Studies in Medical Sciences
Year:2006 | Volume:17 | Issue:1|Papers Count:16

Background & Aims: Hydatid cyst is an endemic zoonosis in Iran which may involve various organs of body. Liver is involved in 80% of the cases; and lung is the second in 5-10% of cases. There are different methods for hydatid cyst surgery treatments; including Video Assisted Thoracic the Surgery, intact cystectomy, lobectomy, evacuation and bronchial opening closure (E.B.O.C). We have chosen the latter procedure.Materials & Methods: This paper is a retrospective review of 120 patients operated between 1990-2002. Results: The patients' age range was 3 up to 60 years; 62% males and 38% females. Patients present by symptoms as cough, sputum, bloody stained sputum, dyspnea, chest pain were 92% of the cases; 8% of the patients discovered incidentally. 10% of the patients suffered bloody stained sputum and 5% had intact hydatid cysts. Chest X ray used as a diagnostic procedure in 100% of the cases, and additional computerized tomography was (CT) used for 24 of the patients. Serologic tests used for 50% of the cases but it was not helpful in diagnosis. All patients were operated via a posterolateral thoracotomty. One hundred patients were operated by evacuation and Bronchial Opening Closure (E.B.O.C), 8 patients lobectomy, and 5 patients by intact cystectomy and Wedge resections, and 7 patients were treated by Video Assisted Thoracotomy Surgery. There were no additional complication in one-year follow up in Evacuation and Bronchial Opening Closure (E.B.O.C) procedure, and the residual cavity gradually filled up in 6 months. Conclusion: Using Evacuation and Bronchial Opening Closure for long hydatic cyst didn't need any procedure to fill the remained cavity. After one year follow up there was not any recurrence or complication.

Background & Aims: Recently, considerable efforts have been made to develop models to permit the accurate prediction of hospital mortality for patients treated in ICU. This study evaluates the acute physiology, age, chronic health evaluation (APACHE3) scoring system, in the context of general adult ICU in the Emam hospital in Urmia.Materials & Methods: 202 patients were admitted between Jan.2002 and Dec 2003 in ICU of Emam hospital.Sociodemographic and severity of illness data were collected for all the patients admitted to the study unit, with using APACHE3 system.Results: The mean age of the patients was 60.39, and 59.9% were male, 42.6%were admitted from recovery unit operation rooms. 86.1% of the patients were of internal and of elective surgery. Overall mortality rate was 21.3% and mean APACHE score was 35.48±17.86.Discussion: In our study inspite of low APACHE score, mortality was more than that expected, and may represent the low care quality in Emam hospital ICU.

Background & Aims: The use of Propofol and adjuvants such as short-acting opioids, adrenergic blockers and local anaesthetic agents may provide adequate conditions for laryngoscopy and tracheal intubation without the need for muscle relaxants. Regarding pharmacokinetic profile of Remifentanil, it was hypothesized that it may also be useful in facilitating tracheal intubation. In this study tracheal intubation conditions in adults have assessed after coinduction with Propofol, Lidocaine and varying doses of Remifentanil.Materials & Methods: A randomized prospective, double-blind study to assess intubating conditions in 90 patients of ASA class I or II, in three groups of 30 cases was designed. Anesthesia was induced with Lidocaine (1.5mg/kg) Propofol (2mg/kg) and three varying doses of Remifentanil (0.5-1-2 mg/kg) in three groups (I.II.III). Tracheal intubation was graded according to ease of laryngoscopy, position of vocal cords, coughing, jaw relaxation and movement of limbs.Results: Tracheal intubation was regarded as acceptable in 20% of group I, 43.3% of group II and 86.7% of group III. All three groups had a decrease in arterial pressure and heart rate but there was no statistically significant difference between groups. The decrease in arterial pressure and heart rate was not regarded as clinically significant.Discusion: Tracheal intubating conditions were better after intubation with Lidocaine, Propofol and Remifentanil (2 mg/kg).

Background & Aims: Brainstem auditory evoked potentials (BAEPs) are a set of seven positive waves recorded from the scalp during the first 12 millisecond following a click; BAEPs are effective in evaluating the integrity of peripheral and central auditory pathways. Chronic renal insufficiency leads to hearing organ's damage due to toxic influence of nitric compounds, electrolyte disorders and ototoxic materials. The aim of this study is evaluating the function of hearing organ with BAEPs in patients with chronic renal failure under hemodialysis.Materials & Methods: This study is a case-control and analytical study. 40 patients with CRF under hemodialysis in Tabriz Imam Hospital and 40 people without CRF were selected. We used BAEP test in both of them. The data were analyzed with SPSSII and independent- sample t-test and Chi- Square tests.Results: There was a significant difference between two groups in BAEP changes, in Ill, IV, V waves and 1- III and Ill-V intervals (p<0.05). There was no correlation between duration of dialysis and BAEP changes. A significant correlation was found between potassium of serum and BAEP changes (p<0.05). There was no correlation between BAEP changes and other lab quantities (p>0.05).Discussion: There was elongation of wave III and V, and I-III and III-V interval in BAEP in other studies. Our study is consistent with those studies. Hemodialysis does not permanently improve hearing, but it may temporarily prevent its further deterioration. BAEP test may be used for monitoring hearing organ damage in course of uremia.

Background & Aims: The problem of maternal mortality illustrates well the access, quantity and quality of the health services, women's situation in the community and also responsiveness of the health system to the women's needs. In recent years the maternal mortality ratio (number of maternal deaths per 100,000 live births per year) in the West Azerbaijan Province was reported to be one of the worst in Iran, (84/100,000).The purpose of this study was to 1) provide a rapid and accurate estimate of maternal mortality in the Province, 2) to identify the various epidemiologic risk factors for maternal deaths.Materials & Methods: The study was a field trial and descriptive- analytic type. The data were collected for a period of 4.5 years. Between Farvardin 1380 and Mehr 1384, all reports of maternal deaths from reporting areas of the province including both private and public sectors were studied. Results: The overall pregnancy-related mortality ratio was 42.4 deaths per 100,000 live births. The pregnancy-related mortality ratio differed by maternal age, maternal education, order of parity and the quality of prenatal and delivery care. Receiving any prenatal care by dead mothers is related significantly by residence in the satellite villages, maternal and her husband's educations. The leading causes of pregnancy-related death were hemorrhage, pregnancy-induced hypertension, indirect causes and embolim.The ratio of unsafe delivery significantly decreased from 1380-1384. Most of the deaths were preventable and the most important contributing factor was health care provider failure.Discussion: In West Azerbaijan, decreasing pregnancy-related mortality ratio requires implementing the interventional programs at community level, improving access to emergency obstetric services and improvements in all walks of life including health services at both prevention and treatment sectors.

Background & Aims: There is conflicting information about whether short term mortality after myocardial infarction (MI) in women is higher than men after adjustment for age and other prognostic factors. We evaluated the effects of patient's sex on in-hospital mortality of MI.Materials & Methods: This cross-sectional, descriptive study has been done since 1380 to 1381 in Talegani Hospital, Urmia. Sampling method is census. The collected information was analyzed with Chi2 test & logistic regression.Results: From 276 patients- (198 Male (71.7%) and78 Female, (28.3%)- hospitalized with MI diagnosis, 48 (17.4%) patients died. The average age of catching MI in men is 57.4±13.5 and in women 67.1±9 years old. The mortality rate during hospitalization was higher in women than in men. (25.6% vs 19.5%; odds ratio for death in women as compared with men was 2.1). In-hospital mortality risk was 1.8 higher in women. (Chi2=5.15, p=0.023) However when mortality rates were examined according to the age groups and sex based differences varied according to the age. Among patients less than 70 yrs, the mortality rate for the women was higher than men. The difference in the rate decreased with increasing age & was no longer significant after the age of 70.Discussion: We suggest that, the women with suspected cardiovascular disease require more attention, so physicians must consider women as a high risk group.

Background & Aims: Cadmium chloride is an essential component of industrial and non-industrial materials such as foods, water and cigarettes. Reports have shown the teratogenic effects of cadmium, thus the present study was performed with the aim of determining the effects of cadmium on the central nervous system in mouse fetuses.Materials & Methods: In this experimental study, 30 female mice were included. Samples were divided in three groups of control, experimental I and n. Experimental groups have received cadmium chloride with dosage of 3 mg/kg and 5 mg/kg intraperitonealy on the 9th day of pregnancy, respectively. The control group received distilled the water. On the 15th day of pregnancy, the mice were killed by ether and their fetuses were removed, then weight and height of the fetuses were measured and then was kept in fixative. Finally, specimens were prepared and stained by H&E.Results: The Weight and height of embryos in experimental groups were significantly lower than the control group. Diameter of third ventricle and cerebral aqueduct in experimental groups significantly were increased compared to the control group. Furthermore lateral and the fourth ventricles thickness in experimental groups were significantly decreased. (p<0.001).Discussion: The results show that prenatal exposure to cadmium chloride can induce significantly changes in CNS and growth of mice fetuses.

Background &Aims: Hemodialysis, a lifesaving procedure, is the only hope as for the most patients with chronic renal failure. In this process, due to the large consumption of water and possibility for passage of microbial products related to endogenous pyrogens, the microbial quality of water is very important and related with short and long term complications of hemodialysis in these patients. This study is designed for evaluation of endotoxin contamination of water in Urmia hemodialysis center. In the first step, degree and source of contamination was discovered and in the second step, after proposal consideration, the degree of efficiency was assessed.Materials & Methods: The study in the first phase was an analytical cross-sectional and in the last phase was experimental. A stratified random sampling was chosen. LAL test was used in order to measure endotoxin level. After data analysis with SPSS Ver10, by a descriptive statistics and determining correlative index and Fridman & Kruskal Wallis test, the results were reviewed. The standard of European pharmacopoeia was used for detecting of contamination.Results: More than 90% of the machines had high endotoxin contamination (more than 5 IU/ml). Contamination was higher at the end of the week relative to the first days. (r=0.56, p=0.048). Water tank had higher effect (r=0.93, p=0.002) and softner & RO system had lesser effect on contamination of system.After interference the results were assessed with Kruskal Wallis test. It showed that contamination definitively decreased in water tank and in 4 of 8 machines (p<0.05).Discussion: The contamination of dialysis water was higher than standard in this center which can be as an important factor of dialysis complications. The results of second phase verified that slight interference in system can definitely decrease the contamination indices. So, we recommend that by doing similar inexpensive studies in other centers, the dialysis complications decrease.

Background &Aims: Osteoporosis is a chronic degenerative disorder that is characterized with reductions in bone mineral density. The cause of osteoporosis is multifactor and nutritional status plays an important role in development and maintenance of bone density and prevention or treatment of osteoporosis. In this study, we survey the nutritional status, dairy products consumption frequency and relationship between dietary calcium and bone mineral density (BMD) in three types: normal, osteopenic and osteoporotic groups of postmenopausal women.Materials & Methods: This cross-sectional descriptive-analytical study was carried out on 46 postmenopausal women in Tabriz (age 58±0.81).For each subject, 24-hours food recall (2 regular days and a holiday) and dairy products frequency questionnaires were completed. Bone mineral density (BM.D.) was measured at LS and FN with using DEXA system.Results: The results of BMD measurement of 6 women were normal, 22 women were osteopenic and 18 women were osteoporotic. The energy and macronutrients intake in all groups were adequate but magnesium intake was obviously lower than the recommended level in all groups. There was a significant difference between normal and osteoporotic groups in calcium intake (p=0.02). Dairy products consumption frequency between normal and osteoporotic groups showed a significant difference (p=0.01).There was a remarkable relationship between dietary calcium and Bone Mineral Density (BM.D.) (p=0.0001, r=0.572).Discussion: The calcium and dairy products consumption frequency in postmenopausal women was lower than the recommended level, thus nutritional education about increasing dietary calcium or supplements was recommended.

Integration of the healthcare and educational systems is one of the most outstanding and significant events in contemporary history of the country. Integration put the medical schools, as producers of the human forces, next to the healthcare system, as one of the most important customers of the medical schools.Integration provided a philosophical, conceptual, and operational basis for change in both medical education and healthcare provision. However, misunderstanding of the new system prevented optimal use of the whole capacity of this novel system.Integration, potentially set the ground for understanding of the unprecedented necessities of the healthcare system, but the medical schools did not pay enough attention to these necessities. In this article the need for change in medical education, especially clinical education, with the aim of responding to the healthcare needs of the communities will be discussed. In my opinion, integration of the improvement knowledge into the clinical teaching is the basis of the whole ranges of the other changes.

Background & Aims: Erosion and pacemaker (device and lead) rejection are rare complications of the Pacemaker implantation. There is a controversy about etiology and management of this problem such as microinfection and loss of blood supply.Case Report: This patient is a 65 years old Iraqi lady who referred to Taleghani hospital in Urmia due to a complete extrusion of the pacemaker generator along with related lead. This process repeated 3 times at last 10 months. The indication of pacemaker implantation in this case was several episodes of syncope due to complete heart block in presence of normal sinus functions. Management of this patient included 2 weeks antibiotic therapy with vancomycine. Then pacemaker (VDD) implanted in the contra lateral. There was no complication after 10 months.Discussion: In past Similar case reports were published but our patient's unique characterization was that she had repeated erosion without evidence of major infections despite a long period of mismanagement.

Background & Aims: Anthrax is a zoonotic disease caused by Bacillus Anthracis which is an aerobic sporulating gram positive rod. There are: cutaneous (95%); inhalation(5%); and infrequently pharyngeal and gastrointestinal anthrax. In rare instances, meningitis and bactremia occurred. In anthrax meningitis and septicemia, there is a primary foci of infection such as cutaneous, pulmonary or gastrointestinal tract, which let the bacteria invade CNS through lymphatic or hematogenous routes. In this case, septicemia and meningitis occurred without any primary foci of infection.Case Report: A 27 years old rural woman was hospitalized with high fever and confusional state with possible diagnosis of meningitis. She had a history of contact with herbivorous animals. There was no history of suspected cutaneous ulcer or respiratory and gastrointestinal symptoms. According to the possibility of acute bacterial meningitis, Lumbar puncture was done and samples for blood culture were taken and empirical therapy was started. The patient died 36 hours after hospitalization. Results of two separate samples of blood culture and cerebro-spinal fluid culture were positive for bacillus anthracis.Discussion: Although anthrax meningitis occurs infrequently, but it is important to think about it in any patient with presentation of acute meningitis, particularly if there is a history of contact with domestic animals even without suspected cutaneous ulcer or respiratory and gastrointestinal symptoms.