative colitis group and 30 control person) filled the questionnaire of cases of chronic stressor (Holmes and Track) and social support. We analyzed the data with t-test, Moncova, chi-square and covariance analysis tests using SPSS software.Finding: 75 patients were studied in the study and control groups. According to the results, the relationship between social support and ulcerative colitis was not significant. In the other hand, results showed that the stress experienced in the past year in patients with ulcerative colitis compared with controls was significantly greater.Conclusion: Based on the results of this study, high stress can exacerbate symptoms in the beginning or relapse of ulcerative colitis. Therefore, learning stress management techniques to patients with ulcerative colitis is recommended.

Background: The typical radiological findings of hydatic cyst are well known. But complicated hydatid cyst have unknown findings. The aim of this study was to determine radiologic findings of hydatid cyst and their relationship to signs and symptoms.Methods: This cross sectional study was performed on 77 patients with pulmonary hydatid cyst referred to Al-zahra hospital in Isfahan. Data of age, sex, signs and symptoms and duration of them, involved lung, chest X-ray (CXR) and CT scan findings were collected and analyzed with chi square and fisher exact tests.Finding: Seventy seven patients with mean age of 34.27±15.41 years and mean duration of symptoms of 143.36±24.4 days were evaluated. 61% were men and 75.7% were women.51.3% of patients had opaque lesion (non complicated) in CXR and CT scan. In 37.7% of patients, the diagnosis was performed only based on CXR and clinical findings. No meaningful relationship was found between sex, clinical findings, involved lobe and side of involved lung with complicated cyst in radiology findings.Conclusion: The diagnosis of pulmonary hydatid cyst is based on radiologic (round radiopaque lesion) and clinical findings.

Background: Otitis Media with effusion is a common cause of conductive hearing loss in children in school age and its pathogenesis is still under debate. In some studies a roll for allergic rhinitis has been suggested.Methods: In this study we investigated two groups (52 patients with otitis media with effusin and 52 healthy persons) for allergic rhinitis based on history, physical examination and nasal discharge smear.In this study, If 20% of PMN cells of nasal smear were eosinophil, that sample was positive for allergic rhinitis.Finding: Allergic was found in 6 persons of study group and only one person of control group. This difference was significant (P<0.05 in chi square test and P=0.028 in fisher test).Conclusion: Our study suggests that allergic rhinitis may play a role in a subset of patients with otitis media with effusin.

Background: Disease crisis causes metabolic changes and alters body weight. The aim of our study was defining the correlation of the difference between ideal body weight and body weight before disease and current body weight with the need to mechanical ventilation, the duration of mechanical ventilation, the length of stay and the outcome of ICU admitted patients.Methods: This analytical cross-sectional study performed in 2010 at Alzahra hospital in Isfahan. Body weight and height of each patient was recorded on admission. Length of stay (LOS) in ICU, the duration of mechanical ventilation (if needed), the SAPS II score and the outcome of each patient were recorded. The data were analyzed by SPSS software.Finding: There was a valuable statistical different between current body weight and ideal body weight (P<0.001) and there was a direct relationship between body weight and ideal body weight with relationship coefficient equal to 0.35. There was a statistical valuable relationship between the duration of mechanical ventilation and the amount of the difference between body weight and ideal body weight of the patients.Conclusion: Based on our findings, if the difference between body weight and ideal body weight rises, the need to mechanical ventilation and the length of stay in ICU will rise.

Background: Tuberculosis (TB) is an infective and important disease in the world. TB is controlled in developed countries but it is one of the important problems in developing countries like Iran. Various researches have linked lack of vitamin D to be the main cause of TB in many individuals. Therefore, theory of the effect of vitamin D supplements in treatment of TB has been made that if confirmed, it helps to treatment of TB and decrease in costs. This clinical trial and accidental double-blind study was performed to clear the controversies on this issue.Methods: A clinical trial study was performed on 90 cases with TB (up than 21 age) referred to 5 centers of health in Isfahan with no history of treatment for the disease. They were selected by method of simple-non probable; then they divided into two groups, one under routine standard drugs and the other, under vitamin D supplement and routine standard drugs. The data consisted of name, age, sex, date, and results of gathered sputum smears in a questionnaire. Consequently, sputum smears were obtained at the end of the weeks 2nd, 4th, 6th and 8th.Finding: There was no significant difference between the two groups in amount of getting negative sputum smear in the weeks 2nd, 4th, 6th and 8th.Conclusion: The role of vitamin D is confirmed in cure of pulmonary TB in cellular and molecular level. However, more studies are necessary to confirm effects of vitamin D supplement in treatment of TB.

Background: Ehlers-danlos syndrome is consisted of a group of heterogeneous and rare inherited disorders of connective tissue that is diagnosed by increased range of joint movements, friability, and increasing of skin elasticity. The diagnosis of this syndrome is often difficult and based on clinical criteria and family history. Many skin lesions are reported from the disease up to now and various and simultaneously skin lesions in this case is the main propose of this report.Case report: A 11-year-old male with cutaneous lesions on the right forearm, left elbow, and right knee was referred after a mild injury. Patient recalled history of similar lessions, delay in wound healing, easy bruising, and recurrent dislocation of wrist from childhood period. According to clinical manifestation, Ehlers-danlos syndrome was probable diagnosis for this patient. However due to the disavailability of specific diagnostic test in our country, there was no definite diagnosis. After sending biopsies of skin lesions to the pathology laboratory, spheroid nodule of forearm, organized hematoma in the elbow, and keratinous cyst in the right knee were diagnosed.Conclusion: Fat necrosis, traumatic hematoma, hernia of fat into the dermis with calcification and atrophic scars have been reported as various skin lesions in Ehlers-Danlos syndrome. Three synchronous skin lesions and perforated keratinous cyst with marked inflammatory of foreign body distinguished this case from other similar previous cases. This case is the first case of Ehlers-Danlos syndrome with mentioned cutaneous dermatologic manifestations in Iran.