MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:45 | Issue:76|Papers Count:26

renal transplantation has now become a preferred treatment modality for patients with end stage renal disease. Accurate recognition and treatment of rejection is major concern in the early post transplant period. This study is carried out to evaluate success of transplantation based on some laboratory findings.The results show that creatinine in both groups were meaningfully decreased 48 hours after transplantation (P<0.006). However average serum concentration of creatinine 48 hours after transplantation in the rejected group compared with the group with successful transplant was higher from a statistical viewpoint (P<0.04).Uric acid evaluation in both groups showed that the uric acid level difference before transplantation and 48 hours after transplantation was not meaningful It was interesting that in the successful transplant group, the serum uric acid level showed considerable statistical decrease 48 hours after operation (P<0.0001) in comparison with preoperative level.In this study, the result related to BUN showed a pattern like uric acid. Although in the case of BUN there was considerable decrease 48 hours after transplantation in the successful group (P<0.0001).The average amount of serum BUN 48 hours after transplantation in the rejected group was considerably more than the successful transplant group (P<0.001). No meaningful difference was observed in ,the total Count of WBC between two groups. Interestingly, it was observed that the total number of leukocyte was not influenced by rejection while the percentage of neutrophil and the total number of neutrophils in mm3 of blood were influenced by rejection, On the other hand, we know that transplant rejection is an immunological activity and it is expected that the number and percentage of lymphocytes in circulation during transplant rejection to be increased.However surprisingly, in the rejected group, there was a meaningful decrease (P<0.006) in lymphocyte count 48 hours after transplantation. This may be because of the immunologic ally suppressive drugs. About monocytes, the number and percentage were not influenced by graft rejection.

T0 determine the frequency and characteristics of hyperuricemia and gout among cyclosporine - treated kidney transplant recipients.Two hundred surviving adult kidney transplant recipients with stable functional allograft after one year of transplantation were evaluated. Medical records were reviewed to determine serum uric acid level, creatinin, and dose of cydosporine at the beginning of hyperuricemia and to evaluate clinical pattern of gout in-patients.Hyperuricemia occurred in 10.5% of kidney transplant recipients in our transplant center (71.4 percent male and 28.5 percent female). The onset of hyperuricemia was 4.5 years after transplantation.Polyarticular arthritis and tophi developed in two (1%) of the post transplant – onset within a mean of 10 years.Both hyperuricemia and gouty arthritis occur among cyclosporine - treated kidney transplant recipients. Clinical pattern of gout in these patients may be different with idiopathic gout in nontransplant case. Management of these patients complicated by interaction with transplant-related medications and patient renal hypo function.

cryptosporidiosis is a zoonotic disease caused by small protozoa, belonging to the coccidial genous cryptosporidium. It is an extended worldwide disease, which can cause diarrhea in children. This parasite cannot be distinguished by the routine laboratory methods because of its tiny size and shape.This study has taken place in parasitology laboratory of Ghaem Hospital and Jihad Daneshgahi laboratory as well as the second one from June] 999 to Sep. 2000, on children under 1° years old who had mild or severe diarrhea, using modified Ziehl-Neelson staining method. Different parameters such as accommodation, parent's income and education, nutritional status of children, drinking water supply, contact with animals and number of family members were also considered.In this survey 235 kids including 108 girls (46% ); and 127 boys (54%) were studied, out of which only 4 stool samples (1.77%) showed Oocyst of parasite, 2 males & 2 females. The highest incidence of infection found in 5 to 6 years old kids. One of the girls showed also Giardia cysts in her stool.Three infected children were living in poor areas of the town, therefore, it seems that conditions of living, sanitation & customs of inhabitants are effective factors for infection, while there is no significant difference in males and females.Finally it is concluded that in children with gastrointestinal symptoms, besides of other entropathogens, we have to pay attention to cryptosporidiosis and ask for special method of stool examination.

A assessment of LASIK for correction of Refractive Errors.Perspective interventional noncomparative case series, 399 eyes (264 patients) with Myopia -Myopia & Astigmatism and! 7 eyes (10 patients) with Hyperopia were involved.all cases were operated with NIDEK EC- 5000 and Chiron Microkeratome. Reguler follow up was one at a day, a WK, a month. 3 months, 6 months and a Year.There were 166 male and 233 female in-group of myopia and myopia with astigmatism (Mean of sphericai Equivalent was-7.8+/-4.2 D), There were seven males and 10 females in-group of Hyperopia (MSE was +5.3+/- 1.3 D).After six months follow up, 99 eayes at mayopia group and 4 eyes at hyperopia group were available. In group of myopia and myopia with astigmatism MSE was -2.7+/-2.3 D and in-group of hyperopia MSE was +3.15+/-3.34 D. After 6 months in myopia group 66.44% wert; within +/-1 D have targeted SE and 88.7% have UCVA better than or equal to 20/40.After 3 months in hyperopia group 166% were within+/-1 D of emmetropia and 100% have UCVA better or equal to 20/40.The mean of regression after 6 months in myapia group was+0.76+/-1.21 and in hyperopia group as -2.3+/-0.64.LASIK is an effective and safe way for reducing the amount of myopia and myopia-astigmatism, but with current algorithm under correction is high. Because of insufficient follow up and low number participant we cannot give a definite conclusion about hyperopia.

To determine etiologic factors in 100 uveitic patients in Khorasan. This crosses - sectional study performed in 100 uveitic patients without uveitis due to trauma, Keratouveitis and endophthalmitis. Diagnosis of uveitis types was according to physical examinationand laboratory tests.Fifty-four patients (54%) were male and forty-six patients (46%) were female. The mean age was 33±16.2 years. Anterior uveitis made 58% of the patients, posterior uveitis 11%, and intermediate uveitis 8% and pan-uveitis 23%. Seventy-six patients had uveitis with unknown etiology.HLAB27 related uveitis was the most common known etiologic factor. 4.2% of patients had HTLV1 positive that dose not correlate with HTLV1 positive in the population of Khorasan. Four patients had uveitis due to T.B and five patients due to toxoplasmosis.The prevalence of uveitis with unknown etiologic factor of this research is similar to other studies. T.B and toxoplasmosis were the most common etiologic factors in the posterior uveitis and HLAB27 related uveitis in the anterior uveitis. Due to high prevalence of HTLV1 in Khorasan, the netiologic importance of it would be evaluated in other studies.

Chronic Rhinitis (CR) is a common disease of upper respiratory tract. The clinical signs are Rhinorrhea, nasal obstruction, sneezing and itching, which may lead patient refer to ORL clinics.CR may be due to non-allergic infectious and non-infectious or allergic etiologic agents. In order to study the etiologic agents and the value of Lab. techniques in diagnosis of CR, a prospective study was undertaken over a 14-month period on J00 patients suffering from CR referring Emam Reza Hospital.Clinical examination and Laboratory tests including cytology smear, Bacterial and fungal culture of the nasal discharge were performed for each patient.56% of the patients were female and 449'0were male. CR was common among the age group 10-19 years old.Rhinorrhea (97%), nasal blockage (87%), sneezing and itching (66%) were the common clinical SIgnS.Nonseasonal Permanent CR was observed in 54% of the patients and 46% had seasonal rhinitis. Personal and familial allergic history was specified in 42% and 24% of the patients respectively.Using cytologic smear of nasal discharges, neutrophilic inflammation in 43%, eosinophilic inflammation in 18% and combined inflammation in 18% of sample was diagnosed.Coagulase negative staphylococci (54%) and aspergillums SPP (18%) were the most common bacteria and fungi cultured respectively.The results confirmed that laboratory tests such as cytology smear and culture of nasal discharge are very helpful for precise diagnosis of chronic rhinitis and its related etiologic agents.

familial Hypophosphatemic Rickets (FHR) is the most common inherited form of rickets that presented with bowing of the lower extremities and delayed walking. Between 1996 and 2001 FHR diagnosed in 25 children in pediatric ward of Imam-Reza hospital (fifteen patients were females and ten patients were males). There were four families with more than one affected child.The mean ages at diagnosis were three years and nine month with rang of 13 months to 12-years. Growth retardation and distal bone thickening of the extremities were prominent features. In conclusion, although nutritional rickets is much more common than FHR in this countries, a high index of suspicion is necessary FHR is not to be missed or delayed, with grave consequences in terms of growth retardation and bone deformity.

There are several reports about the effects of postnatal Phenobarbital on intraventricular hemorrhage. This study is carried out to determine the effect of Phenobarbital on prevention of IVH in preterm infants.In NICU Ghaem Hospital all infants with a birth weight< 1500grams, gestational age< 34 weeks and with a postnatal age less than 12 hs who did not required mechanical ventilation enrolled and randomly assigned to Phenobarbital and control group.Infants in treated group received two loading dose of 10mg/kg/dose of Phenobarbital 12 hours appears, followed by a maintenance dose of 2.5mg/kg every 12 hours for 6 days. Serial brain sonographies were obtained on day 1-3, repeated between day 4-7, and between day 8 until discharge on all of infants.58 infants < 1500 grams and gestational age< 34 weeks randomly were divided Phenobarbital group (n=26) and control group (N=32). Ten infants (17.2%) developed IVH, which three (11.5%) patients were in Phenobarbital group and seven (21.9%) were in control group, this difference is not significant (p=0.248). There is also no difference in severity of IVH between two groups (p=0.476).This study showed no significant effect of Phenobarbital on prevention or severity of IVH and further studies are needed to recommend Phenobarbital for routine use.

The aim of this study was to investigate the cardiac manifestations in patients suffering from systemic lupuserythematous (SLE) and its correlation with renal involvement. Hematological and serological indices were also evaluated.Fifty-two patients with SLE criteria were studied. For statistical purposes, forty normal volunteers matched by age and sex, as "Control Group" was compared.Cardiac involvement was positive echocardiographically in 78.9 % of patients, compared with 20% of control group, but symptomatic cardiac involvement was present in only 45% suggesting that in SLE, heart involvement is common but usually aSYI1lptomatic.There was no statistically significant correlation between sex, age and duration of disease, with cardiac involvement.Our data showed that cardiac auscultation and EKG are commonly normal in-patients with echocardiography-proved 'cardiac involvement.Antiphospholipid Ab, PT/PTT abnormalities, positive VDRL and thrombocytopenia showed no significant correlation, and so did for serum complement, anti DNA antibody and LE cell.

salmonella organisms are gram negative bacilli that produce clinical syndrome like gastroenteritis and sever disease. Gastroenteritis is the most common clinical syndrome and is often referred to as Salmonella, food poisoning.The major vehicles of transmission salmonella are foods of animal origin; including eggs especially due to ingestion of raw or improperly cooked eggs. Therefore children should not eat raw or undercooked eggs. Infants after 6 months needs food supplement and egg is the important food to feed children because yolk egg easily digested and contain protein, vitamin D, and iron.This research has been done to investigate the contamination of salmonella in two kinds of eggs in different seasons of year. Experiments were done for salmonella cultures by samples were taken from shell- white and yolk of each egg. Cultures were done for 240 eggs (120 commercial- 120 local) and 30 eggs that well cooked and 30 undercooked.In general the contamination of eggs were observed in 5-6 per 1000 eggs cultured; one positive culture from shell and one positive culture from yolk (local). Salmonella and other organisms may contaminate eggs, therefore we must to avoid consumption of undercooked egg and washing shell, then boiling egg is the best prevention for contamination.

A nthracofibrosis is defined as bronchoscopic findings of bronchial stenos is or obliteration with black pigmentation on overlying mucosa.The aims of this study were to define the clinical characteristics of the patients with bronchoscopic features of Anthracofibrosis and to determine the relation between Anthracofibrosis with tuberculosis.We reviewed the records of 1118 patients who underwent fiberoptic bronchoscopy at Ghaem Hospital, Mashhad University of Medical Sciences from March 98 to February 2000.Anthrocofibrosis was diagnosed on the basis of bronchoscopic findings in 29 patients, 9 men and 20 women ranging in age from 52-90 years (mean 71 years). All of them proved to have tuberculous bronchial stenos is.The chief complaints of all patients were cough (29/29) with variable amount of sputum.Dyspneas on exertion seen in 15/29 while fever and constitutional symptoms were infrequent <25%). Anthrocofibrosis (24/529) most frequently involved the right upper lobe bronchus while combination of bronchi were involved and narrowed in 23 patients. In all patients tuberculosis was confirmed either by the presence of granulomatous inflammation in biopsy specimens (17/29) or positive smear and culture of bronchial washing for acid fast bacilli (15/29).Pathologic specimens obtained by bronchoscopic biopsy showed bronchial inflammation and fibrosis with interspersed anthracotic pigments.In conclusion: Tuberculous bronchial stenosis can cause anthracotic pigmentation in the mucosa and fibrosis of bronchi in response to infection. Detailed work up for the presence of tuberculosis should be performed in all patients with bronchoscopic findings of Anthracofibrosis in order to avoid unnecessary procedures.

We need an instrumentation system for obtaining fusion, ideal curve correction and minimal complication. This is a study of 24 cases of idiopathic scoliosis in the range of 14-23 years old since 1996 to 1998 undergo CD system operation in Shafa Yahyaian Hospital.This result is obtained: the rate of average curve correction was 75%. Curve correction was in all axises. The level of fusion was less than Harrington system, without any complication (e.g.: pseudoarthrosis, instrument failure). Postoperatively there was not need to body cast, intra operative blood loss was about 750 cc, and the operative time was about 5.5 hours, in comparison with references and other studies in this center and Harrington system. This method is preferred and ideal for treatment of idioscoliosis.

we determined whether intravesical bacillus callmete Guerin (BCG) is associated with variated level of prostate - specific- Antigen (P.S.A.).We treated 60 men with superficial bladder cancer that candidated intravesical immunotherapy with B.C.G. Clinical examination (DRE), blood samples for PSA and transrectal ultrasonography were obtained before and one, two and three months after BCG instillation. PSA level greater than four ng/cc was considered clinically significant. Each patient with PSA>4 or nodule in clinical examination or lesion in ultrasonography were candidated for biopsy.We observed elevated PSA in 19 men (30%) after B.C.G. therapy, of which 17 men (28.3%) had 2-fold elevated level. Overall average PSA increased 1.7 ng/cc (1.17 SD) before BCG instillation to 3.63ng/cc (2.76SD) one month after treatment and then decreased 2.09 ng/cc (0.89SD) three months after treatment (P<0.05). Histological examination of prostate in 13 patients has done (patient with PSA>4ng/cc or nodule) and results consiste of: 6(54%) Granolomatous prostatitis, 3(27.3%) BPH and 2 (18.2%) normal.Hypoecho lesion is the most common finding in sonography of Granolumatous prostatitis. There are significant relationships between ultrasonographic finding, PSA level and result of biopsy (P<0.05).Our findings indicate that intravesiacal B.C.G. therapy was associated with clinically significant increase in serum PSA in 30% of men.This effect is self - limited and PSA returns to normal level within 3 months after instillation. Most common lesion Of prostate after B.C.G. therapy is Granolomatous prostatitis.If the patient is candidate for biopsy we recommend delaying biopsy at least for 3 months while monitoring PSA.

Multiple-choice tests are the most popular objective tests utilized in medical schools. The aim of test analysis is to identify strength and weakness of tests. Since there is no evidence on assessing the validity and reliability of paper and pencil tests in the field of medicine, this study was conducted to analyze the multiple-choice tests used at Mashhad Medical School in 2002.In this descriptive study, we analyzed the data obtained from 24 multiple-choice question tests Mashhad Medical School. Investigating 1496 questions, difficulty and discriminative indexes were calculated for each question. We also measured the reliability and standard en-orof measurement for all the tests. The data analysis was done by SPSS software.The mean of tests reliability was 0.72±0.13 (min 0.4 &max 0.93). Concerning basic and clinical sciences The mean of the tests reliability was a calculated as 0.88±0.03 and 0.68±0.12 respectively.There was a significant difference between clinical and basic sciences fields (P=0.0001). The mean of standard errors of measurement was 3.51±1.11 (min 2.15 & max 5.78). For basic sciences field this parameter was measured as 2.8±0.4 and for the part of clinical sciences, it amounted to 3.1±1.1. There was also a significant difference between clinical and basic fields (P =0.0001). In 52.2% of cases, difficulty indexes of questions were unacceptable. On the other hand 7.6% of questions were absolutely difficult and 44.6% were extremely easy. The results also have revealed that 49.3% of the questions lacked the adequate discriminative ability to discern between poor and good the examinees. Overall, only one third of multiple-choice questions had difficulty and discriminative indexes in the appropriate areas.According to findings, improvement of test quality and evaluation process is necessary; so statistical results of test analysis should be applied for later tests.

Evaluation of scholastic achievements an important part of the educational process. Therefore assessment principles, methods and practices must be entirely compatible with education objectives.The previous studies have indicated that at most medical college’s evaluation methods are monotonous. These traditional methods are neither profitable nor appropriate to assess the clinical skills. Consequently this research was conducted to determine how medical students view current clinical evaluation methods at the internship stage in Mashad University in 2001.In this cross-sectional study, we analyzed the data obtained through filling in the questionnaire by 161 interns. The most popular tests include written (58.5%) and oral exams (18%). In 84.5% of cases the final test was held in conference hall and staffroom. The patients-bedside comprised4.9%.The evaluations of clinical skills through direct observation include 10.6% of the whole cases. On the other hand 91.3% of the interns stipulated that the quality of their performance were not considered at all or regarded to a tiny extent. Furthermore only 5% of interns stressed that a medical doctor's typical needs was adequately met by current methods. They also deemed the present evaluation as quite inappropriate (22.4%) since their final scores hardly reveal their gained professional competence (46.6%). One third of them emphasized on the dire need to revise and evolve the evaluation methods.Due to a strong and sensible relationship between evaluation and learning, and its important role to promote learning and assessment principles, methods and practices must be thoroughly compatible with educational objectives and should promote learning.

Kikuchi-Fujimoto's disease, also called histiocytic necrotizing lymphadenitis, is an exteremly rare self-limiting reactive process, which almost always present with cervical lymphadenopathy, occasionally associated with fever or skin rashes.Most patients are young adults predominantly females. Etiology is unknown although viruses or autoimmune disorders are suspected.Final diagnostic key is lymph node biopsy and histologic study. The pathogonomonic histopathologic feature is necrotic foci rich in karyorrhectic debris surrounded by immunoblasts, histiocytes and plasmacytoid monocytes, but lacking plasma cells, neutrophils and eosinophils. This disease is a benign process and most patients recover in one to four months without therapy.We report five histopathologically diagnosed cases of the disease and reviewing related literature.

Isolated Central Nervous System vasculitis Primary Angitis of the CNS (PACNS)is a rare condition that involve the CNS. ill fact it is a kind of vacuities, which is confined to the CNS, and there is not any evidence of extra- CNS involvement.The patient who is presented is a 39 years old woman who admitted in neurological emergency ward of Ghaem hospital with several neurological symptoms.Her brain imaging showed muitifocal brain hemorrhages frequently. Despite diagnostic evaluation, there wasn't any explanation for these hemorrhages: so streotaxic brain biopsy was done, and pathologic study of obtained specimen confirmed the CNS vasculitis. The patient treated with high dose Prednisisolone and fortunately she answered dramatically. Now the patient is well and he is only under medication with Anti Epileptic Drug for seizure control.

Cancer of colon and rectum is the most common cancer of adult gastrointestinal tract. Most cases of colorectal cancer are diagnosed in-patients over the age of fifty and the incidence of the disease rises steadily after that age.Between 6 and 8 percent of cases occur in individuals under fifty and rare in individual younger than 20 years of age. This is a report of rectal carcinoma in a 13-year-old girl.  

Previously healthy lO-year-old boy presented with a history of painful right-sided neck swelling and fever. Past medical history was unremarkable.His fever generally ranged between 39 and 40.2°c. Physical exam showed a painful, war mass -3 by 6cm and centered on the middle of the left anterior neck area. There was no history of angina, cough, sinusitis, weight loss, night sweat and exposure to tuberculosis patient. His pediatrician prescribed a 10-day course of erythromycin with suspicion of bacterial adenitis. In spite of finishing the course of antibiotic therapy the fever persisted and swelling remained unchanged.He had a cat at home. His grandfather living another city has proven tuberculosis and he is on TB drugs. A maternal aunt had toxoplasmosis with two repeated, abortions; his 15-year-old brother had chronic sinobronchitis.On admission and on physical examination he had fever (39.5 C) vital signs were normal. A tender big mass measuring 3x8cm was palpable with a warm and erythomatuos overlying skin. There was no other lymphadenitis and skin rash, no hepatosplenomegaly and no abnormal heart sound and rests of the physical exams were all normal.Lab exam revealed a WBC count 6.500/mm3 with 65% Neutrocytes 26% lymphocytes and 9% monocytes. ESR, were 70 mm/h, liver function tests; SGOT/400 Iu, SGPT1750 Iu, and bilirobine normal.Blood and urine culture sterile, PPD without any indurations and redness. P.A. chest, X-ray was normal.With diagnosis of bacterial adenitis, antibiotic started. In spite of initiation of erythromycin the patient remained febrile without any change in neck mass. So, febrile agglutination tests for toxoplasma gondii, standard tube agglutination test for brucella and widal test were non-reactive. Rhemotoid factor and serologic tests for EBV, and CMV, also were non-reactive. Ultrasonographic imaging of neck, revealed enlarged lymphadenitis.Eventually for confirmative diagnosis Symphnodebiopsy was done.

Human T lymphotropic virus type I (HTLV) , the first retrovirus detected in humans, is present throughout the world with small cluster of high endemicity located in areas where the virus is rare or absent.This highly restricted geographic seroprevalence is a remarkable feature of HTLVI Epidemiology. Highly endemic areas (seroprevalence higher than 2 percent) include regions located in south western islands of Japan, the Caribbean, South Africa, intertropical Africa, Iran and in Melanesia. It is estimated that between 15 -20 million people are infected worldwide, with about 2 to 10 % developing during their lifetime an HTLVI associated disease (ATL, HAM/TSP, uveitis, etc.). HTLVI has been the focus of many studies during the last two decades. In this article we aimed to overview the most recent advances in this field.

Excisionallymph node biopsy in macroscopic study showed a big lymph node with complete capsule.Inside of lymph node was a whitish-pink colour. In microscopic evaluation of lymph nodt massive necrosis with coagulation tracing were seen.Lymph node aspiration culture and smear were negative. No acid fast Bacilli were found. So thl preparation was compatible with Kikuchi disease.The pathology of Kikuchi disease is necrotizing lymphadenitis without presence of PMN am usually necrotic tissue are infiltrated with transformed T.lymphocytes. The etiology of Kikuchi disseat is not clearly. known. It may be a SLE like disease with characteristics of autoimmune disease.