Medical Journal of Mashhad University of Medical Sciences
Year:2005 | Volume:48 | Issue:87|Papers Count:21

Introduction: Methicillin resistant Staphylococcus aurous (MRSA) are one of the main reasons of nosocomial infection in the world and the treatment of this multidrug resistant bacteria is difficult thus making the identifying this bacteria is important. The purpose of this  study is to determine the appropriate method for identification of methicillin resistant Staphylococcus aurous. Material and Methods: In this study, 86 types of Staphylococcus aurous separated from 86 patients were tested. The purpose was to determine their resistance to methicillin using phenotypic methods and detection of mecA gene. In this study, polymerase chain reaction '(PCR) was considered as the standard method for identification of mecA gene and the two methods of phenotypic disc diffusion and Etest were compared with it. The PCR test was done as Multiplex PCR and in addition to the mec A gene, the 16SrRNA was also amplified and used as the internal control. Results: Forty-six strains showed resistance to methicillin and forty strains showed sensitivity to methicillin. The results from the E test showed a 100% compatibility with the PCR, but the similarity between the results from the oxacillin disc and those of PCR was only 43.8%. The results from the disc diffusion method for the other antibiotics used in this study were as follows: Methicillin resistant Staphylococcus aurous showed more resistance to erythromycin, ciprofloxacin, cloxacillin and cefotaxim in comparison with Methicillin sensitive Staphylococcus aurous (MSSA). Conclusion: The results show PCR and Etest are similar in sensitivity and specificity, which are the best methods in methicillin resistant Staphylococcus aurous identification.

Introduction: The importance of renal diseases and prevention of them encouraged us to carry out this study. Our purpose was to determine the prevalence of abnormal urinary findings in school aged children in Hamedan. Material and Methods: We have investigated 800 students (400 boys and 400 girls) aged 10-11years from the school population of Hamedan city. Fresh urine specimens were screened using a dipstick for chemical analysis. In those patients in whom urinary abnormalities were found, further investigations, urine analysis, urine culture and sonography of urinary system, were carried out. Results: The prevalence of proteinuria, hematuria, hemoglobinuria, positive nitrites in urine, glucosuria and bilirubinuria were 1.4%, 4.1%.11.5%,0.75%,0.1% and 0.75% respectively. There was no statistically significant difference between prevalence of abnormal urinary findings in girls and boys except for positive nitrites in urine. Positive nitrites in urine were detected only in girls. In further evaluations, we found five cases of urinary tract infection, two cases of orthostatic proteinuria and one case of diabetes mellitus. Conclusion: The most frequent abnormal finding in our study was hemoglobinuria. Other abnormal findings, in order of frequency, were hematuria, proteinuria, positive nitrites in urine and bilirubinuria, and then glucosuria. According to significance of final findings in this study, we suggest performing of dipstick test for girls and boys before attending in the primary school.

Introduction: Tinea unguium is a fungal infection of both fingernails and toenails and can affecting patient's nail health. In order to detect epidemiological aspect and also etiologic agent of this mycose during 1997-2004, a total of 514 patients (298 (58%) female and 216 (42%) male) with suspected nail disease were examined to determine the causative agents and prevalence of onychomycosis in Northwest area of Iran. Material and Methods: The diagnosis of Tinea unguium was established through visualization of fungal mycelium's and artroconidia in a direct microscopic examination of nail scrapings and by isolation of exact dermatophyte colony from culture of clinical samples in S (Saboursud's Dextrose Agar) and SCC (Mycosel Agar) medium. Results: Examination of sample from nail of these patients in 36 (7%) had positive and 478 (93%) negalive results. From all of36 case with positve exam, 15 (42%) cases were female and 21 (58%) case male. 15 [(42%) (8 male, 7 female)] Case from all of36 positive cases, had Tinea unguium in fmgernails and 21 [(58%) (13 male, 8 female)] in toenails. Trichophyton mentagrophyes var. interdigitale and var. mentagrophytes (9 cases), T. Verrucosum(5), Microsporum canis (4 cases), T. Violaceum (3 cases), T. schoenleinii (2 cases) and T. rubrum (2%) were isolated from culture of Samples in S (Saboursud's Dextose Agar) and SCC (Mycosel Agar) Medium. Conclusion: This survey has provided useful information on the prevalence, causative agents, risk factors and health implications of onychomycosis in Northwest area of lran.

Introduction: Each year, a lot of people get blind due to eye injuries. Most of them are occure in lathe machine workers. The goal of this study is to understand the factors that make eye injuries and protective ways among these workers. Material and Methods: A cross-sectional survey was conducted by interviewers using uniform questions on 351 lathe machine workers. Results: Among the workers, only 49% of them were used goggles and 7% didn't have any eye protective devices and the rest of operators (44%) didn't use their goggles. We found more work experience makes the operators to be more concern about their eyes (p=0.016). There was significant relation between the level of education and usage of goggles too (p=0.000). Conclusion: How grasp the information and why they didn't use the protector, are topics that should be noticed more for effective public health policy. There is a need for preventive education and enforcement of safety regulations for the informal occupational sector to avoid ocular injuries.

Introduction: To evaluate the necessity of adjustment of antiestrogens dose according to change in serum testosterone levels in the treatment of idiopathic oligospermia in infertile men.Material and Methods: This study performed on 160infertile men with idiopathic oligospermia treated with clomiphene citrate In 125 patients (group I) serum testosterone levels was below upper limit of normal (>750 ng/mg), three weeks after beginning treatment. In other 35 patients (group TI) serum testosterone levels raised over normal. Of patients with over normal testosterone level in 20patients (group IIA) drug dose reduced to half and in 15 remained (group lIB) continued previous dose. After three weeks we repeated testosterone level. Semen analysis was repeated after 6months in all patients. In all groups mean sperm count after treatment was compared with before treatment by paired students tests.Results: Six months after treatment in group I, mean sperm count increase from (9.6 ± 3.7) x 106 / ml to (13.1 ± 3.9) x 106 /ml that was significant statistically. In group IIA serum testosterone levels three weeks after decline drug dose dropped to normal range and mean sperm count increased from (9.8 ± 3.6) x 106/ ml to (13.9 ± 4.2) x 10 / ml that like group I was significant statistically. In group IIB, that did not decrease drug dose, testosterone levels remained over normal (>750 ng/ml) and mean sperm count from (9.6 ± 3.4) x 106 I ml got to (9.3 ± 3.6) x 106/ ml that was insignificant statistically. Conclusion: We recommend serum testosterone level must be measured 3 weeks after the beginning of the antiesterogene treatment and secondary adjusting the drug dose to keep testosterone level normal range in infertile men.

Introduction: BCC (basal cell carcinoma) is the most common malignant neoplasm of the skin. Ultra-violet ray is the most important risk factor for it. The purpose of this study is to investigate the epidemiologic features and the effect of diverse variables on each other. Material and Methods: This descriptive study from 1982 to 2002 was done in skin and pathology department of Mashhad Imam Reza hospital. 1844 patients with BCC are evaluated. Patients information including age, sex, localization and job was collected in forms. Collected data were processed by descriptive statistics, frequency tables and analytical statistics. Results: 1844 BCC cases with an age range (mean ± 2SD) of 58 ± 28years and a man to women ratio of about 1.46 to 1 were found which shows a meaningful difference (p<0.001) between the mean age of men (60 years) and women (55 year) . The most prevalent site of involvement are nose, face, periorbital and scalp regions respectively.%85of patients are in age range of 40 to 79 years. Children (less than 15 years) constitute only %0/23 of cases. It seems that in both sex by increasing the age there is a reduction in the relative prevalence of BCC in scalp and ear regions and an increment in lip and nose areas. Women have a meaningful (p<0.001) lower relative prevalence in ear and neck sites. Also in this study chest, shoulder, and back (non sun-exposed areas) constitute only about % 1 of all BCC cases which shows a great difference with other references (about %15). A clear correlation was not found between job and involved region of the skin. Conclusion: Higher prevalence of BCC and higher rate of scalp and ear skin involvement in men may be due to occupational factors and special style of clothing in women. Much less relative involvement of non-sun exposed areas both in men and women may also be a reflection of social habits and daily clothing style.

ntroduction: Because penetrating cardiac injuries are increasing and early diagnosis has better results, we need a reliable diagnostic method. The aim of this study is evaluation of subxyphoid pericardial window in diagnosis and treatment of penetrating cardiac injuries. Material and Methods: This cross sectional descriptive study has done from 1370-1380 in Mashhad Imam Reza hospital. All patients with penetrating chest trauma in paracardiac area underwent suxyphoid pericardial window. Findings: 106 patients with penetrating paracardiac trauma undergone subxyphoid pericardial window. 84 cases had stab wound and 22 cases had gunshot or shotgun wound. Results: The results of subxyphoid pericardial window were positive in 28 cases (26/4%). In 11of these patients there was no sign and symptom. 28 cases had heart injury (20 ventricular injuries, 3 atrial injuries and 5 pericardial injuries). 21 cases had undergone simple repairs. 39 cases needed laparotomy and 28 visceral injuries were diagnosed. There were no mortality and significant morbidity. Conclusion: subxyphoid pericardial window is a safe and reliable method in diagnosis of cardiac injuries especially in medical centers that there aren't any diagnostic methods.

Introduction: Ischemic stroke in young adults is a serious socioeconomic problem and a common cause of mortality and morbidity. The purpose of this study is to clarify pathogenic and clinical feature of ischemic stroke in young adults, based on the most common etiologies we can discuss about primary prevention in this range of age.Material and Methods: From February 1999 to January 2002, 106patients of consecutive admission in neurology ward of Ghaem hospital with ischemic stroke aged 15-45 years (55men, 51women) were studied. Sex, vascular risk factor including: hypertetion, diabetes mellitus, hyperlipidemia, smoking and OCP, cardiac source of emboli (emblogenic cardiac disease) and clinical categories of stroke were examined. Serologic test, CT Scan, MRI, angiography and echo Doppler of carotid and vertebral arteries transthorasic and transesophageal echocardiography were performed. Results: Men were slightly predominant in this study (52%men, 48%women). The youngest age was 15 years old but majority of patients were between 31-45 years (72.6%) of age. Following etiologies were obtained: 1) Cardiovascular emboli (52.5%), 2) premature atherosclerosis (11.3%) 3) Non atherosclerotic vasculopathy (2.8%),4) antiphospholipid antibody (1.9%),5) OCP (HO) consumption (1.9%), 6) Hereditary coagulopathy (1.9%) and 23.6%  remained with unknown etiology. Out of 64 embologenic cardiac disease the most ftequent was rheumatic heart disease (42%) and other etiologies were MVP (26.3%), prosthetic valves (10.9%), PFO (patent foramen ovale) (6.2%), acute MI (4.7%),CHF(4.7%), endocarditic (4.7%)Conclusion: Patients < = 45 years of ages are likely to have various and unique etiologies for ischemic stroke. A specific diagnosis approach is strongly recommended for young patients with ischemic stroke, so it is necessary to look for and identify the source of cardiac embolism and initiate adequate treatment for prevention of recurrence.  

Introduction: Pleural effusion occurs in variety of abnormalities. Its traditional classification as transudates or exudates is useful, differentiation between transudates and exudates is the first diagnostic approach of a patient with pleural effusion.This study evaluates usefulness of pleural alkaline phosphates (PAP) level for distinguishing between exudative and transudative effusion and also differentiates tuberculous from malignant effusion based on the level of PAP. Material and Methods: We studied 100 patients with pleural effusion who referred to Ghaem Hospital; Mashhad University of Medical Sciences during a period of one year. All patients underwent diagnostic thoracentesis. The level of pleural - fluid glucose, protein, lactate dehydrogenase (LDH), cholesterol, alkaline phosphatase were measured. We considered the threshold level of 20 ID for PAP in differentiating transudates from exudates.Results: Among 100 patients with pleural effusion, 43 patients had exudative (tuberculous), 37 had exudative (malignant), and 20 had transudative effusion due to congestive heart failure (CHF). Mean value of PAP in transudative effusion, exudative tuberculous and malignant effusion were: 15.4 ± 3.5, 51.58 ± 4.47 and 79.13 ± 24.22 respectively. The difference between mean value of PAP in transudative and exudative effusion was statistically significant (p<0.001). Sensitivity, specificity and efficiency of these criteria were: 96.7 %, 86 % and 94% respectively. Conclusion: Detennination of the PAP level is useful and highly effective for distinguishing between transudates and exsudates and should be included in biochemical analysis of pleural effusions. Our study did not show significant difference between mean value of PAP in tuberculous and malignant exsudative effusions.

Introduction: HTL V -1 Associated myelopathy (HAM) is one of the endemic diseases of the north of Khorasan province and usually manifests as a clinical syndrome of chronic progressive spastic paraparesis. Most proposed treatments in HAM are symptomatic but a few etiological treatments such as Danazol is considered. Material and Methods: This is a "before and after clinical trial" study. Only 53 patients of 61patients in which the HAM were documented by MRI, blood & CSF serology and PCR, and CSF cytology and biochemistry, qualified to admitted in this study. Before administration of drugs and along the treatment period the severity of symptoms and motor disability (According to Motor Disability Grading) were appraised monthly for 6 months.Results: Among 38 patients in the first group who were treated with danazol after 6 months the difference between MDG0 and MDG6 (indicator of motor disability improvement) was 0.89, but there was no difference between MDG0 and MDG6 among the other group who were treated with multivitamin (P<0.001). Considering subjective findings and satisfaction of patients comparing symptoms such as Pain, parestesia, muscular stiffness and gate and Urinary difficulties there was a significant difference between these two groups. Of course the validity of test was more for muscular stiffness (P<0.001) and less for parestesia (P=0.348). Conclusion: This study revealed that Danazol has a partial effect on improvement of motor disability and symptoms of HAM; and as there are much less side effect for Danazol than other regimens such as corticostroids and cytotoxic drugs it can be proposed, but the efficacy of danazol maybe less than these regimens.

Introduction: Hypokalemicperiodicparalysi is classified in disorders named chanalopathies.  Many cases of hypokalemic paralysis are admitted in Ghaem Hospital every year. In this research we decided to study clinical and paraclinical manifestations and also primary and secondary etiologies of these disorders. Material and Methods: During one year study, 20patients were admitted with Hypokalemic manifestation. Most of them had eaten high carbohydrate diet. 10cases had history of drug consumption. In 3 cases, their attacks were related to cold exposure. 2 cases had non neurologic symptoms including nausea, vomiting or myalgia. The longest duration of paralysis was around 6 - 12 hours. Only in one patient, there was a positive history of familial paralysis. In most of the patients the pattern of weakness was as four limb weakness with lower limbs dominancy. In 16 cases, serum potassium (K) was below 3 meq/I. In 6 cases, ABG showed metabolic acidosis. In 5 Casrs, thyroid function tests showed hyperthyroidism. There was laxative consumption in one patient and prolonged diarrhea in another one. Conclusion: This study showed that majority of hypokalemic cases have secondary causes and hypokalemic periodic paralysis is a rare cause.

Introduction: Recently, hospitalization of IV drug abusers has increased and associated with Some diagnostic and therapeutic problems. This study designed to determine the epidemiologic features of these patients and to identify their common infections.Material and Methods: This study is a descriptive cross- sectional one. Data were obtained from 53 questionairs from hospitalized patients in infectious diseases ward of Immam Reza hospital in 1381-2.Results: Heroin was the most commonly used illicit drug(94.33%).Other less commonly used drugs were cristal, opium and market drugs. The most common causes for IVD As hospitalization, in decreasing order were infectious endocarditis (28. 31%), soft tissue infection (16.98%), pneumonia (15.9%), septic DVT (15.9%), nonseptic DVT (7.55%) and miscellaneous (7.55%).In overal, blood cultures were positive in 32.08% of cases; including 82.35% staphylococcus aureus,11.76% streptococcus pyogen and 15.88%entrococci of positive cultures. There was no positive culture for aerobic gram-negative bacilli. Anti-HCV ab, Anti-HIV ab and HBs Ag were positive in 67.92%, 5.66% and 3.77% of cases, respectively.Conclusion: This study indicates a high prevalence of probable HCV infection in IVD As. Based on this study, it seam's reasonable to administer combination of Cloxacillin and aminoglycoside empirically for infectious endocarditis, Septic DVT and sepsis in IVDAs. Dueto high prevalence of tuberculosis in this group of patiens, we recommend to consider anti-TB drugs as part of  empirical regimens for severe pneumonia in IVDAs.

Introduction: Since the first time, when the Prone position was introduced as a therapeutic maneuver in lung disease, numerous studies in both adult and pediatric subjects have almost uniformly reported an improvement in PaO2 in the Prone position compared to supine.Material and Method: To determine the effect of body position on oxygenation, 31 healthy low birth weight infants which were just feeding and being prepared for discharge, were followed by trans-coetaneous (tc) monitoring for Sp02with position changes all the patients were low birth weight but none of them had respiratory disease at the time of study. Results: Mean (±SD) tc SpO2 during 30 minutes in Prone and supine positions were; 94.85% (±6.6) and 93.05 (±7.5%)respectively. (p=0.089). Also mean (±SD) tc SP02at 30th min in Prone And Supine positions, Were 93.06% (±7.8%) and 93.16% (±8.5%)respectively (P=0.9).Conclusion: These findings suggest that, there is no significant improvement in arterial oxygen tension in Prone versus supine position in healthy low birth weight infants.

Introduction: Blood transfusion is a necessary component of cardiac surgery with cardiopulmonary bypass because of severe bleeding and coagulopathies. On the other hand, today, there is a great interest in reducing blood transfusion with different methods. One of which is acute normovolemic hemodilution, a way of autologous transfusions. In this study, reduction of transfusion of allogenic blood has been investigated. Material and methods: This clinical- trail study was performed in Ghaem Hospital of Mashhad in 1382.100 patients undergoing different cardiac surgery with cardiopulmonary bypass and hematocrit were investigated (a above 40%) The patients were divided into two groups of case and control randomly. They were all anesthetized with high-dose fentanyl method.In ANH group, the volume of blood withdrawn preoperatively was equal to the estimated blood volume (EBV) multiplied by the patients initial Hct (Hcto) minus the minimum allowable Hct (Hctf), divided by the average Hct (Hctav).As the blood was withdrawing, crystalloid solutions  were administered approximately three times of blood volume removed. The withdrawn blood was transfused immediately after operation in ICD.Results: Hct decreased from 46.2 to 35.7 in case group and ITom43.4 to 34.1 in control group 72 hours postoperative. The reduction of Hct after 72 hours, did not differ significantly between ANH and control group (P=0.475)But the units of blood transfused, reduced remarkably in ANH group.Conclusion: We concluded that ANH is an effective method of reducing blood transfusion in cardiac surgery and we recommend its performance in all the patients undergoing cardiac surgery.

Introduction: Cement less total hip arthroplasty is a new method for fixation of hip prosthesis in which biologic fixation. Is used and does not poses problems related to cement. The propose of this prospective study is to asses mid-term results of cement less total hip replacement for patients younger than 60 years, who have a high level of physical activity and for those whose cement fixation has a short survey.Material and Methods: The study consisted of 45 hips in 41 patients. They were 31 males and 10 females. The youngest patient was 29 years old and the oldest was 60,with a mean of 48 years. Causes of hip joint pathology were in 11.1% primary osteoartrits ,71.1%secondary osteoarthritis ,8.8% Rheumatoid Arthrits,4.4% hip joint tuberculosis ,2.2% Ankylosing Spondylitis ,2.2% with history of hip joint infection at childhood. Physical examination and radiologic evaluation before and after surgery and then at 6 weeks, 3 months, 6 months, 12 months, and  then anualy was performed and recorded. We used Hariss Hip Scoring System for clinical assessment.Results: Cement less total hip prosthesis was used for all patients. Full weight bearing begun 3 months after operation. Mean score of patients before the surgery and at the last examination were 47 and 90 respectively. Ninty percent of patients were without pain and limp. Prevalence of thigh pain was 10% that responded to usual analgesics and provided a comfortable life. There was 17% femoral and 4.4% acetabular osteolysis. One case underwent revision surgery because of recurrent dislocations. We had no infection but 2 cases encountered proneal neropraxia, which completely improved at 6 weeks. There was no thromembolic event, priprosthetic fracture or loosening. Conclusion: Cement less total hip replacement is an interesting method for patients with high physical level and younger in that cement becomes loose very soon. It also has not the problems of cement extraction in the case of revision. Cement less total hip prosthesis is valuable with enough survey and low complications.

Introduction: Scabies infestation with ordinary clinical features affects healthy people. Norwegian (crusted) scabies is and unusual and severe form of disease in which hundreds to thousands of mite sarcopt scabiei are present and in cases of misdiagnosis or delay in treatment may cause an epidemy.In this report a patient is presented with an unusual and severe infestation in a background of Post transplant immunosuppression.A 33 years old woman under immunosuppressive treatment due to kidney transplantation developed a severe and extensive scabies infestation wich quickly caused infestation in lots of her close contactants.Conclusion: In transplant recipient patients with pruritic, unusual, and severe dermatoses, this infestation should be considered, and with quick diagnosis and appropriate treatment its complications become avoidable.

Introduction: Vitamin D-dependent rickets type II (VDDR II) is a rare syndrome resulting severe rickets and is resistant to treatment with vitamin D and its derivatives. Patient with this disease,  who are frequently the children of consanguineous marriages, present With elevated circulating concentrations of 1,25 - dihydroxy vitamin D. Alopecia has been noted in many of these patients and it has been suggested that this feature may indicate a more marked resistance to treatment. We describe a 2-year-old boy with this disease who presented with severe clinical and radiological rickets since the age of 1 and alopecia since birth.

Introduction: Benign postoperative intrahepatic cholestasis (BPOIHC) is one of the causes of postoperative jaundice in which intrahepatic cholestasis is significant and there is, no inflammation or hepatic cell necrosis. The aim of this study is to present BPOIHC for better diagnosis and avoidance of unnecessary operations.From 2001- 2004 all patients that have developed postoperative jaundice have been studied with proper clinical and paraclinical tests and other causes of jaundice have been ruled out.Patients with postoperative jaundice have also been studied with proper clinical and paraclinical tests. In this report 3 patients with criteria of BPOIHC have been studied. Jaundice has begun from day 3-8 after operation. Non of them had pruritus, fever, or hepatosplenomegaly. Transaminase levels were normal. Alkaline phosphatase level was in normal range. Abdominal ultrasonography and CT scan were normal.These patients were observed and no problematic treatment has begun.Conclusion: BPOIHC must be in differential diagnosis of postoperative jaundice and with exclusion of other causes of jaundice when this diagnosis is made, the patients must be observed only until jaundice subsides.