MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2009 | Volume:52 | Issue:2|Papers Count:15

Introduction: Prevalence of folate and cobalamin deficiency in elderly is high. Determining a cut off point forlow and marginal levels of folate and cobalamin deficiency before development of anemia or neurocognitive presentations in elderly is essential.Materials and Methods: In this cross-sectional study 280 persons above 65 years old in the twelve regions of Mashhad city were admitted to Emam Reza (pbuh) hospital. They were physically examined by a general practitioner. Other data were obtained by questionnaire. Serum cobalamin and folate level were analyzed by RIA method. 76 persons, who had cobalamin of 120-450 pg/ml and folate of 1.5-7 ng/ml without any interfering factor for homocystein (Hcy) measurement (creatinin>1.5g/dl, cigarette smoking and consuming certain kind of drugs) were analyzed for serum homocystein by Elisa method. All collected data was statistically analyzed by SPSS software.Results: 48.7% of elderly had hyperhomocysteinemia. Hcy was inversely correlated with cobalamin (p=0.001) and folate below cut off point (p=0.044). For Hcy>15 mol/lm, cut off points for cobalamin and folate deficiency were <330 pg/ml and <6.5 ng/ml respectively. Prevalence of cobalamin deficiency in low levels (<122 pg/ml) was 22.7% and in marginal levels (122-330 pg/ml) was 51.8%. Prevalence of folate deficiency in low levels (<3 ng/ml) was 16.7% and in marginal levels (<6.5 ng/ml) was 64.2%.Conclusion: According to definition of cut off point, Prevalence of cobalamin & folate deficiency especially in marginal levels was higher than which is recorded. It is recommended that before development of signs and symptoms and other complications of hyperhomocysteinemia, all elderly patients undergoes screening for cobalamin and folate deficiency in appropriate intervals.

Introduction: Endoscopy is an invasive and painful procedure in children. Since children can not tolerate pain and stress, sedation is necessary in pediatric endoscopy. The aim of this study was comparison of propofol versus intravenous midazolam for reducing anxiety in children.Materials and Methods: In this study, 103 patients (2-14 years old) in whom endoscopy was indicated were divided into three groups. In the first group, patients received propofol, in the second group, intravenous midazolam was given and patients in the third group received no sedation. Procedures were performed in the endoscopy room. Heart rate, respiratory rate and oxygen saturation were recorded before and during endoscopy in 1 minute intervals. Tremor, sweating and pain scores were recorded by using Visual Analogue Scale (VAS).Results: A significant increase in heart rate was documented in all groups (p=0.038). Respiratory rate also increased in all groups. Too Oxygen saturation decreased in the propofol group, but it was not statistically significant (p=0.17). Pain score in propofol group was significantly lower than those receiving midazolam (20±22 vs 50±27, p<0.001). No noticeable side effect was seen in the propofol group.Conclusion: It seems that propofol is a very useful and effective drug for reducing pain and stress in children and its administration leads to a safe sedation in pediatric endoscopy.

Introduction: Re-exploration of the neck after pervious neck surgery such as thyroidectomy may be too difficult. So diagnosis of coexisting pathologies before the first surgical intervention makes the operation more convenient and decreases morbidity and costs.Materials and Methods: Thyroid function tests and serum Ca and PTH measurement were done in all patients who were candidate for thyroid surgery in Mashhad University of Medical Sciences from Jan 2004 to Jan 2006.MIBI scan was also performed in those with high Ca or PTH. Parathyroid glands exploration was done during surgery and grossly abnormal glands were sent for pathologic study.Results: Among 150 patients, 20% were male and 80% were female. Cervical mass was seen in 98%, hyperthyroidism signs were reported in 6.7% and dyspnea in 4%. Multinodular goiter (55.4%) and papillary carcinoma (26%) were common pathologies. Parathyroid mass was detected in 5 patients (33%) during surgery which was parathyroid adenoma in 4 cases (80%). In patients with and without parathyroid adenoma, the rate of hypercalcemia were 100% and 95.2%, hypophosphatemia 100% and 97.9%, increased PTH 100% and 30.1%, intraoperative parathyroid mass palpation 100% and 0.7%, and positive parathyroid scan 100% and 30.8% respectively.Conclusion: We suggest that hypercalcemia and hypophosphatemia are not useful indicators for prediction of parathyroid adenoma in patients with thyroid mass but increased PTH, intraoperative parathyroid palpation and parathyroid scan are accurate indicators for prediction of parathyroid adenoma in this regard.

Introduction: Nephrolithiasis has a high prevalence in population. Our objective was to compare time of stone passage, severity of pain, frequency of the use of analgesics and the course of disability between groups A, B and C.Materials and Methods: In this randomized controlled trial study, 240 patients were selected .inclusion criteria was all patient with 5-9mm stone diameter, and exclusion criteria was opium addiction. All of patients were categorized in 3 groups with Block Balance Randomize and double blind method. Each group consisted of 80 persons. In group A (i.e. control group) patients were given daily Diclofenac suppositories of 100mg and Diclofenac tablets of 25mg. In group B patients were given Tamsulosin tablets of 0.4 mg in addition to routine treatment and in group C patients were given Terazosin tablets of 2 mg in addition to routine treatment.Results: The rate of ureteral stone passage in group B (85.5%) was more than group A (80%) and group C (83.3%), the mean expulsion time group A with 14.9 days was more than group B (12.1 days) and group C (12.2 days), also severity of pain on the basis of VAS chart in group B (4.7) less than group A (5.5) and C (5.2), extra analgesic requirement in α blockers group (B:4 patients and C:2 patients) less than control group (8 patients), and all of these were non significantly different Patients were visited three months after lithotripsy.Conclusion: a blockers are decrease symptoms of pain and no effective response on expulsion of stones.

Introduction: COPD is a common pulmonary disease. One of the inflammatory factors in COPD is CRP which has a pathogenic role in pulmonary hypertension; therefore, our aim was to investigate the relationship between the level of serum CRP and pulmonary hypertension in COPD Patients.Materials and Methods: This prospective study was done from 2007 to 2008 in patients of pulmonary ward. Initially, COPD was confirmed in patients; and active infections, collagen vascular disease, heart disease, cancers and other diseases were ruled out. Mean pulmonary pressure was measured by echocardiography. Quantitative serum CRP was measured and compared with pulmonary hypertension.Results: From fifty five patients, forty were male and fifteen were female. Mean age was 63.67 year with SD of 9.94 years. According to the Gold Criteria, twenty-eight males and seven females had severe and very severe disease. Thirty-three males and thirteen females had mild pulmonary hypertension. Mean level of FEV1 percentage was 38.2 with SD of 17.39. Between the level of FEV1 percentage and hs CRP was seen an inverse linear correlation. Between quantitative serum CRP and mean pulmonary pressure a frank direct linear correlation was seen.Conclusion: CRP induces pulmonary hypertension in COPD and measurement of serum hs CRP for estimating severity of pulmonary hypertension is useful, cost efficient, easy and available.

Introduction: Addiction to opium is a social, economical, political, and cultural problem, and behavioral aspects can be an extreme financial burden for society. In this study, we evaluated all deaths due to opium abuse reported to Khorasan legal medicine center regarding demographic data, the type of drugs, the route of usage, laboratory and autopsy data.Materials and Methods: In this descriptive cross-sectional study the samples were the cadavers which were referred to Khorasan legal medicine center during 2 years from March 20, 2004 to March 20, 2006. Statistic analyses were performed by SPSS statistic software.Results: Most of the cases were men (93.4%). The most common age period was 21-30 years (36.3%), most of them were self-employed (24.6%) and with high school education (27%). Tattooing was significantly common (34.4%) and common fatal route of opiate abuse was IV injection (64.1%) with morphine (32.7%). The most common pathologic finding was pulmonary congestion (36.5%).Conclusion: In this 2 year survey, we tried to recognize those factors which are effective in addiction in order to reduce the death because of opium overdose in long terms.

Introduction: Electrical injuries currently remain a world-wide problem. Electrical burn injuries account for fewer than 5% of admissions (reported range 3-9%) to major burn centers. Electrical injuries are arbitrarily divided into high voltage (>1000 V), low voltage (<1000 V), lightening strikes, and electric arc. The aim of this study was to explorethe mechanisms, complications, morbidity, and mortality associated with electrical injuries.Material and Methods: This descriptive study was done from 2002 to 2006 in burn department of Imam Reza hospital of Mashhad. 132 patients with electrical injuries were admitted to the burn center. Collected data included: age, gender, etiology, burn size, hospital stay, amputation of limb and mortality. Data was gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables.Results: Of 5875 acute burn admissions during a 5-year period, 132 patients (2.4%) had electrical burn injuries. Their mean age was 26 years (range 2-63 years). Ninety-seven percent (128 patients) were male, and the extent of burn ranged from 1% to 80% TBSA (mean, 13.8% TBSA). High-voltage electricity caused 75.7% (100 patients) of the electrical injuries, 23.5% (31 patients) were caused by low-voltage currents and 0.75% (1 patient) by lightening. Twenty six patients (19.7%) required one or more amputations. Six patients (4.5%) died.Conclusion: Electrical burn injuries continue to be a serious problem of modern society. Climbing power poles is the most common mechanism for high-voltage injury. Special consideration is required to prevent this type of injury in our region.

Introduction: Although Laparoscopic Cholecystectomy (LC) is one of the most common elective surgeries, its indication in acute cholecystitis is controversial.Materials and Methods: This retrospective study is comprised of 182 patients with acute or chronic cholecystitis admitted at Ekbatan and Tamin Ejtamaiee hospitals and underwent laparoscopic cholecystectomy from March 2002 to September 2006. Patients were divided into two groups: 1- patients with acute cholecystitis and 2- patients with chronic cholecystitis on the basis of surgical and pathological findings. Patients were compared for laparoscopic cholecystectomy results, complications, duration of hospital stay, and factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy.Results: From 182 patients underwent LC, 39 (21.4%) were male and 143 (78.6%) were female. The mean age of patients was 49±15.9 years (17-85 year). The mean age of patients with acute cholecystitis who underwent LC was significantly lower than those with chronic cholecystitis (p<0.05). The conversion rates was significantly higher in the acute cholecystitis group (p<0.05). Adhesion was the main reason for conversion to open surgery which was found in 16 (72.7%) patients. The conversion rate was 13.6% for adhesion plus hydrops, 9% for edema and 4.5% for pancereatic head cancer.Conclusion: This study showed that LC is an appropriate safe method for treatment of cholecystitis and can be served as the method of choice and first line therapy for cholecystitis.

Introduction: Goltz syndrome (Focal Dermal Hypoplasia) is a rare syndrome results from developmental defects in tissues with meso-ectodermal origin such as skin, eyes, mouth and teeth, musculoskeletal and central nervous system.We report a 6 years old girl with FDH who had several features of skin, eyes and mouth involvement with multiple skeletal defects and absence of fibula which has not been reported previously.