MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2010 | Volume:53 | Issue:2|Papers Count:13

Introduction: Nocturia commonly seen with aging may result from several conditions of which benign prostatic hyperplasia (BPH) and loss of nighttime vasopressin production (or release) are very common causes. The relief of obstructive symptoms of BPH without addressing the nocturnal polyuria may result in disappointing clinical results. Materials and Methods: A total of adult men (mean age: 62+ /- 2.5 years old) with BPH and bothering nocturia (> or = 2voids / night) were treated with oral desmopressin at bedtime. Exclusion criteria included active urinay tract infection, history of myocardial infarction, congestive heart failure, angina and hyponatremia. Patients received desmopressin tablets (0.1,0.2,or 0.4mg ) during a 3 – wk dose titration period and after 1- wk washout period the effective drug dose continued for 6 to 8 – wk . Positive Clinical response defined as > or =50% decrease in nocturnal voiding episodes. Results: All intervened patients improved with such a treatment. The average of symptoms duration was 3.45 +/- 0.62 years. Nocturia episodes decreased from a mean of 4 +/- 0.36 episodes/ night before treatment to1.17 +/- 0.28 episodes/ night after therapy (p< 0.0001). I-PSS decreased from 16.9 +/- 1.16 before treatment to10.47 +/- 0.98 after therapy (p< 0.0001). Serum sodium levels changes were significant (p= 0.02), but hyponatremia did not occur. Also, there was a correlation between age and nocturia episodes (p< 0.0001, r = 0.744. Conclusion: Oral desmopressin tablets provide an effective and well tolerated treatment for nocturia due to BPH and cause significant reduction in nocturia episodes; I-PSS measures serum sodium levels with limited side effects.

Introduction: HBV infection is the most common cause of chronic hepatitis in Iran. HDV prevalence in chronic carriers of HBV has not been studied in the north-east of Iran. This study evaluated the prevalence, risk factors and co-infections of HDV with HCV.Materials and Methods: This cross-sectional study was carried out From Sep_ Oct 2004 to Sep_Oct 2005. The patients divided into two groups, inactive chronic carrier and chronic liver disease (chronic hepatitis and/or liver cirrhosis). Our study included 350 chronic HBV carriers in whom we assessed HDV Ab by ELISA method, then HDV Ab positive patients were assessed for risk factors and Co-infections with HCV. Later risk factors and co-infections were compared in HDV positive and HDV negative patients. Results: Analysis of serum markers indicated that 10% (35/350) of patients had evidence of HDV infection; Anti-HDV was found in 4.5% (7/153) of patients with inactive carriers, and in 14.2% (28/197) of patients with chronic liver disease (chronic hepatitis and/or cirrhosis). Main risk factors of HDV positive and HDV negative infections included positive family history, blood transfusion, which were almost equal in two groups (p> 0.5). One out of thirty five (2.8%) of HDV positive patients showed triple infection of HBV/HDV/HCV. Also, 2.8% (1/35) of HDV negative patients showed dual infection of HBV/HCV.Conclusion: The present study shows that HDV infection is prevalent in the north-east of Iran, particularly in chronic hepatitis and cirrhosis, and it should be studied in them. Routine assessment of HCV in these patients is not recommended, unless risk factors exist.

Introduction: Positive effectiveness of antiemetic drugs was approved in reduction of post-operative nauseaand vomiting) PONV. The purpose of this study was comparison of Dexamethazone and Ondansetron with Dexamethazone and Metoclopramide in preventation of PONV.Materials and Methods: In this study, was selected 80 women in ASA class I, II for elective abdominal hysterectomy under general anaesthesia and was divided in to two groups (n= 40). One group received a combination of Dexamethazone with Ondansetron and in second group was injected a combination of Dexamethasone with Metoclopramide near the end of surgery. PONV was evaluated at 2hr and 6 hr after operation. The results were analyzed, using pearson chi-square and fisher’s exact test.Results: Injection of two drugs Ondansetron and Metoclopramide affect in reduction PONV. But, the rate of reduction of nausea and vomiting was not significant in 2 groups in 2 hr after surgery (p= 0.723). Its rate was significantly lower in Ondansetron group after 6 hr (p< 0/001).Conclusion: In the patients with selective hysterectomy under general anesthesia for reduction of PONV can be apply from acombination of Dexamethasone and Ondansetron which show more effectiveness and longer duration as compared to Metoclopramide and Dexamethasone.

Introduction: Now attention focuses on additional actions of statins which are independent from 3 hydroxy3 methylglutarylcoenzyme a reductase inhibition of them. The aim of this study was antihypertensive effect of statins.Materials and Methods: We performed a randomized, -blinded, placebo-controlled trial with equal allocation to simvastatin, 20 mg; or placebo for 6 months from December 2008 till June 2009. one hundred patients without known cardiovascular disease or diabetes mellitus, with low-density lipoprotein cholesterol screening levels of 130 to 190 mg/dL & BP <140/90 mm Hg ,had assessment of BP at rest in supine position (SBP and DBP, respectively) in monthly manner for two months. Blood pressure values for placebo vs statins were compared.Results: The average of blood pressure in the statin group was124.8/81.12 and in the placebo was 123.75/87.125. Statins modestly but significantly reduced BP relative to placebo, 115.5/71.9 (p= 0.02)) in one month after treatment. In placebo group BP reached to 124.25/84.25. However in the second month systolic blood pressure decreased but the diastolic blood pressure increased by one MM/HG (p= 0.5). In The placebo group blood pressure increased to 128.32/89.6.Conclusion: Reductions in SBP and DBP occurred with statins in normotensive and prehypertensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events and the mortality reported on statins.

Introduction: To determine efficacy of intralesional injection of verapamil in improvement of symptoms and signs of peyronie's disease.Materials and Methods: In this study 27 patients were assessed of them 23 with single plaque of peyronie’s disease and the mean age of 50.2 years (21-72 years) underwent a total of 12 intralesional injection of verapamil. Before treatment, 16 patients (69.9 %) had pain, 23 patients (100%) penile induration, 19 patients (82.6%) penile curvature and 20 patients (86.9%) experienced erectile dysfunction. Then 3 months after injections, symptoms and signs of patients evaluated again. Results: Pain resolved in 16 patients (100%), penile nodularity and chordea reduced in 18 (81%) and 14 patients (73.7%) respectively. Erectile dysfunction improved in 13 patients (65%). One patient (4.3%) found new penile nodularity in the opposite side of the initial nodule.Conclusion: Intralesional injection of verapamil is a simple and effective method in patients with peyronie's disease that have not responded to oral medication.

Introduction: Blur vision due to astigmatism and spherical refractive errors reduce stereopsis and develop amblyopia in children. The aim of this study was to determine the effect of different type and amount of induced unilateral myopic and hypropic astigmatic anisometropia on stereopsis.Materials and Methods: This interventional study was performed on 60 normal patients after primary examination and refraction, the primary stereopsis was determined by TNO and Titmus stereotests. Myopic and hypropic astigmatic anisometropia were induced using trial lenses of 1 to 4 D, minus and plus in horizontal, vertical and oblique axis. The stereopsis was then determined by TNO and Titmus stereotests. Data were analyzed, using SPSS version 11.50.Patients with previous amblyopia, manifest deviations, ocular pathology and more than 4 prism heterophoria and abnormal fusion response with Bagolini test were excluded from the study.Results: Mean stereopsis was 40.83±2.78 and 31.50±6.59 seconds of arc with Titmus and TNO stereotests respectively before intervention in all patients. Stereopsis levels were reduced significantly with respect to the degree and types of meridional anisometropia (p< 0.001). Maximum reduction of stereopsis occurred with 4 D myopic and hypropic astigmatic anisometropia in oblique axis. It was 1930±271/5 and 1780±518/6 second of arc for TNO test and 773.33±101/4 and 693.33±/179.9 second of arc for Titmus stereotest. Comparison between mean stereopsis in myopic or hypropic astigmatic anisometropia was statistically significant in all three axes; horizontal, vertical and oblique (p< 0.000).Conclusion: According to the findings of this study, uncorrected meridional anisometropia (myopic and hypropic anisometropia) like spherical anisometropia has advers effect on binocular vision development and stereopsis. It can also develop amblyopia in critical age of children. 4 D meridional anisometropia reduced stereopsis to below 1% which indicated liner relation between them. These findings show that the low oblique and vertical astigmatic anisometropia reduce stereopsis more than the horizontal axis.

Introduction: Childhood obesity is increasingly common and is associated with health problems. In particular, obesity plays a central role in the metabolic syndrome. We estimated the prevalence of metabolic syndrome. In obese children and adolescents 5-15 years old.Materials and Methods: This descriptive cross Sectional study took place from April 2008 to March 2009, a total of 249 children and adolescents 5-15 years old with BMI>85percentil evaluated for growth parameters, BMI, blood pressure, Lipid profile, fasting blood sugar, insulin, and OGTT. Results: Mean age recorded was 9.8±2.8 year, females with the range of 5-10 years old and males with above l0 years old. Of them 70.6% were female and others male, 66.5% were obese and 33.5% over weight.Frequency of hyperinsulinism, impaired glucose tolerance test, Insulin resistance and type 2 diabetes were 27.3%, 11.6%, 3.6% and 1.2% respectively. Overall 30% of children had high blood pressure and 66.2% dyslipidemia.Conclusion: Frequency of metabolic syndrome in this study was 20.1% and dyslipidemia was more common.

Introduction: Previous studies have shown that early postoperative colon anastomosis oral feeding is feasible. Traditionally patients were fed when flatus or defecation documented the return of bowel function. Materials and Methods: All patients who underwent elective laparotomy with colon resection and anastomosis between December 2006 –and December 2007 were prospectively randomized to one of the following two groups: group 1: early oral feeding--all patients received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated; group 2: regular feeding--all patients were treated in the "traditional" way, with feeding only after the resolution of their postoperative ileus. The patients were monitored for vomiting, bowel movements, time of regular diet consumption, complications, amount of serum received and length of hospitalization. Results: A total of 64 consecutive patients were studied, 32 patients in group 1 and 32 patients in group 2. There were no significant differences between the early and regular feeding groups in the overall complications or mortality, but there were significant reduction of length of hospitalization and serum reception in the early oral feeding group.Conclusion: Early oral feeding after elective colon surgery is safe and can be tolerated by the patients. Thus, it may become a routine feature of postoperative management in these patients.

Introduction: Sick building Syndrome is a Collection of neurological, irritancy, respiratory, dermatology & sensory symptoms that we can not relate them to the diagnosis of other diseases. With recognized people having sick building syndrome, we can make better environment for them at work & try to prevent the sickness. The aim of this study was assessment of symptoms of sick building syndrome & determination of indoor air pollutants in some buildings of university. Materials and Methods: This study was a cross – sectional assessment, it accomplished with special methods for the measurement of indoor air pollutants & questionnaires. There was a maximum of 4 weeks time interval between the measurement and filling the questionnaires. Data were analyzed using SPSS 11.5, chi –square, ANOVA using p< 0.05. Results: A total of 23.3% of personnel’s had sick building syndrome, 21.9% of them had only neurological, 10.3% irritancy, 5.2% respiratory, 6.8% dermatologic & 4% had sensory symptoms. Mean of the indoor air pollutants for CO2, Ozone, CO & NOx were 526.93, 0, 4.92,0 PPM respectively. Mean of formaldehyde was 0.15 mg/m3 respiratory particles 3.56 mg/m3, total particles 5.793 mg/m3, wet temperatures 14.28°C & 22.27°C for dry temperature. Humidity was 41.36%, air velocity 0.16 m/s, noise 58.38 dBA, light or luminosity 421.37 lux. Bacteria and fungi were 1.73 & 0 CFU/m3 respectively. In building C, neurological symptoms with increasing CO were shown. Conclusion: The results of this study are similar to those from other studies & may be even more significant. It can be concluded that by making a better working environment and ventilatin of buildings, sick building syndrome could be avoided to some degree.

Hepatitis delta virus also known as hepatitis “D” Virus requires the presence of HBV for Virion assembly but not for replication. Both co-infection and super-infection of HBV with HDV result in more severe complications compared to infection with HBV alone. In combination with HBV, hepatitis D virus has the highest mortality of all the hepatitis infections.Following exposure to HDV, there is a period of 3 to 7 weeks for having an anti HDV positive test. Even after ending the incubation period of HDV, still the diagnosis of HDV may be established, using PCR which is more sensitive and specific than both IgM and IgG anti HDV.Title of IgM-anti HDV correlates with the level of HDV replication, and titles of 1:1000 are indicative of ongoing infection.The detection of interahepatic HDV antigen has been proposed as the “gold standard” of diagnosis of hepatitis delta virus infection; particularly when anti HDV is negative in the beginning of disease or chronically diseased patients. Another pitfall in diagnosis of HDV infection; can be found in triple infections of HBV, HDV and HCV. The inhibitory effects of HCV on HBV replication might be another factor for the decreasing of HDV antibody and perhaps false-negative anti HDV test.

Introduction: Restrictive cardiomyopathy defined by increased ventricular wall stiffness and impaired LV filling and heart failure symptoms. This type of cardiomyopathy occurs with lower frequency relative to the dilated and hypertrophic cardiomyopathies. IRCM in 50% is idiopathic and in 50% is secondary to specific clinical disorders especially amyloidosis. Cardiac amyloidosis usually occurs during primary amyloidosis (AL type amyloidosis). Primary amyloidosis is often seen in people with multiple myelomacancer or in the in course of immunocytic dyscrasia. Disease process results from tissue deposition of proteins that have a unique secondary structure. Cardiac amyloidosis is an invariably progressive infiltrative cardiomyopathy that carries a grave prognosis we have presented a case of Cardiac amyloidosis which is a rare clinical disorder. Case report: The Present case was a 46 years old man who admitted for progressive dyspnea and congestive heart failure. Echocardiography revealed increased ventricular wall thickness with small size ventricles, enlarged atria, and a thickened intertribal septum and advanced diastolic dysfunction. Electrocardiography revealed low QRS voltage and normal sinus rhythm. Gingival Biopsy examined by congo Red staining and immunohistochemistry identified specific amyloid proteins. Pathology report confirmed amyloidosis.Conclusion: In patient complaining of progressive congestive heart failure and suspected to have restrictive cardiomyopathy, cardiac amyloidosis should be born in mind.