Journal of Advances in Medical and Biomedical Research
Year:2002 | Volume:10 | Issue:41|Papers Count:12

Background: Surgical evacuation has been used as a standard treatment procedure for missed abortion, but it is an invasive technique. So medical treatments have been introduced for this problem using vaginal Misoprostol tablets. In this study we tried to evaluate misoprostol theraputic effects in patients with missed abortion, admitted in Mirza koochak Khan Hospital (2000-2001) in Tehran. Materials and Methods: In this quasi experimental study 60 patients with missed abortion were selected by simple sampling and were divided into two groups: 30 patients with amenorrhea <13 weeks and 30 patients with amenorrhea 13 weeks. 200 mcg vaginal Misoprostol was applied to posterior fornix and this was repeated every 4 hours for maximum of four doses until complete expulsion of products of conception happened. Effects and side effects of these tablets were evaluated in all patients and compared in two groups. All data were analysed using t-test and chi-square tests.Results: 40 women experienced complete abortion (63% in group 1 and 16.7% in group 2) (P<0.0001). The frequency of profuse bleeding and administration of oxytocin for control of bleeding in the group 2 (with more prolonged amenorrhea) was more than group 1 (P<0.05). Other complications including fever, diarrhea, nausea and pain appeared to be similar in two groups. Background parameters such as age, number of taken pills, and the time spent for abortion were also similar in two groups. Patients in group 2 had a higher number of pregnancies and deliveries in their history.Conclusion: Vaginal Misoprostol could be effective in the management of missed abortion specifically in patients who have had amenorrhea for less than 13 weeks. According to non-invasiveness of this method and low costs, it is recommended for missed abortions (<13 weeks) as the first - line treatment.

Background: Regarding to high prevalence of diabetes mellitus among Iranian Muslims, and due to the importance of metabolic control in these patients and existence of some vague and contraversial information about the effect of fasting in diabetic patients, this study was designed to detect the effect of Ramadan fasting on some metabolic indices in diabetic patients. Materials and methods: This is a quasi-experimental study. All of the patients with type 2 diabetes who wished to keep fasting in Ramadan were selected 3 days before Ramadan .All of the patients were on oral hypoglycemic agents. Their height, weight, body mass index, systolic and diastolic blood pressure, fasting and 2 hour post prandial serum glucose, serum cholesterol, LDL and HDL cholesterol, triglyceride, insulin, creatinin and hemoglobin A1c were measured. At the end of Ramadan the patients were visited again. All of the patients with less than 20 sequential days of fasting were excluded from the study. Changes in the above markers were analysed by paired t-test and sign-test. Results: The survey was carried out on 40 patients (24 females and 16 males). A significant statistical reduction in weight, body mass index, serum cholesterol, creatinine and also in serum insulin was observed at the end of the study (P<0.05). There was a significant elevation in the level of fasting blood sugar but, there was no change in the level of HbA1c and 2 hour post prandial blood sugar. Total cholestrol level was reduced after Ramadan but, no significant changes was observed in the level of HDL, LDL cholestrol and triglyceride. The changes in systolic and diastolic blood pressure were not significant, either. There were no complications such as hypoglycemia in our patients during fasting.Conclusion: Ramadan fasting not only is not harmful for type 2 diabetes mellitus but also is useful for fat diabetic patients. Further studies with more patients specially patients taking insulin is recommended.

Introduction: Regarding to the side effects of muscle relaxants specially non - depolarizing agents, this study was done to determine the protective effect of alcohol on muscle paralysis induced by atracorium in preparation of isolated chicken biventer cervices muscle.Materials and methods: This experimental study was performed on two groups of chicken biventer cervices muscle. In each group, 6 chickens were recruited. After inserting the muscles in organ bath containing Tirod physiologic solution and oxygen at 37°c, atracorium was introduced to the first group. A combination of alcohol and atracorium was added to the second group. Percent of muscle paralysis and duration of contraction in each group was then registered. Student t-test was performed for analysis of the data.Results: Percent of muscle paralysis followed by atracorium introduction in chick biventer cervices muscle was decreased in the presence of ethanol (p<0.01). Duration of paralysis was decreased also in the group receiving ethanol compared with the group receiving atracorium alone (p<0.01). Conclusion: Results suggested that ethanol with possible presynaptic and postsynaptic effects can protect the muscle against the paralysis induced by atracorium.

Background: Estimation of the size of enlarged non-gravid uterus comparing with gravid uterine size by means of bimanual examination is important for therapeutic planning in these patients. This study was designed to compare the size of uterus by bimanual examination and ultrasonographic methods in patients with enlarged non-gravid uterus in Shohadae Tajrish Hospital (2000).Materials and Methods: In this correlational type survey 49 candidate patients for abdominal hysterectomy were selected by simple sampling and uterine size was evaluated by bimanual examination. The uterine size was evaluated again by ultrasonography for all the patients. After hysterectomy uterine size was recorded in the operating room. Results were analysed using Pearson's correlation coefficient and linear regression formula.Results: Patients were 35-56 years old (Mean 45.3 ± 5.4 y). A significant correlation existed between uterine length and width using bimanual examination and ultrasonography (r=0.71, P<0.0001). Also considering fundal height only, equation as: Uterine size = 0.865×L was obtained. Also true uterine size (post hysterectomy) had a significant correlation with ultrasonographic uterine length (r= 0.7, P<0.0001).Conclusion: There is a significant correlation between estimation of uterine size by bimanual examination and ultrasonography. In patients with problematic bimanual exam, ultrasound can be used for estimation of uterine size could estimate uterine size according to the gestational age.

Background: Health services' cost is a determinant factor in policy making and strategy formulating. Activity- based costing (ABC) is a new costing method that was used in this study to analyse the costs of health services in Zanjan district in the financial year 1999-2000. Materials and Methods: In this descriptive study primarily all of Zanjan DHS`s processes were identified and categorized in four levels, including: organization supporting level, health program supporting level, homogenous health activities supporting level and health services performing level. The financial informations of Zanjan DHS was recorded by a standard software. In order to calculate the cost of each service, data related to the frequency of performed service and average time spent for service performance were collected. Then, the cost of each identified process was calculated and classified based on the above mentioned levels. Finally, the cost of each service was calculated by tracing it from the related three sustained activity levels and adding direct resources expenses to it. Results: The most and least expensive services were assessed to be visiting industrial factories and physical examination of urban students. At the organization supporting level the most expensive service was issuing the staff papers and the cheapest service was issuing the official missions documents. Drug educational process related programs and the disease planning were the most expensive and cheapest services at the level of health program support respectively. At the last level, industrial health activities and repaired maintenance were the most expensive services in contrast to drug related subjects and housekeeping which appeared to be the cheapest services.Conclusion: With the exception of unit level costs, the costs in other levels of services were considered to be overheads. Regarding the ability of ABC method to separate the types of costs, it is possible to increase the productivity of health services by this method. Applying of ABC in health services pricing is recommended.

Background: Hepatitis A is an enterically transmitted disease that still remains endemic in many developing countries. In some countries improvements in living conditions have recently led to changes in epidemiology of hepatitis A virus (HAV) infection. This study was performed to determine the serologic frequency of hepatitis A infection among children visited in pediatric hospitals of Tehran, in 2002. Materials and Methods: The study group included 1018 children. These children were visited in four major pediatric hospitals of Tehran. The children were divided into three age groups. Groups 1 (6 months - 4.9 years; n=469), Group 2 (5.0-9.9 years; n=290), and Group 3 (10.0-14.9 years; n=259). The level of serum anti-HAV IgG was measured by commercial ELISA kits in all samples. The data were analysed with chi- square test. Results: In all subjects, serologic frequency of hepatitis A was 22.3% (95% CI: 19.7 - 24.9%). There was no significant difference between boys and girls regarding their seropositivity for HAV (22.2% versus 22.5%). The frequency of hepatitis A infection was not different between three age groups (21.1% group 1, 21% group 2 and 25.9% group 3).Conclusions: Epidemiology of hepatitis A has been changed at least in some urban areas in Iran. For prevention of sudden epidemies of hepatitis A due to neighboring of highly contaminated areas, some changes in prophylaxis and immunization methods against hepatitis A are recommended.

Background: Musculoskeletal disorders originating from inappropriate occupational postures are one of the most important occupational problems, which cause inability to work and early resignation. According to the importance of identification of inappropriate work related postures, this study was performed to assess ergonomic situations of workers of Pars Switch factory working in assembly and production halls by OWAS method in 2001.Materials and Methods: In order to perform this descriptive study all of the working posts of assembly and production halls of the factory which included 14 working posts were selected as samples and assessed by means of OWAS (with its high validity and reliability). A total of 886 postures were registered and using OWAS software the data were analysed. Results: Evaluations revealed that working post of HL at assembly hall gained the highest percent of abnormal work postures (67.7%). Also 3.7% of all inappropriate postures are included in the work phase of handing the screws.Conclusion: Standing posture was the most important ergonomic problem in this factory. Performance of further studies in order to prevent inappropriate postures is recommended.

Background: Water is an important transmitter of pathogenic agents. So drinking water must be refined and disinfected. Due to the importance of the subject and in order to evaluate the quality of drinking water this study was performed in Zanjan during year 2000.Materials and Methods: In this descriptive study, microbial indicators and chlorination quality of water were determined to ensure the quality according to WHO recommendations. Sample numbers were estimated based on one sample per 10000 population plus 10 additional samples. Samples were examined for coliforms by 5 tube fermentation method. Residual chlorine was estimated using Di-ethyl-P-phenylene d-amine by colorimetric method.Results: Microbial examination in presumptive and confirmatory stages revealed a desirable quality in %95 and 98% of sample respectively. Also the amount of residual chlorine among all of the collorimetric subjects were as the following: 0.5-0.8 mg/lit (Standard amounts) in 75-78% of samples, Zero in 1.85% and <0.5 mg/l or >0.8 mg/l in 12.4% of samples. Turbidity and PH were also measured and appeared to be in the standard ranges. Conclusion: Based on WHO water quality guidelines and national microbial standards the quality of drinking water of Zanjan city has desirable standard values.