Journal of Isfahan Medical School
Year:2011 | Volume:28 | Issue:114|Papers Count:17

Background: The development of venous thromboembolism is influenced by a variety of genetic and environmental risk factors. A few studies have ascertained whether thrombophilic defects are risk factors for venous thromboembolism in Middle East and Iranian populations or not.Methods: We conducted a case-control study involving 66 consecutive patients with deep vein thrombosis without immobility and 66 healthy controls from the Al-Zahra Hospital in Isfahan, Iran.Finding: The most frequent thrombophilic risk factor for deep vein thrombosis was homocysteine (31/66) (OR=3.6, 95% CI= (1.66-7.84)). Anticardiolipin antibody was seen in 10.6% (OR=7.71, 95% CI= (0.99-64.55)). There were no significant differences for other risk factor such as Protein S, Protein C, Antithrombin III, Factor V leiden, and Prothrombin mutation.Conclusion: In spite of western studies, Factor V leiden and Prothrombin mutation are rare between Iranian patients. However, homocysteine and anticadiolipin anti bodies are the most frequent risk factors. Screening for Factor V leiden and Prothrombin mutation have not cost benefit and further studies with larger sample size need to detect new mutations and assess the influence of ethnicity on thrombophilia.

Background: Obsessive compulsive disorder (OCD) is a chronic disorder with significant influence on social, emotional, and occupational performances. Although epidemiologic investigations is proved on this disorder in different cultures but obsessive compulsive disorder with religious contents is more prevalent among religious populations such as Middle East Jews and Muslims. Many clinical researches showed therapeutic spiritual interventions could obviously decrease symptoms of patients with depression, anxiety, and obsessive disorder. The aim of this study was to evaluate the efficacy of religious cognitive-behavioral therapy on obsessive compulsive disorder with religious content and its co-morbidities.Methods: In this randomized controlled clinical trial, our intervention consisted of 10 weekly spiritual cognitive-behavioral therapy 90-minutes sessions supervised by both a clergyman and a psychiatrist. Among outpatient obsessive compulsive disorder subjects visited in Noor psychiatric clinic, Isfahan, randomly 50 patients with 17 and more Yale Brown scores and religious content obsessive symptoms were selected and divided into two equal intervention and control groups. Yale Brown, SCL-90, and Hamilton depression questionnaires were used in this study. Data were analyzed by ANOVA/ANCOVA repeated measure tests using SPSS13 software.Finding: Mean age of patients was 32.9 ± 8.86 years. Ninety fore percent of patients (n=47) were female and remaining were male. Yale Brown scores in three stages (before intervention, after fifth and tenth session) in both groups decreased, specially in intervention group, but showed no significant difference (P=0.294). However, there were significant differences between mean scores of two groups (P=0.047). Comparison of obsession subscale and compulsion subscale of Yale Brown scale showed decrease in three stages of the study. Decreasing trend in obsession subscale was not statistically significant (f (2, 42) =0.94; P=0.398), but decreasing trend in compulsive subscale was (f (2, 43) =36.008; P<0.001).Conclusion: In non-responder religious obsessive disorder patients with religious contents, religious based interventions like religious cognitive-behavioral therapy could significantly increase clinical response. Such intervention could improve co-morbid symptoms as well as global severity index (who are worsened clinical response and prognosis of obsessive compulsive disorder) in addition to obsessive symptoms.

Background: b-thalassemia major is among the most common genetic disorders in Iran. Blood transfusion, as the main stem of management of these patients, has numerous side effects including iron overload. Delayed puberty as a major complication of these patients is multifactorial but seems to be mainly secondary to iron deposition within pituitary gland. This study was designed to compare pituitary MRI signal changes in thalasemia patients with and without delayed puberty.Methods: From b-thalassemia patients, 27cases between 15-25 years were included, 13 with delayed and 14 with normal puberty (according to clinical exam). Pituitary MRI was done, then signal and dimensions of gland was determined and compared by statistical analysis between two groups.Finding: Decreased signal of any degree was detected in 93% of patients. Normal signal and also mild and moderate hyposignality showed no significant difference between two groups (P=0.317, 0.083, and 0.655, respectively), but severe hyposignality was higher in delayed puberty group (P=0.034). Also, decreased volume and height of gland was significantly higher among delayed puberty group (P=0.002 and 0.006 respectively).Conclusion: MRI could be appropriate for diagnosis of delayed puberty in patients with b-thalassemia.

Background: The most common complication of herpes zoster is postherpetic neuralgia (PHN), which can cause chronic and debilitating pain. In some patients, pain persists for weeks or even years after regression of the rash and many drugs and methods should be used to treat the pain. As many patients are elder and suffer from chronic diseases, they would be affected by drug complications. Recently, subcutaneous injection of botulinum toxin is used as a new method for controlling pain with little complications. There are a few case studies about effect of botulinum toxin injection to relieve pain. We assessed the effect of subcutaneous injection of botulinum toxin on relieving pain in postherpetic neuralgia.Methods: In this intervention study, 15 patients suffer postherpetic neuralgia were enrolled by convincing sampling method. Information as age, sex, dermatome, place and duration of pain, and severity of pain were registered in patients. Then botulinum toxin injected 15 units per 10 cm² subcutaneously. Patients were followed in 2nd day, 2nd week, and 4th week after injection and pain was measured by visual analog score (VAS). Data were analyzed by Repeated Measure ANOVA test using SPSS16 software.Finding: Six patients were male and 9 were female. The mean age was 60±4.5 year and duration of pain was 6.5 month. Mean of VAS in 2nd day, 2nd week, and 4th week were 6.4, 7.2, and 7.6 respectively. Patients’ pain in 4th week were decreased compare with before injection but the difference was not statistically significant (P=0.06).Conclusion: It seemed that subcutaneously injection of botulinum toxin can relieve pain in postherpetic neuralgia. Hence this decrease in duration of the time was observed to be lesser, repetition of injection could be more effective for controlling the pain.

Background: Addiction is considered as one of the major problems in the society. Various social psychological and biological issues affect creating interest to drugs and continuing it. Besides, being an illness itself, addiction is a basis for transmitting diseases; the most important of them are AIDS and hepatitis. In this study, we tried to investigate high-risk personal behaviors of intravenous drug abusers that can increase the incidence of infectious diseases transmitting.Methods: In this descriptive study, the persons who had history of intravenous drug abuse referred to Isfahan addition prohibition centers were investigated. They were 539 persons totally. Required information about high-risk behaviors and demographic characteristic were fetched by a standardized questionnaire, by a same-sex researcher.Finding: The ratio of illegal sex was about 55%; most of condom and tattooing consumers was young people. Seniors had intravenous drug abuser sexual partners more than the others. Also, subtle linear ratio between number of arrests and aging existed. But there was not any significant difference in terms of age, utilizing share syringe, different ways of drug abuse and sexual relationship between different age groups.Conclusion: Regarding the results, increasing the number of intravenous drug abusers, the obligation of awareness in various fields including protected sexual relationship, avoiding use of shared syringe and preventing tattoo is obvious.

Background: Multipe sclerosis (MS) is a demyelinative disease of central nervous system which because of high prevalence and high morbidity is in the focus of scientists’ attention. Hearing loss in 6- 10% of patients with MS is seen. Also, impaired speech reception threshold is 40-50% in MS patients. The aim of this study was comparing the prevalence of sensorinural hearing loss and impaired speech reception threshold in MS and control groups.Methods: In a case-control cross-sectional study, 112 patients with MS and 112 healthy people in control group were assessed in Isfahan. Demographic findings, presenting symptoms and number of lesion in MRI were obtained.Finding: From 112 patients with MS, 75% were women. The age was 28.02±6.6 years in MS group and 25.22±3.8 years in control group. In this study, sensorineural hearing loss in patients with MS was 40.2% compared to 6.3% in controls (P<0.001). Also, sensorineural hearing loss prevalence in women (40.5%) was more than men (39.3%) in MS group. There prevalence of mild and profound impaired speech reception threshold was 33.9% and 1.8% respectively; while there was moderate impaired speech reception threshold only in 0.9% of our control group. Speech reception threshold of all women in control group was normal and only one man (3.5%) had impaired speech reception threshold in control group (P=0.33).Discussion: In patients with MS, the prevalence of sensorineural hearing loss and impaired speech reception threshold were like recent studies. Higher age may be a potential source of sensorineural hearing loss in MS group. Women sexuality may be a potential source of impaired speech reception threshold.

Background: Every orthopedist everyday encounter with at least one patient with anterior knee pain and for further evaluation will request radiography, especially axial knee radiography. This descriptive study was planned to determine the sensitivity, specificity, positive predictive value and negative predictive value of axial knee view respect to arthroscopic finding, as gold standard technique for evaluation of patellofemoral malalingnment.Methods: In convenient manner from 61 patients who was candidate for arthroscopy, irrespective to initial diagnosis, axial view was done and reported by radiologist and according to his report, patient was classified to lateral tilt positive, lateral subluxation positive or negative. Then, patellofemoral joint was studied arthroscopically from anterolateral portal to determine if central ridge of patella seat in trochlear groove before 45o of knee flexion or not? If seating was not occur 45o of knee flexion, the patella was consider arthroscopically positive for patellofemoral malalignment. Then radiographic findings, based on arthroscopic finding, were classified to true positive, true negative, false positive, false positive and false negative.Finding: Sensitivity, specificity, positive predictive value and negative predictive value were 71%, 38%, 60% and 50%, respectively. Sensitivity and specificity of positive tilt axial view compare to arthroscopy were 56% and 41%, respectively.Conclusion: Based on the results of this study, the most valuable diagnostic method for patellofemoral malalingnment was physical examination; however, axial view has good correlation to arthroscopy.

Background: Measles vaccination in Iran is an expanded program. Since 1973- 2002, all infants have received live attenuated measles vaccine (0.5 ml, subcutaneous, A.I.K strain) at the 9th and 15th months of life. Before 2002, we confronted outbreaks of measles in previously vaccinated adults from all over the country. Reports showed convincing evidence of secondary measles vaccine failure. The Ministry of Health and Medical Sciences of the Islamic Republic of Iran launched a mass Measles-Rubella (MR) vaccination campaign throughout the country from 5 to 31 December 2003. More than 32 million inhabitants between 5 and 25 years old received the Measles-Rubella (MR) vaccine. The aim of this program was to eliminate measles and to control congenital rubella syndrome. This study was conducted to determine the prevalence of positive measles antibody titers in a group of adults who received mass MR vaccine.Methods: We conducted this cross-sectional survey on a group of adults 20–30 years old (30 men and 30 women) referred to marriage consulting clinic in Isfahan University of Medical Sciences in 2008. All participants had received routine vaccination against measles during their infancy and MR mass vaccination in December 2003. Serum IgG measles antibody was measured using ELISA (Trinity Biotech, Bay, Ireland). We considered immune serum Ratio (ISR), antibody titers of £ 0.09 IU/ml as negative, 0.91–1.09 IU/ml as intermediate, and ³ 1.10 IU/ml as positive respectively. Data were analyzed by SSPS software Student-t and Pearson correlation tests at the significance level of P<0.05.Finding: In women group, all had positive titers (100%); in men group, 27 (90%) positive titer, two (6.6%) borderlines, and one (3.4) negative titer were seen. The mean serum antibody titer in women was 2.02±0.56 IU/ml and in men was 1.91±0.53 IU/ml. The mean serum titer in 20-23 years old group was 1.84 IU/ml, in 24-27 years old was 2.12 IU/ml and in 28-30 years old was 2.17 IU/ml. No statistically significant correlation was found between serum antibody titer and age (P=0.136). The correlation between antibody titer and sex also did not turn to be statistically significant (P=0.447).Conclusion: In our study, 100% of women and about 96% of men had positive protective serum titer, meaning that there has been a good vaccine induced protection for the majority of vaccinates volunteers. However, for interruption of virus transmission in the community, more than 95% of the population must be protected.

Background: Flexor tendon injures, especially in zone II, need primary repair. It is obvious that in case of not repairing it primarily or repair failure, one or two-stage flexor tendon reconstruction become necessary. The aim of this study was to determine the results of two-stage reconstruction of hand flexor tendons in zone II.Methods: In a cross-sectional study, all patients underwent two-stage reconstruction surgery of finger flexor tendon in Alzahra and Kashani hospitals in Isfahan from 2001 to 2007 were selected in a simple- sampling method. Age, sex, mechanism of injury, initial performed treatment, along with lesions (digital nerves or arteries), presence or absence of local and phalanges fractures, motion weakness sensory status of finger at the admitting time, indication for reconstruction, rate of improvement and ultimate satisfaction was recorded.Finding: Thirty one patients with average age of 26.09±9.62 years that 71% of them were men were included in the study. Before operation, 87.1% of patients had weak finger range of motion; 3 months after operation, 67.7% of them had relatively weak range of motion at the end of study only; 25.8% of patients had very weak range of motion 6 moths after surgery (P<0.001).45.2% of patients were satisfied and none of them were unsatisfied or completely unsatisfied.Conclusion: Two-stage flexor tendon reconstruction in hand in zone two is the method of choice for secondary repair or managing tendon repair complications.

Background: Lidocaine7%-Tetracaine 7% is one of the materials recently offered for performing laser- assisted hair removal. The aim of this study was to compare the effects of this material with placebo on side effects of laser-assisted hair removal.Methods: This clinical trial was carried out on 110 women referred to Isfahan Spadana laser clinic for laser-assisted hair removal. Lidocaine7%-Tetracaine7% was applied on one-half of the face, whereas placebo was applied on the other side to create local anesthesia and after 30 minutes the place was cleaned and was investigated for complications (edema, erythema, and pallor); then laser therapy was begin. In the end of the therapy, the patient’s pain was estimated based on VAS (Visual Analog Scale). The data was analyzed using SPSS software by chi square and paired t tests.Finding: The mean age of patients was 27.74±10.8 years. Average level of anesthesia 30 minutes after using Lidocaine7%-Tetracaine7% and placebo based on VAS were respectively 3.6±1.4 and 8.4±1.5 (P=0.001). In other words, patients have felt less pain by using Lidocaine7%-Tetracaine7%.Frequency of complications in patients was not significantly different between two groups.Conclusion: Considering the better effect of Lidocaine7%-Tetracaine7% compared to placebo and its minimal side effects, we can use it before perform laser-assisted hair removal.

Background: Cutaneuos leishmaniasis is a common parasitic disease in 88 countries. Iran is one of the hyperendemic regions of cutaneuos lieshmaniasis. Mesotherapy is a technique used to deliver medication to a specific area of the body to treat a specific condition. This is done by painless multiple intradermal microinjections.Methods: In this clinical trial study, 90 patients with confirmed cutaneuos lieshmaniasis in Isfahan Lieshmaniasis Research Center, were selected and randomly divided into 2 groups. Group A and B were treated by classic intralesional and mesotherapy injection respectively; intralesional injection of glucantime once a week for a maximum of 6 weeks was done for both groups. Patients were followed one week, one month and 3 months after the treatment. P value<0.05 was considered as significant level.Results: Sixty patients completed the study. There was no significant difference between the mean of changes of disease indecies of the lesions (size of ulcer, erythema and induration) in classic group and mesotherapy group. The speed of the lesion-cure regarding cure of ulcer, erythema and induration in the mesotherapy group was significantly less than classic group. The mean value of pain severity and the mean volume of the drug needed for each centimeter of the lesions in Mesotherapy group was significantly less than classic group. The results showed no statistical significant difference between the clinical and parasitological cure rate of the two groups.Conclusion: Intralesional injection of glucantime by mesutherapy was more rapid, painless and cost effective than the classic method. This could promote the compliance of patients in the treatments procedure.

Background: Renal transplantation is the treatment of choice for patients with end stage renal disease (ESRD). In cases of ant graft dysfunction at any time after transplantation, kidney biopsy is the golden standard for diagnosis. Kidney biopsies are categorized according to the Banff classification. This study aimed to evaluate the frequency of different allograft biopsies.Methods: In this cross-sectional study, the renal allograft biopsies obtained in both Alzahra and Noor in Isfahan, centers during the years 2006 to 2008 were studied based on Banff classification. The information and data were obtained from the department of pathology. When the data were completely gathered, they were analyzed via SPSS software.Finding: From 161 specimens, 68% were men and 32% were women.85% of the grafts were from living unrelated donors, 9.9% from cadaver and 5% from living related donors. The relative frequencies of pathology diagnosis of biopsies were as 13.7% Tubular atrophy and interstitial fibrosis (TA & IF) grade II, 9.9% TA & IF III, 6.8% Acute rejection (AR) IA, 5.6% AR IB, 5% infarction, 5% borderline, 4.3% AR IIA, 4.3% TA& IF I, 3.7% antibody rejection and 1.9% AR IIB; also 44.7% had unrelated pathology to rejection. The greatest mean age for the patients under biopsy was for TA& IF I (45.5 years) and the smallest was for acute tubular necrosis (ATN) (24 years). The greatest mean time for biopsy was for TA& IF III (2666.2 days after biopsy) and the smallest was for ATN (72.8 days after biopsy).Conclusion: A great number of studies on renal allograft pathologies have been done in different transplant centers around the world. No studies have been done on pathologies in Alzahra and Khorshid hospitals in Isfahan which are referral centers for transplantation. This study can give us a picture of the major causes of graft dysfunction in our country according to race, environment and...

Background: The Scorpion is an actual public health problem in several parts of the world; because, either incidence, or severity of envenomation is high and managed with difficulty by health services, or of these two reasons at the same time. Although there have been several studies of scorpionism in many parts of the country, this was the first study of this kind in Isfahan.Methods: The aim of this study was to describe the epidemiology and some common clinical symptoms and signs among humans stung by scorpion in the central province of Iran, Isfahan. The study was conducted in the emergency departments of “Noor” and “Khoor” hospitals between 2007 and 2009. All data were collected by physicians in a researcher-made questionnaire. Clinical signs and symptoms of all the patients presented to the hospital with a history of scorpion envonomation were recorded.Finding: Of all the patients presented to the emergency department after a scorpion sting during the 1.5 years period of the study, 147 patients achieved inclusion criteria. All the patients received supportive therapy and no severe case was reported; so there was no need for long term hospitalization. There was no need for antivenom according to clinical signs and symptoms. All the patients were discharged home a short time after admission and no sequel was notified.Conclusion: According to this study, scorpionism is not of clinical importance in this geographical region, and the most important achievement is that there was no need of antivenom in managing the patients.