MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2011 | Volume:54 | Issue:2|Papers Count:12

IntroductionPleural effusion is one of the most common and important complications in pulmonology. When the absorption of pleural fluid is less than its secretion, effusion happens and diagnosis between TB and malignant pleural fluid is important. C reactive protein with high sensivity (hsCRP) is secreted by tissue when inflammations is present. The aim of this study was hsCRP evaluation could help to differentiate between TB and malignant pleural effusion.Materials and Methods 100 patients with TB or Malignant pleural effusion who referred to Emam Reza hospital, Mashhad in 2009 underwent thoracocentesis; then hsCRP with photometry methods were analyzed. All data were analyzed by SPSS 11 and cutoff point for hsCRP with ROC curve was found.Result Mean age was 53.41 years±19.63 SD. Mean concentration of hsCRP was 9.53 (mg/lit) with SD 5.78 (mg/lit). hsCRP concentration in TB group was13.6±5.6 and in malignant pleural effusion group was 6.00±3.93 (mg/lit). They had significant different with statistical analysis (P<0.001). Sensitivty of hsCRP to differentiate between TB and malignancy with cutoff point of 8.35 (mg/lit) is 92% and specificity is 78%. They had significant different with statistical analysis (P<0.001).ConclusionhsCRP cloud help us to differentiate between TB and malignant pleural effusion.

IntroductionThe preferred type of access for chronic hemodialysis (HD) is an Arterio-Venous (A-V) Fistula. However most of the ESRD patients does not have a mature fistula at the time of starting HD due to late referral to the nephrologists so the managing physicians have to use temporary catheters with high rate of complications. Materials and MethodsIn a retrospective study we determined and compared the prevalence of temporary catheters or A-V Fistula use at the time of starting chronic HD from November 1995 to June 2009. We have divided our patients in three different groups. Group A: HD patients between 1995-2005, Group B: HD patients between 2006-2007, and Group C: HD patients after 2007. ResultsA total of 473 ESRD patients (288 male, 185 female; mean age, 55.8± 16.4 years) were included in the study. Causes of ESRD were HTN 34.1%, DM 20. 08%, glomeronephritis 9.72%, obstructive uropathy 8.46%, ADPKD 5.92%, and unknown 21.77%. Overall the prevalence of temporary catheters and A-V Fistula use were 86.5 and 13.5 percent. But the prevalence was different in the studied groups: group A (93.6% and 6.4%), in group B (85.0% and 15.0%) and in group C (67.5% and 29. 5%) respectively. There was a significant increase in A-V Fistula use after 2005 (p=0.00) and especially after 2007 (p=0.000).ConclusionAlthough there was a significant increment in the A-V Fistula use, it is not still enough and general physicians, nurses and chronic kidney disease patients have to be educated about the benefits of early A-V Fistula creation.

IntroductionPreeclampsia is a common complication of pregnancy with the prevalence of 2-7% which increases fetal-maternal mortality. Despite many researches in this field, the etiology of preeclampsia is still unknown and different theories are suggested. Recently the role of deficiency of trace elements is emphasized. Selenium is one of the trace elements which as an antioxidant play an important role in protection of endothelial cells of blood vessel with counterbalancing of oxygen free radicals. The aim of this study was to compare serum level of selenium in women with preeclampsia and normal pregnant women. Materials and MethodsThis cohort study was performed on 35 women with severe preeclampsia as case group and 30 normal pregnant women as control group in Emam Reza Hospital during 2007-2009. Two groups were matched in terms of maternal age, gestational age, and BMI. Serum level of selenium was measured by spectrophotometer with method of atomic absorption. Data was analyzed with SPSS software version 18 and T-student test. P≤0.05 was considered statistically significant. ResultsThe mean serum level of selenium was significantly decreased in preeclamptic women compared to the healthy pregnant women (P<0.05). In preeclampsia group, pregnancy outcomes were worse in women with lower selenium level. ConclusionThis study showed that severe preeclampsia is related with decreased concentration of selenium; early measurement of this element can be useful for early prediction of preeclampsia.

IntroductionChronic non-cancer pain has been considered as causes of Opium addiction in human beings. The knowledge of its incidence as an initial reason for Opium consumption among Opium addict people may affect a) addiction prevention plans, b) addiction treatment programmes and even 3) educational goals for training medical students. Therefore, this study aimed to determine this incidence among Opium addict people referred to an addiction treatment center. Materials and MethodsThis is a cross sectional study which was performed in Ahwaz during 2006-2008.First, a pilot study was carried out in which the study sample size was calculated. Participants were evaluated by physical examination, pain scaling via VAS, physical examination and psychological interview based on DSM4 criteria and SCL90 questionnaire. The obtained data were analyzed by descriptive analysis of SPSS and χ square test. ResultsFinally, 21 patients out of 224 participants were found to suffer from a type of chronic physical pain before Opium addiction. Psychological abnormalities were more frequent in pain suffered patients (p<0.007).ConclusionThere were some people who seek for getting rid of physical pain. But, they were deviating to a street drug abuse status. This issue should be considered in prevention and treatment of addiction.

IntroductionAnorectal myectomy and anal dilation under anesthesia could be an effective way in the treatment of patients with ultrashort_segment Hirschprung. In this article we studied the outcomes of anorectal myectomy.Materials and MethodsOur study group was 61 patients with the disease who had reffered to SHEIKH hospital from the second half of 1386 to the first half of 1388. Barium enema and anorectal myectomy was performed in all patient. Follow up after myectomy was in the second week after surgery and then monthly. For the complications and results, patients were also divided in to 3 groups based on the presence or absence of ganglion cell in the muscular resectal region, and the results were compared in each group.ResultsBleeding, infection of the operation zone, sepsis, entrocolitis, and anal stenosis was not observed in any patient after surgery. 4 patients had gas incontinence and 3 had fecal incontinence after surgery which was cured in 3-6 months with bio-feedback orders. 40 patients (87.5%) had complete remission after surgery and 2 (4.17%) had partial remission and 4 (8.33%) had no remission at all. Based on these results, there is no relation between gender, complications of surgery and the results of surgery. ConclusionAnorectal myectomy could be an effective treatment strategy for patients with following situations: absence of anatomical abnormalities-chronic constipation in spite of medical treatment-absence of transitional zone in barium enema-failure of anorectal reflex relaxation with rectal distention in anorectal manometry.

IntroductionObesity, a public health problem is growing in prevalence over the recent decade. One morbidity associated with obesity is cardiovascular disease (CVD) which is invariably related to dyslipidaemia. The purpose of the present study is to examine the effect of walking exercise in order to reduce the risk of (CVD) in sedentary obese girls.Materials and MethodsTwenty untrained obese (BMI>30) girls with age 22.00±1.50 years volunteer took place in this research and then they were randomly divided in two groups (Control: n=10 Experimental: n=10). At first and after 2 months HDL-c, LDL-c and BMI were assessed. Then the experimental group started to do exercise programme. The data by unpaired-t-test at the level of p<0.05 were analyzed.ResultsThe study finding showed that reduced BMI (p=0.001), LDL-c (p=0.006) significantly decreased but HDL-c (p=0.004) significantly increased in exercise group.ConclusionThis study demonstrated that a programme of regular physical activity such as walking exercise significantly can change the lipoprotein's metabolism in body and reduce the risk of (CVD) in obese girls.

IntroductionDue to life-threatening complication of LP in patients with deterioration of consciousness due to meningitis (=brain herniation) the LP procedure safety without brain CT scan is debated. Materials and MethodsThis descriptive cross-sectional study was done on patients suspected of meningitis with decreased consciousness referred to the infectious emergency of Emam Reza Hospital, Mashhad, Iran from April 2006 to March 2008. All patients underwent physical examination (neurologic and ophthalmoscopic) of the patients by residents of infectious diseases. Data (results of physical examination, neurologic, ophtalmoscopic, brain CT scan and LP) were collected. Then statistical analysis was performed with SPSS software and descriptive statistical methods. Results136 patients were evaluated. The mean age of patients was 43.88±21.185 years and 58.5% (24) of the cases were male. The result of brain CT was normal in 53.7%. The most frequent abnormal brain CT results were hypodencity lesions (12%). 2.4 % (1) of patients had abnormal CT-Scan with space occupying lesion with mass effect and midline shift, and final diagnosis was brain abscess due to chronic mastoiditis. ConclusionThis study showed that abnormal finding of brain CT-Scan in adult meningitis with loss of consciousness is approximately 50% and mass effect was seen in 2.4% of patients.

IntroductionPrevalence of ischemic heart diseases, especially acute myocardial infarction and its incidence in lower age has increased and treatment during the acute phase of myocardial infarction plays an important role in the prognosis and quality of life. In our study, we aimed to evaluate the effects of streptokinase on treatment of acute myocardial infarction based on different variables.Materials and MethodsIn our study, we evaluated patients with acute myocardial infarction who received streptokinase. Information obtained from patients based on patient examination, ECG findings (before and after drug administration) and the results of relevant laboratory tests, then entered in the relevant checklist. Criteria for response to drug were reduced chest pain with at least 50 percent reduction in ECG ST Elevation in electrocardiography taken 30 or 90 minutes after the Streptokinase therapyResultsRelation between age (P<0.001), LDL (0.001), diabetes mellitus (P=0.01), location of MI (P=0.001), Killip Class (P<0.001), patients referring delay (P<0.001) and the effect of streptokinase were significant. While gender, hypertension, smoking, previous ischemic heart disease, time of symptoms onset and type of streptokinase didn’t affect significantly the response to streptokinase.ConclusionConsidering our results, patients with acute MI less than 30 years and more than 80 years, diabetics, LDL more than 100mg/dl, extensive anterior MI, new LBBB, Killip Class 3 or 4 and delay of referring more than 12 hours predict poor response streptokinase, and may benefit more from early invasive strategy than thrombotic therapy.

IntroductionPrimary gastric Glomus tumour is rare and much less frequent than gastrointestinal stromal tumors(GIST). at least 150 of them have been reported in articles, but no one had been published in Iran. Case reportPatient was a 59 years old man with the chief complains of sense of epigastric fullness after meal. Endosonography showed a hypoechoic mass in muscularis mucosa with 29×14 mm dimentions. patient underwent wedge resection of gastric tumour. In microscopy, sheets and nodules of round to polyhedral uniform cells with bland round to oval nuclei in the background of branched hemangiopericytoma-like vascular stroma with hyalinised wall were seen. Smooth Muscle Actin, desmin, chromogranin and CD117 were determined immunohistochemicaly, the first marker was positive and the reminders were negative. ConclusionPrimary gastric Glomus tumour is essentially a benign neoplasm, in order to prevent unnecessary radical surgery, its differentiation from others malignant lesions is mandatory.