MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2005 | Volume:48 | Issue:88|Papers Count:21

Introduction: Cardiovascular diseases especially coronary artery diseases are the first cause of death in Iran. Regarding to the diversity of risk factors in different geographical regions and different races, the authors decided to assess risk factors in patients undergoing coronary bypass surgery. Materials and Methods: In this case-control study, 100 patients undergoing coronary bypass surgery and 100 patient who did not need to coronary bypass surgery, were observed during Aban 1382- Azar 1383 at Javad-ul - Aemeh subspecialty hospital. Demographic, laboratory and angiographic data were gathered via interview and observation in a questionnaire and analyzed by statistical methods. Results: In case group, 76% of patients and 41% of patients in control group were male (p=0.001).The mean age in case group was 58.98+9.98 and in control group was 48.14+15.14. There was a significant difference between two groups (p=0.001). 50% of the case group and 24% of control group had hypertension (p=0.001). 33% of the case group and 14% of control group had a history of smoking. There was found a significant difference between them (p=0.001). The mean of FBS in the case group was 138.68+72/26 and in the control group 117.1+53.3 (p=0.023). The most of patients were employee in case group and in control group, most of had a business job (p= 0.004). Between the others such as LD/HDL, APOA1, APOB100, AOA1/APB100, urea, creatinine, blood group and Rh, there was not found a significant difference.Conclusion: Regarding the findings, presence more than one of 6 risk factors increase the risk of coronary bypass surgery in patients, prevention and control of the disease is necessary, because many of problems such as economical, social, physical and psychic issue could be prevented.

Introduction: some of the cardiovascular risk factors which have been identified include: Dyslipidemia, Diabetes mellitus, hypertension, Smoking, Insulin resistance, Abdominal obesity, Inflammation, Prothrombotic state. In many past studies, apolipoprotein B (apo B) was mentioned as the best marker of lipid profile. This is also approved that LDL-C is the major lipoprotein that produces atherosclerosis but comparison between apo Band LDL-C has rarely performed for prediction of cardiovascular events. The present study compares exclusively this issue, for the first time in Iran. On the other hand, it is known that metabolic syndrome is defined by the presence of three or more of abdominal obesity, hypertriglyceridemia, low HDL, hypertension, high fasting blood sugar. Because of high prevalence of metabolic syndrome in Iran and high prevalence of dyslipidemia in these patients, the present study performed within them. Material and Methods: 66 adult patients (above 20 years old) with metabolic syndrome were chosen between referred patients to endocrinology and cardiology clinics of Imam Reza hospital in Mashad. The following variables were studied: Blood pressure, Waist, Body Mass Index (BMI), Triglyceride, Cholesterol, Fasting blood sugar, HDL, LDL and apo B. The patients were divided into four groups upon high or normal levels of LDL and also high or normal levels of apo B. Then, the means of mentioned variables were compared in different groups and the correlations of apo B and LDL-C with other variables were also measured by statistical tests. Results: Among total 66 patients there were 11 men and 55 women in the range of 21-78 years old with the mean of 46.15±13.43.15% of the patients of this study had normal LDL but high apo B. The comparison of cardiovascular risk factors between this group and the high LDL, normal apo B group did not show any significant difference, except for cholesterol which its mean was higher in second group. The correlations of apo B with cholesterol, TG, HDL, LDL and FBS were significant (P<0.001) for cholesterol and P<0.05 for the others), But LDL-C correlated with cholesterol and waist only (P<0.0001 for cholesterol and P<0.05 for waist). Conclusions: Although, comparison between the two groups: with only high apo B and only high LDL did not show considerable significant difference but for the reason that apo B correlated with a wider array of cardiovascular risk factors, in comparison with LDL-C, it conclude, that apo B is a better predictor for cardiovascular events, generally. Patients with normal standard lipid profile but high apo B benefit from lipid lowering treatment. In conclusion, the measuring of apo B is suggested in addition to routine lipid profile tests, at least in metabolic syndrome patients.

Introduction: One of the fatal outcomes of hematologic cancers is bone marrow suppression & consequently the occurrence of fever & neutropenia. Even if the source of fever is unknown, according to the high risk of mortality during fever & neutropenia due to malignancy, empiric antibiotic therapy is unevitable. In this way, research for providing the best antibiotical regimen (according to different epidemiologies of microbial flora between countries, cities, hospitals & even various departments of it, beside the variations in races & genetics of world's population) by comparative study of 4 antibiotical regimens is the main goal of this research. Material and Methods: An interventional prospective study from September 2003 to October 2004 in departments of hematology-Oncology, infectious diseases & internal medicine emergencies, was performed on 103 cases who had hematologic cancers, fever, neutropenia (PMN<500) & without known source of infection. For these patients, antibiotical regimens of Ceftazidime + Amikacin (regimen No.1), Ciprofloxacin + Ceftriaxone (regimen No.2), Imipenem (regimen No.3) & Ceftazidime (regimen No.4) were used by systemic randomized sampling. Interruption or decline of fever beside the hemodynamic stability of patients in the first 72 hours of therapy with each of the regimens were the criteria of treatment's effectiveness & drugs' side effects were evaluated simultaneously. The information was collected by using of questionnaire & statistical analysis was performed by Chi- Square test according to SPSS. Results: Of 103 Patients who were studied, randomly 34 cases were treated with regimen NO.1 (20 positive responses & 14 negative), 27 0ases with regimen NO.2 (9 positive & 18 negative), 17 cases with regimen NO.3 (12 positive & 5 negative) & 25 cases with regimenNo.4 (16 positive & 9 negative). According to statistical analysis results regimen NO.2 in comparison to other regimens has a statistical meaningful difference, but other regimens, although has a superiority to regimen No.2, do not have any preference to each other. On the other hand ,there were only 11 cases of drug's adverse reactions in this study that are not analyzable(by statistics).Conclusion: In the epidemiologic status of Iran (& specially Mashad), similar to other parts of the world, the best treatment of fever & neutropenia without significant source of infection due to hematologic malignancies in high risk patients, is the usage of broad spectrum beta- lactam antibiotics with suitable coverage against gram negative bacteria, specially Pseudomonas. The usage of oral antibiotics (Ciprofloxacin) is not enough & reliable. On the other hand, treatment with combination regimens (Ceftazidime + Amikacin) or expensive drugs (Impienem) has no preference from the non expensive & simple ones (Ceftazidime). Correct monotherapy with Ceftazidime not only reduces the side effects of combination regimens, but also is cost - benefit for patients & provides this possibility for greater number of patients to benefit from the usual facilities.

Introduction: Penicillin has been the choice for treatment of Streptococcus pneumonia infections for a long time, but there are many studies that suggest resistance to penicillin. Penicillin resistance pattern varies in different populations and determination of this pattern is necessary for choosing appropriate antibiotic. MIC determination is the best method for evaluation of antibiotics resistance. Material and Methods: Total 54 strains of Streptococcus pneumonia isolated from inpatients of Imam Reza and Ghaem hospital during one year (2003 - 2004) were included in this surveillance. This research is a descriptive study to evaluate the Penicillin MIC in Streptococcus pneumonia, using E. test (Episilometery Test). Results: Using E.test, 4 patients (7.4%) had Penicillin resistant pneumococci, 34 patients (62.9%) had intermediately resistant pneumococci and 16 patients (29.6 %) had Penicillin sensitive pneumococci.Conclusion: It seems that the most important etiology of Penicillin resistance is incorrect antibiotic prescription and usage. According to this study penicillin should not be used for treatment of some high-risk Pneumococcal infections, such as meningitis.

Introduction: Staphylococcus aureus is a common pathogen in community-acquired and nosocomial infections, and inappropriate use of antibiotics during recent decades resulted in spreading MRSA isolates. According to some studies 60% of its hospital acquired staphylococcal infections were reported to be resistant to meticillin. The aim of present study was to determine the prevalence of MRSA among clinical isolates in Imam Reza General Hospital of Mashhad. Material and Methods: In present article we performed E-test and disk diffusion methods to determine the prevalence of MRSA among 115 isolates obtained from different units in Imam Reza general hospital of Mashad. Results: The results show that 69 isolates (60%) were nosocomial and 46 (40%) was community acquired. MRSA was the ethiologic agents in 75.4% of nosocomial infections, while most of community acquired infections (93.3%) were sensitive to methicillin. Almost all of the isolates obtained from bum unit (30 isolates) were MRSA. All of the isolates were vancomycin sensitive but penicillin resistant by disk diffusion method. From 33 isolates which were resistant to methicillin by E-test, 9 (27.3%) reported sensitive by Oxacillin disk; hence its usefulness for practical means remains doubtful.Conclusion: If our results would be confirmed by future studies, it seems that MRSA has a very high prevalence in Iran, whose control and eradication demands a very solid and subtle program.

Introduction: Direct antimicrobial susceptibility testing (DST) of urine specimen is very favorable because of its time saving property. This study was designed to evaluate the performance and accuracy of DST in urinary tract infection in comparison with standard antimicrobial susceptibility test. Material and Methods: We performed D.S.T using eight recommended antibiotic on urine specimen from 150 pregnant women with suspected UTI and compared the results with the result of standardized disc diffusion susceptibility tests done on the same specimen. Results: Direct tests were acceptable for 94% of specimen with UTIs which is caused with one bacterium. Errors were more common in low bacterial and mixed UTI in direct test. Conclusion: Direct antimicrobial susceptibility testing (DST), for urine specimen, offers efficient, rapid and accurate results when were use selectively and interpreted carefully.    

Introduction: Background: Widespread Alopecia Areata (AA) is difficult to treat and modalities such as topical and systemic steroids, topical sensitizers (e.g. squaric acid dibuty lester and diphencyprone), psoralen-ultraviolet A (PUVA) therapy, minoxidil, and Immunomodulators have been tried. Material and Methods: Patients with widespread AA (> 40% scalp involvement), including Alopesia Totalis (AT) and universalis (AU) were treated with 300 mg oral prednisolone pulsed at month intervals, for a minimum of 4 doses or until cosmetically acceptable hair growth was obtained. Response to therapy was monitored by clinical assessment and patients were examined monthly for sideffects of steroids. Result: Seventeen patients (12 men, 5 women) with a mean age of 23.8 years (11-50 years) were recruited. They had alopecia for a mean period of 5.5 years (1-16y).10 patients (4AA, 1AT, 5AD) received 300mg pulse therapy at least for 4 months. 2 (20%) patients (2AU) out of 10 evaluated treated, showed cosmetically acceptable hair growth, response was evident on average after 3months and cosmetically acceptable at 5 months. Side effects were surprisingly rare and mild. Conclusions: An oral monthly pulse of prednisolone 300 mg is safe and can be administered on an out patient basis. Although good efficacy of oral pulse therapy in the treatment of extensive AA previously has been reported, but the result of our study was not as effective as their, and there is requirement for more studies especially in selective patients.

Introduction: Androgenetic alopecia (AGA) is one of the most common dermatologic disorders with a multifactorial etiology.Inflammatory activators such as Demodex infection may play a role in pathogenesis of some cases of androgenetic alopecia that do not respond to common treatments such as Minoxidil and finasteride. The goal of this study is to evaluate the relationship between Demodex infestation and AGA. Material and method: In this case -control study, 41 patients with AGA referred to dermatology clinics of Imam Reza Hospital, and 33 healthy individuals as control were evaluated. All of them were between 20-40 years old men. In order to identify Demodex infestation they were referred to lmam Reza Parasitology lab. Results: Demodex was detected in 19.5% of patients and 15.2% of controls, so there was no significant relationship between them, statistically.Most of patients (85.4%) had greasy hair. The most common pattern of baldness was II degree in Hamilton scale. Conclusion: There is no relation between AGA and Demodex.

Introduction: This descriptive study was performed between 1997 and 2003 in pediatric nephrology clinic of Ghaem hospital (IRAN) Standard voiding cystourethrography and direct radionuclide cystography were done in 23 patients with urinary tract infection and hydronephrosis. Personal data, past history, underlying problems and radiographic results were collected in a questionnaire. The data were analyzed by descriptive statistical methods. Material and Methods: Twenty three patients with high suspicion to VUR but with normal cystogram (14 standard VCUG, 9DRNC) were subjected to cystography different from the previous one. Results: VUR was showed in 6 and 3 cases (totally 9 cases) respectively. Conclusion: Combining standard VCUG with DRNC in selected patients may enhance the predictive value for diagnosis of VUR higher than one of them alone.

Introduction: According WHO reports, Iran is recognized as important foci for Leishmaniesis in the world. This disease caused by different species of leishmania and identification of these species is useful for control and prevention of the disease. The phenotypic characters of causative organisms are similar, also epidemiological and clinical evidences alone, can not account for the differentiation of species. Molecular techniques, most notably isoenzym electrophoresis, have revolutionized the identification of this parasite. Material and Methods: This description study in 1378 - 1379 was done in Mashhad indispite Mashhad had been considered as foci of L. tropica, but recently rural forms also have been reported. Then, we decide to identify the leishmania species in Mashhad. For the first time, to obtain precise data on leishmania species indigenous to the city of Mashhad, 18 stocks isolated from the sores of patients suffering from CL from south- west part of the city, were compared between themselves and with reference strains of L. tropica and .L. mojor. The comparison was made by examination of the electrophoresis pattern of 6 enzymes; GPI. MDH, G6PD, PGM, NH1, NH2 using polyacrylamide gel electrophoresis.Results: The isolates from cutaneous lesions fell clearly in one group.Conclusion: They all gave isoenzyme patterns identical to those of reference strains of L. major. Then against previously in had been taught, not only L. tropica but also L. major specially in Outskirts of city is responsible for cutaneous leshmaniasis in Mashhad.

Introduction: Subarachnoid hemorrhage (SAH) is the most common presentation of spontaneous rupture of cerebral aneurysms but in some cases the only manifestation of cerebral aneurysm rupture is either intraventricular hemorrhage or intracerebral hemorrhage (with or without SAH). In this study different prognostic factors are discussed. Material and Methods: During a 7 year period, 100 patients with cerebral aneurysms were evaluated retrospectively and the results were analyzed in this article. Results: The sex ration was 3/2 with a female predominance: (62% female and 39% male), median age was 45 years, and the average Glascow Coma Scale (GCS) at admission was 12.4. Forty-two percent of the patients had hypertension; 9% were opium addicted and 11% had diabetes mellitus. Average Hunt and Hess grade was 2.8. Most of patients had delayed operation. 17% of the patients had rebleeding and 18% had vasospasm. The results of operations were excellent in 61%, good in 22% with 5% falling bad results and 7% dead. Conclusion: The incidence of SAH is not uncommon in Iran. In order to prevent complications and reduce the risk factors in the patients with SAH rapid diagnosis and appropriated management (medical or surgical) should be done.

Introduction: Pathologic myopia, as a leading cause of blindness, produces significant vitreoretinal degenerative changes. Knowing the extent of the problem in any region will help to stabilize appropriate preventive measures. Material and Methods: 100 eyes of 50 myopic patients (28 females and 22 males) with an average age of 27.14 years and myopia of -12 diopteres were examined in ophthalmology clinic, Emam Reza General Hospital, Mashhad University of Medical Sinences. Results: Observed in eighty-four percent of patients, Chorioretinal degenerative changes were the most common, followed by vitreoretinaal detachments (27%), decreased or lossed macular reflex (23%), posterior pole staphyloma (21%), temporac crescent (14%), vitreous syneresis (14%), Fuch's spots (7%), and Lacquer cracks (5%). There was a statistically significant correlation between retinal detachment and age, posterior pole staphyloma and age, posterior pole staphyloma and severity of myopia, and poor macular reflex and severity of myopia (all p<0.05).Conclusion: The study demonstrated a wide range of posterior segment pathologies in our patients. The results are comparable to that of previous studies elsewhere. It insists once more the importance of educating the patients about proper protective measures.

Introduction: This study evaluates surgery and decortication in children with empyema following pneumonia. Material and Methods: This descriptive study was performed in 1991-2001 in Imam Reza hospital. 31 patients with empyema following pneumonia admitted and treated in pediatric and surgical wards. Various methods of treatment and related factors evaluated. These methods include antibiotic therapy, thoracocentesis, chest tube insertion, open surgery with decortication. Patient response evaluated with improvement in general condition and clinically. Pleural thickening in CT per se doesn't need additional treatment. Fibrinolytic drugs such as streptokinase and urokinase didn't used. Results: The patients divided in two groups. Group 1 includes 23 patients and had response to antibiotics and chest tube drainage of pleural cavity. Group 2 includes 8 patients that need to decortication. 3 patients undergo pneumonectomy due to lung abscess. Delay in pleural cavity drainage with chest tube in group 2 was 18 days and in group 1 was 5/4 days. All patients in group 2 had response to surgery.Conclusions: Empyema following pneumonia in children responses to early antibiotic therapy and pleural cavity drainage and seldom need to surgery. Deciding to surgery and decortication based on clinical especially infectious findings and pleural thickening in CT scan per se doesn't need surgery.

A 24 year-old male student with a chronic HBV healthy carrier history: came to a private clinic, because of dark urine, yellow sclera, nausea, loss of appetite and a painful liver when it was palpated by the physician. The patient had fever since a week ago. In pharyngeal examination, exudative amigdalitis with edema and red tissue infiltration was found. In liver examination, it was felt, two centimeter below the ribs, and spleen at left side was palpable. Giant lymphnodes were seen in both sides of neck, but on no other sites. Maculopapular exanthemas were present on the skin of chest and anterior portion of neck. The patient complained of abdominal dis-comfort, myalgia and mild weakness but no arthralgia. He had mild dizziness and on third day of his fever, he noticed that his urine was dark brown colour and the day after, urine discolauration, he awoke with yellow discolouration of his eyes and skin. Because of history of HBsAg chronic, carriery he had taken some herbal supplements and had swallowed several alive river fishes. His pulse was 98 beats per minute with blood pressure of 120/70 mm Hg. His respiratory rate was 22 beats perminute. An early systolic murmur was present at the right upper sternal border. On auscultation his lungs were normal. The remainder of his physical examination was normal. The white cell count was 13, 250 per cubic millimeter, platelet count175000 per cubic millimeter. The hemoglobulin 9.5 g per decilitre, the reticulocyte count was 1.5 percent. The total Bilirubine level was 8.5 mg per decilitre, ALT 450, SLT 400, LDH level 190 (normal up-to 180). Urine test was negative for blood. Viral serological tests for hepatitis A, C and D were negative, HBeAg was negative, HBeAb and total anti HBC antibodies tests were positive. The activity of G6PD was normal. HDV infection, particularly super infection, is associated with a risk of acute hepatitis. The differentiation between acute and chronic HDV infection is typically made by serologic markers including the presence or absence of IgM, anti HBC and IgM or IgG antibodies to HDV. In this patient with an old history of chronic carrier of HBV and an acute form of paranchymal hepatitis, super infection of HDV infection was suspected, but it was negative by performing of HDV antibody. A peripheral blood smear for morphology of WBC was done and then a diagnostic procedure was performed.

 introduction: Crimean-Congo hemorrhagic fever (CCHF), an acute viral disease in humans, is characterized by extensive ecchymoses, bleeding, and hepatic dysfunction and is associated with a 30% case-fatality ratio. We describe the clinical, and laboratory findings and the role of supportive and antiviral therapy for 2 patients who received a diagnosis of Crimean- Congo hemorrhagic fever (CCHF). The patients had immunoglobulin M antibodies results positive for CCHF virus in blood. One of the patients was considered to have severe case of CCHF with clinical picture of fever, headache, abdominal pain, myalgia, drowsiness, epistaxis, hematemesis, and hepatitis. One of the patients was given ribavirin, and both survived. Conclusion: We suggest using ribavirin to treat patients, particularly those with severe cases. 

Introduction: Metaplastic carcinoma is a rare form of breast carcinoma that has Carcinomatous and sarcomatous parts. This malignant tumor often manifest as an irregular, rapidly growing mass in breast and diagnosis of this neoplasm may be difficult to distinguish hiostologically from the other spindle cell lesions in the breast. Metaplastic carcinoma have poor prognosis as compared to the other type of breast carcinoma. The purpose of this report is presenting rare cases of metaplastic breast carcinoma as the cause of malignant breast mass and diagnosis of this neoplasm. In this report we describe two cases of metaplastic of breast in 46 and 40 years old females that after clinical and histopathologic survey confirmed by immunohistochemical method and cytokeratin Antibody. Conclusion: According to unusual morphologic appearance of metaplastic carcinoma of breast, this malignant tumor noticed in differential diagnosis of all breast tumor with spindle cell and confirmed by immunohistochemical method.

Introduction: Crimean-Congo hemorrhagic fever (CCHF), an acute viral disease in humans, is characterized by extensive ecchymoses, bleeding, and hepatic dysfunction and is associated with a 30% case-fatality ratio. We describe the clinical, and laboratory findings and the role of supportive and antiviral therapy for 2 patients who received a diagnosis of Crimean-Congo hemorrhagic fever (CCHF).The patients had immunoglobulin M antibodies results positive for CCHF virus in blood. One of the patients was considered to have severe case of CCHF with clinical picture of fever, headache, abdominal pain, myalgia, drowsiness, epistaxis, hematemesis, and hepatitis. One of the patients was given ribavirin, and both survived.Conclusion: We suggest using ribavirin to treat patients, particularly those with severe cases.

Peripheral blood smear and CBC revealed leukocytosis (15, 500), an absolute lymphocytosis (80%) and an increase in the number of atypical lymphocytes. The most striking finding of peripheral film was Downey cells, a large mononuclear cell with eccenteric nucleus. Atypical lymocytes represented 12% of WBCs. These finding strongly suggest Infectious Mononuleosis, but it should be kept in mind that atypical lymphocytes may also occur in other diseases, like CMV infection, toxoplasmosis, Bacterial endocarditis, streptococcal infections and hypersensitivity states.Both relative and absolute neutropenia often develop early in the course of Inf Mononucleosis. Toxic granules and Dohle bodies may also be present.So the definitive diagnosis of Inf Mononucleosis is established by EBV-Specific serology. Recovery of the virus does not distinguish between current and past infections. In those cases where Inf Mononucleosis produces clinically apparent disease, aditional tests such as Hetrophil antibodies titer and WBC count and differential, find a place in diagnosis. So hetrophil antibody test (Paul-Bunnell) was done and it was positive.Recent advances in immunology have permitted the application of latex agglutination, RIA and Elisa assay to detection of the hetrophil response.Aplastic anemia is the most serious hematologic complication of Inf Mononucleosis. Less serious but more common than paneytophenia is the occurrence of hemolytic anemia affecting 0.5% to 3% of the patients with Infect Mononucleosis. Almost all episodes of hemolysis resolve spontaneously.Thrombocytopenia and platelet function abnormalities have also been described in Inf mononucleosis. Abnormal platelet aggregation and release of PLT factors have been reported. Dermatological manifestation occurs between 5%-10%, administration of antibiotic agents and appearance of a Maculopapular rask is a common complication of antibiotic therapy in IM, especially who receive ampicillin or penicillin. Exudative pharyngeal infection may be the result of streptococal infection. Neurologic complication occurring with EBV infection include: encephalitis, Meningitis, optic neuritis Guillian Barre' synd, SSPE, depression and psychosis. Depression occurs quite frequently in some patients objects appear distorted and change in size that is called "Alice in wonder -land syndrome".This patient received corticosteroid and after that acute symptom relieved. Routine administration of steroids in all cases to engender unnecessary risk. Additional therapies include INF-2, Metronidzole, Tinidazole, Acyclovir and There agents decrease anaerobic flora in the throat. Clinical controlled trials have not demonstrated any benefit in Acyclovir therapy.