Scientific Journal of Kurdistan University of Medical Sciences
Year:2006 | Volume:10 | Issue:4 (Serial number 38)|Papers Count:14

Background and Aim: Bronchoscopic methods including: biopsy, bronchial washing and bronchial lavage have different rates of accuracy. Routine use of bronchial cytology as a simple method for diagnosis of lung cancer diagnosis is controversial. This study was performed to compare the diagnostic value of bronchial washing in lung cancer before and after biopsy.Materials and Methods: Patients with clinical and radiographic signs of lung cancer were included in this study, from January 2000 to July 2002, 1050 patients referred to Endoscopic ward of Imam Khomeini hospital (Tehran) and underwent bronchoscopy. Lung cancer was demonstrated in 80 patients. Biopsy was our gold standard for diagnosis of lung malignant tumor in this study. Bronchial washing specimens before and after biopsy and biopsy specimens were studied by an expert pathologist and the pathologic reports were collected. Data were analyzed and sensitivity of bronchial washing cytology was estimated.Results: According to the results of this study 55 patients with confirmed diagnosis of lung cancer had negative cytology indicating the sensitivity of cytology of bronchial washing to be 31.25 percent. Bronchial washing cytology was positive both before and after biopsy in 20 patients but positive tests were obtained in 3 patients only before and in 2 only after biopsy. In general, the sensitivities of bronchial washing cytology before and after biopsy were 28.5% and 27.5% respectively which were compatible in 95.6% of cases.Conclusion: According to the result of this study bronchial washing cytology is not recommended as a routine procedure for diagnosis of lung cancer but if biopsy is contraindicated this procedure may be helpful.

Background and Aim: The brain rennin-angiotensin system (RAS) has an important role in the regulation of cardiovascular function. The aim of the present study was to determine the effects of reversible inactivation of the ACe on normotensive and hypertensive rats (renal hypertension).Materials & Methods: Two groups of normotensive Wistar rats were selected for this study. In one group, hypertension was induced by Goldblatt method and another group was subjected to sham procedure. After 6 weeks, tests were performed on anesthetized rats with Urethane (1.5 mg/kg). In order to perform bilateral reversible inactivation, lidocaine (1 μl) was injected through guide cannuli that had been implanted in the ACe. Then direct measurements of femoral blood pressure were recorded just before and 5, 10, 20, 40, and 60 minutes after injection of lidocaine. Considering the baseline values, degree of changes was determined and compared between the two groups.Results: Our results revealed that sham-inactivation led to a significant increase of blood pressure only at 5 minutes after injection (P<0.05). There was no significant difference in blood pressure at different times before and after injection of lidocaine in the hypertensive group.  Conclusion: This study concludes that the change in the Ace activity during induction of hypertension is due to the change in RAS activity.

Background and Aim: Bilateral tubal ligation is a limited surgical procedure with minimal tissue injury, yet postoperative recovery time-span and analgesic requirements are not often proportional to this kind of surgery.Materials and Methods: Sixty ASA I-II females scheduled for TL minilaparatomy under general anesthesia were entered into this prospective, randomized, double blind, placebo-controlled clinical trial. Patients were randomly divided into two groups. Exclusion criteria were chronic abdominal pain, obesity, drug abuse, intubation and need for other surgical procedures in addition to TL. The patients received 10 mg Metocloprimede, 20 mg Hyoscine or equal volume of isotonic saline (control) as pre anesthetic agents. In experimental group (n=29) 10cc and 3cc Bupivacaine (0.25%) and in control group (n=31) 10cc and 3cc isotonic saline were injected bilaterally into incision site and mesosalpinx respectively. IV petidin (25 mg as needed) was given to relieve pain in post anesthesia care unit. Presence of pain, severity of pain and need for analgesics were assessed postoperatively in recovery unit, 6 and 24 hour and also 7 days after surgery. The collected data were analyzed by means of X², Mann-Whitney and T-tests.Results: Pain score at recovery, and in the seventh postoperative day were significantly lower in the experimental than in the control group (p<0.05). But no differences between pain scores were noticed in Bupivacaine and control groups after 6 and 24 hours of operation. The total amount of analgesics required for pain relief was significantly more in control group than in bupivacaine group (p<0.05).Conclusions: This study suggests that a regimen of IV injection of Metoclopramide (10 mg) and Hyoscine (20 mg), accompanied with Bupivacaine infiltration into the periumblical skin incision site and into both medial and lateral segments of uterine tubes and mesosalpinx, bilaterally, can eliminate pain in both the immediate postoperative recovery period and 7 days after minilaparatomy for tubal ligation.

Background and Aim: Women with chronic renal failure can resume normal fertility after Kidney transplantation. However, in such pregnancies, potential risks of immunosuppressive agents on pregnancy status and fetus should be taken into consideration. There are some reports indicating fetal malformations, preterm labour, abortion and intrauterine growth retardation in such pregnancies. The present study was designed to evaluate the status of pregnancy in women with kidney transplantation in Renal Transplantation Center of the 4th Shahid Mehrab Hospital in Kermanshah.Materials and Methods: This was a descriptive-analytic study and the medical records of women who had pregnancy after renal transplantation during 1368-1378 were reviewed. Necessary data concerning the serum creatinine level, blood pressure during pregnancy, age at the time of pregnancy, interval between transplantation and child-birth and occurrence of acute allograft rejection during pregnancy were collected. The newborns were examined twice in a 6 month interval for physical growth, developmental status and major malformations.Results: 11 pregnancies occurred in 9 women with kidney transplantation, , but one case led to abortion (9%). Immunosuppressive therapy consisted of cyclosporine A and steroid in 3 cases (30%), and cyclosporine A, steroid and azathioprine in 7 cases (70%). The time interval between transplantation and childbirth was 24.6±15.67 months, and the mean age of mothers during pregnancy was 27.22±5.74 years. There was no significant difference between mean systolic and diastolic blood pressures and serum creatinine level before and during pregnancy. There was no acute allograft rejection or any other remarkable problems during pregnancy. Only four newborns, 3 boys and one girl were brought for follow up. 3 cases of pregnancies were unwanted and only one case was intentional. The mean weight of the newborns was 2.62±0.47 Kg, and one of them was underweight (25%). Physical growth and development of these newborns were normal and there was no obvious congenital malformation.Conclusion: Although immunosuppressive agents can cross placental barrier and expose mother and fetus to potential risks, this study like other recent studies revealed that supportive measures before pregnancy and close monitoring of the pregnant women by an experienced and multidisciplinary team,  may lead to the birth of a healthy baby, without any adverse effect on the function of the allograft.

Background and Aim: Septicemia is one of the most important neonatal diseases which occur as a result of bacterial infection. The major criterion for its diagnosis is based on body fluid cultures specially blood culture. The aim of this study is to determine the prevalence of septicemia and also detection of isolated bacterial sensitivity to selected antibiotics in neonatal ward of Beast Hospital.Materials and Methods: This study is descriptive. Blood cultures were ordered for all hospitalized neonates. A questionnaire including clinical manifestations of septicemia such as fever, hyporeflexia, hypothermia, cyanosis, abdominal distention, loss of appetite and jaundice was filled out for every neonate clinically suspected of having septicemia. At last the collected data were analyzed by means of SPSS software and descriptive statistics.Results: This study included 700 specimen of blood cultures, %17.6 of the cases were suspected of having septicemia but %30 of them had positive blood cultures. The most common species isolated was coagulase negative staphylococci. As to sign and symptoms hyporeflexia, juandice, and anorexia were detected most frequently. Sensitivity of gram negative bacteria to ciprofloxacin was %100 & to cefotaxime %66.7. Sensitivity of gram positive bacteria to cephalotin was %43, while gram negative bacteria had highest resistance rate to ampicilin & cephalotine in %100 and gram positive bacteria to oxacilin in %68.6 & cotrimoxasol in %62.9 of the cases. In this study prevalence of septicemia in those having positive blood cultures was 30% with a mortality rate of 4.9%.Conclusion: This research shows that clinical manifestation is not enough for the diagnosis of septicemia and blood cultures should be considered necessary in suspected cases. Considering high resistance rate of isolated bacteria to ampicilin & cephalotin, culture and antibiogram can be of great value to select suitable antibiotic. Ciprofloxacin can be regarded as the drug of choice for gram negative bacteria. To reduce prevalence and mortality rates of septicemia, proper planning to confront microorganisms & nosocomial infections is necessary. Also appropriate and timely prescription of antibiotics by pediatricians can prevent bacterial resistance to antibiotics.

Background and Aim: Vitamin D requirements are met by its synthesis in the skin as a result of exposure to UVB (ultra violet B) and also by food. Despite abundant UVB in sunny countries, there is evidence of high prevalence of Vitamin D (vit D) deficiency in these areas.Materials and Methods: 5 cities with different longitudes and latitudes were chosen. Patients were selected by random cluster sampling. Blood samples obtained from healthy subjects. After centrifuging the sera collected sent to the EMRC (Endocrinology & Metabolism Research Centre) laboratory for measurement of 25(OH) vitamin D [25(OH)D] and PTH levels. Based on the level of 25(OH), the subjects were classified into 7 groups. Different levels of Vit D deficiency were determined as normal, mild, moderate and severe Vit D deficiency.Results: 5329 people were evaluated for 25(OH)D and three threshold  levels for women (40, 25 and 12 nmol/L) and two  for men (35 and 25 nmol/L) were determined. Mild Vit D deficiency was observed in 27.2% of women and 37.25% of men. Severe or moderate Vit D deficiency was noticed in 47.85% of women and 34.75 % of men.Conclusion: The results of this study are compatible with those of other studies in the Middle East. Prevalence of Vit D deficiency in these areas needs justification. Plans for fortification of articles of food with Vit D are recommended.

Background and Aim: Nosocomial Infections are nearly the most important health problem in the world. The high costs of treatment, the great number of patients with high mortality and morbidity rates and also increased incidence of these infections are suggestive of the importance of these infections. The aim of this study was to assess the epidemiologic status and the rate of acquired infections together with their related factors in ICU and post ICU patients at Tohid Hospital, in Sanandaj.Material and Methods: This is a cross sectional descriptive study. The sample size included 160 patients who had been admitted to ICU and post ICU during a period of 6 months. Demographic data and prevalence rate of nosocomial infections and results of clinical and Para-clinical measures were recorded. The data were analyzed by means of SPSS-win software.Results: In our study the prevalence rate of nosocomial infections was 15.6%. The most frequent infections were pneumonia (68%), UTI (19.2%), bed sore (7.8%), sepsis (3.8%) and infections of unknown origin (3.8%). The most frequent isolated microorganisms were Klebsiella Pneumonia (47.05%), Ecoli (17.64%), and Entrobacter spp (17.64%). There was an important relationship between the duration of hospitalization and the prevalence rate of the infections (p=0.000). But there was no significant linkage between age, intubation or tracheostomy with the prevalence rate of the infections.Conclusions: The results of our study supported previous data concerning nosocomial infections. In order to decrease the rate of nosocomial infections, assignment of one nurse for one patient and proper hand washing should be emphasized.

Background and Aim: The aim of this cross sectional study was to determine the prevalence of intestinal colonization by vancomaycin-resistant enterococci (VRE) in Namazi Hospital in Shiraz.Materials and Methods: Serial rectal swabs were obtained every 5 days from all the 700 hospitalized patients, (from December 2003 through July 2004), and VRE (Vancomycin-resistant Enterococci) were detected by disk diffusion method and then confirmed with Minimum Inhibitory Concentration dilution Method. The data collected out of interviews and patients' records, were analyzed by means of chi-square test.Results: 99 (%14) out of 700 patients were colonized by VRE. 3% of 23 patients, who had negative tests for VRE, at the time of hospitalization, were colonized by resistant enterococci. In this study the prevalence of VRE showed a significant relationship with variables of age, ward, history of previous admissions, history of previous antibiotic use, duration of hospitalization, underlying disease, neutropenia, renal failure, dialysis and major surgery (p<0/05). But association between prevalence of VRE and sex, clinical outcome or conditions such as immunosuppression, cancer and diabetes were not statistically significant (p>0.05). Conclusion: This study that was the first on VRE in Iran and revealed that colonizeation with VRE has a high prevalence in Namazi Hospital and this organism might be endemic in large hospitals. Interventional strategies are required to control this emerging nosocomial infection.

Background and Aim: Placing and entrapment of an object into the nasal cavity can lead to an unpleasant experience in the early childhood. The aim of this study was to determine the type of foreign bodies, assessment of clinical symptoms and complications of this problem in children referring to Tohid Hospital in Sanandaj from 1380 to 1384.Materials and Methods: This is a prospective descriptive study and included all the cases of nasal foreign bodies that had referred to Tohid Hospital. The sample size comprised 196 children and sampling method was census. Collected data were recorded in questionnaires and analyzed by means of SPSS. Win.Results: 196 children of the age of 10 or younger with an average age of 3 years were included in this study. 57.1% of the patients were male, and 42.9% female. Foreign bodies were detected in the right nasal cavity in 126 cases (64.3%), while in 69(35.2%) of cases the left nasal cavity was involved. In 0.5% of cases foreign bodies were found bilaterally. Removal of foreign bodies in 71.4% of cases was performed within 48 hours, while in 28.6% of the patients this was achieved from 48 hours to a few months after foreign body insertion. 66.7% of the foreign bodies removed by physician and emergency room personnel. The most common nasal foreign bodies were grains (16.8%), toy parts (14.8%) and tissue paper (13.3%). Various clinical presentations included mucopurulent nasal discharge (32.9%), nasal obstructions (22.2%), halitosis (13.3%), chronic cough (9.5%), epistaxis (10.1%), mouth breathing (6.3%) and sneezing (5.7%). The main complications were vestibulitis (38.3%), sinusitis (28.3%), persistent crusting and local atrophic rhinitis (16.7%), rhinolits (5%), S.O.M (3.3%), adhesion and nasal stenos is (3.3%), nasal septal perforation (1.7%), saddle nose deformities (1.7%) and formation of granulation tissue (1.7%).Conclusion: The results of this research concerning types of nasal foreign bodies was compatible with those of others studies. Parents should be warned against attemping to remove inaccessible objects out of the nose of their children. Education and training of physicians and personnel of emergency unit should be regarded necessary.

HTLV1 is a retrovirus, and its spread has led to infection of 10-20 million people in the world. In spite of its high prevalence, the symptom occurs only in about 5% of the infected population. Transmission of this virus is often from mother to fetus by way of placenta or more importantly to newborn baby through breast feeding. The second way is of a greater significance.Another way of transmission of the virus is by sexual intercourse especially from man to woman and the third way is through transfusion and IDU (parental).For the first time in Iran (in 1991) the northeastern part of Khorasan Province was labeled as an endemic area; also the disease has been reported from Tehran, Gorgan and Khozestan provinces; however, no case had ever been reported from Kurdistan province yet.The patient under study is a 28-Year-old girl with unusual symptoms such as and eight-year history of weakness of lower limbs with gradual spread to the upper limbs as well as paresthesia of the four limbs and urine frequency. In physical examination hypereflexia in all the four limbes and planter extensors, colonus and sensory disorders in the limbs were detected bilaterally.The paraclinical studies including MRI, laboratory tests and (VER) were normal. Only MRI revealed a non specific emblem. The patient had been treated as a case of MS for eight years. HTLV1 antibody test which had been requested was positive. Therefore, the patient was labeled as a case of HTLV1 and hospitalized for proper treatment.

Background and Aim: In patients who have a chronic disease such as end stage renal disease (ESRD) for which cure is not a realistic goal, improving performance and well-being of the patients should be regarded as primary objectives. However, the status of performance in the dialysis patients is lower than normal. The aim of this study was to determine the effect of self-care educational program on decreasing the problems and improving the quality of life of dialysis patients.Materials and Methods: This study was a Quasi-Experimental research in which pretest and posttest were designed for one group in the educational hospitals of Iran and Tehran medical science universities in 1383-1384. From 36 patients invited to participate in the study, 4 of them refused to cooperate. 32 patients took part in the study. The patients were chosen on the basis of a non-randomized sampling. Every patient was assessed two times in an interval of two weeks before starting dialysis by questionnaires about educational requirement, quality of life and by a checklist. In order to validate the results, the laboratory variables were analyzed on the average two months prior to the education. Then an educational program including existing problems was designed and the characteristics of every subject were determined and the required information was presented in two sessions. After the educational period, the laboratory variables and quality of life two months after education were evaluated and analyzed. Also the checklists were reviewed in two stages, two weeks apart (third and fifth weeks).Results: The results of this study showed that there was a significant decrease in serum urea, s uric acid, s p, weight gain at intervals between dialyses, systolic blood pressure, edema, and skin itching, local vascular problems with improvement of the quality of life. Conclusion: Performing the self-care educational program had a positive effect on decreasing the problems leading to improvement of the quality of life of dialysis patients.