Vol 49, No 1 (2011)

Published: 2011-01-15


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    No Abstract

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    Sub chronic exposure to lead in rats slows gastric emptying, but little is known about the effects of lead on gastric secretion. This study was designed to investigate the effects of lead on gastric acid secretion and its possible mechanisms in rats. Lead acetate was dissolved in drinking water in a concentration of 1%. Sodium acetate-containing water with a molar concentration similar to lead was also prepared. We had nine groups of animals (n=8); four of them were exposed to lead for 1, 2, 3, and 4 weeks (Pb1, Pb2, Pb3 and Pb4 groups, respectively). Sodium acetate solution was given to another four groups for 1, 2, 3, and 4 weeks (Na1, Na2, Na3 and Na4 groups, respectively). Gastric secretion was collected by washout technique and its acid output was measured in the basal (Basal Acid Output, BAO), vogotomy (Vagotomized Acid Output, VAO), and vagally stimulated (Vagally Stimulated Acid Output, VSAO) states using titrator instrument. Nitric oxide (NO) metabolite of gastric tissue was determined by Griess micro assay method to evaluate the possible mechanism of lead effect on gastric secretion. VSAO was significantly less in Pb1 and Pb2 groups than Na1 and Na2 ones respectively (1.75 ± 0.17, 2.10 ± 0.30 vs. 5.79 ± 0.20, 6.18 ± 0.27 µmol/15min) (P=0.001, P=0.001). BAO was significantly more in Pb3 and Pb4 groups than Na3 and Na4 ones respectively (2.77 ± 0.37, 2.80 ± 0.31 vs. 1.73 ± 0.16, 1.79 ± 0.34 µmol/15min) (P=0.01, P=0.02), but it was the same after vagotomy. VSAO was more in Pb3 and Pb4 groups than their Na counterparts (P=0.001, P=0.0001). NO metabolite of gastric tissue was more in all Pb groups in comparison to their Na counterparts (P=0.0001). In this study, it seems that lead exposure, via NO mechanism, has different effects on acid secretion. Nitric oxide in small and large amounts decrease and increase gastric acid secretion, respectively.

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    The main issues in nasal surgery are to stabilize the nose in the good position after surgery and preserve the cartilages and bones in the favorable situation and reduce the risk of deviation recurrence. Also it is necessary to avoid the synechia formation, nasal valve narrowing, hematoma and bleeding. Due to the above mentioned problems and in order to solve and minimize them nasal packing, nasal splint and nasal mold have been advised. Patients for whom the nasal packing used may faced to some problems like naso-pulmonary reflex, intractable pain, sleep disorder, post operation infection and very dangerous complication like toxic shock syndrome. We have two groups of patients and three surgeons (one of the surgeons used post operative nasal packing in his patients and the two others surgeons did not).Complications and morbidities were compared in these two groups. Comparing the two groups showed that the rate of complication and morbidities between these two groups were same and the differences were not valuable, except the pain and discomfort post operatively and at the time of its removal. Nasal packing has several risks for the patients while its effects are not studied. Septoplasty can be safely performed without postoperative nasal packing. Nasal packing had no main findings that compensated its usage. Septal suture is one of the procedures that can be used as alternative method to nasal packing. Therefore the nasal packing after septoplasty should be reserved for the patients with increased risk of bleeding.

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    Anosmia following head trauma is relatively common and in many cases is persistent and irreversible. The ability to objectively measure such a decline in smelling, for both clinical and medicolegal goals, is very important. The aim of this study was to find results of brain Single Photon Emission Computed Tomography (SPECT) in anosmic subjects after closed head trauma. This case-control cross sectional study was conducted in a tertiary referral University Hospital. The brain perfusion state of nineteen anosmic patients and thirteen normal controls was evaluated by means of the SPECT with 99mtc- ECD infusion- before and after olfactory stimulation. The orbitofrontal lobe of the brain was assumed as the region of interest and changes in perfusion of this area before and after the stimulations were compared in two groups. The mean of brain perfusion in controls before and after the stimulation was 8.26% ± 0.19% and 9.89% ± 0.54%, respectively (P < 0.0001). Among patients group, these quantities were 7.97% ± 1.05% and 8.49% ± 1.5%, respectively (P < 0.004). The difference between all the measures in cases and controls were statistically significant (P < 0.0001). There were no differences in age and sex between two groups. The brain SPECT is an objective technique suitable for evaluating anosmia following the head trauma and it may be used with other diagnostic modalities.

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    C-reactive protein (CRP) is an acute-phase protein synthesized predominantly by the hepatocytes in response to tissue damage or inflammation. Levels of acute-phase proteins rise rapidly, during infection and after injury. We take up the study to correlate serum CRP levels with other important predictive markers of outcome in COPD. Patient with stable COPD (no exacerbation in the last two months) were taken up for the study. Parameters taken to correlate were age, grade of dyspnea, FEV1. It was found the CRP is negatively correlated with FEV1 and grade of dyspnea but not correlated with age.

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    The objective of this study was evaluation of excessive pregnancy weight gain effect in non-diabetic women with normal pre-pregnancy BMI on macrosomia of neonate. In a descriptive cross-sectional study, neonate weighs of all term pregnancy in non-diabetic women with normal pre-pregnancy BMI delivered from 2002 to 2004 in Shaheed Sadoughi Hospital in Yazd, were evaluated. Compared with mothers with normal pregnancy weight gain, the risk of macrosomia in offsprings was significantly elevated in women who had excess weight gain. The odds ratio (OR) was 3.3 (95% confidence interval [CI] = 2.2 - 5.1, P = 0.0001). Given the complications associated with delivering large babies, women may benefit from not gaining excess weight in pregnancy.

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    Developmental dysplasia of the hip (DDH) is one of the most widely discussed abnormalities in neonates. The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to over diagnosis, which might cause over treatment. Variations in the incidence of developmental dysplasia of the hip are well known. During six months study since September 2006 all 1300 neonates (2600 hips) were born in our hospital examined clinically and sonographically (587 hips) in the first 48 hours of life. Sonography was performed according to Graf's method, which considers mild hip sonographic abnormalities as type II a. Type IIb Graf were considered pathologic. Sonography screening of 587 hips detected 36 instances of deviation from normal indicating a sonographic DDH incidence of 12.5%. However, only 8 neonates remained abnormal and required treatment, indicating a true DDH incidence of 6 per 1000 live birth. Risk of diagnosis clinically and sonographicaly were 2.5 and 4.5 percent respectively and was significant (P<0.00001, x2 =1170). In order to avoid over diagnosis in first days examination, repeated clinical and sonographic examination is required.

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     Low Birth weight infants are at risk of many problems. Therefore their outcome must evaluate in different ages especially in school age. In this study we determined prevalence of ophthalmic, hearing, speaking and school readiness problems in children who were born low birth weight and compared them with normal birth weight children. In a cross-sectional and retrospective study, all Primary School children referred to special educational organization center for screening before entrance to school were elected in Mashhad, Iran. In this study 2400 children enrolled to study and were checked for ophthalmic, hearing, speaking and school readiness problems by valid instrument. Data were analyzed by SPSS 11.5. This study showed that 8.3% of our population had birth weight less than 2500 gram. Visual impairment in LBW (Low Birth Weight) and NBW (Normal Birth Weight) was 8.29% vs. 5.74% and there was statistically significant difference between them (P=0.015). Hearing problem in LBW and NBW was 2.1% vs. 1.3 and it was not statistically significant. Speaking problem in LBW and NBW was 2.6% vs. 2.2% and it was not statistically significant. School readiness problem in LBW and NBW was 12.4% vs. 5.8% and it was statistically significant (P<0.001). According to the results, neurological problems in our society is more than other society and pay attention to this problem is critical. We believe that in our country, it is necessary to provide a program to routinely evaluate LBW children.

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    Communication disorder is a widespread disabling problems and associated with adverse, long term outcome that impact on individuals, families and academic achievement of children in the school years and affect vocational choices later in adulthood. The aim of this study was to determine prevalence of speech disorders specifically stuttering, voice, and speech-sound disorders in primary school students in Iran-Yazd. In a descriptive study, 7881 primary school students in Yazd evaluated in view from of speech disorders with use of direct and face to face assessment technique in 2005. The prevalence of total speech disorders was 14.8% among whom 13.8% had speech-sound disorder, 1.2% stuttering and 0.47% voice disorder. The prevalence of speech disorders was higher than in males (16.7%) as compared to females (12.7%). Pattern of prevalence of the three speech disorders was significantly different according to gender, parental education and by number of family member. There was no significant difference across speech disorders and birth order, religion and paternal consanguinity. These prevalence figures are higher than more studies that using parent or teacher reports.

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    Today, to increase effectiveness is a Strategy for success of organizations and their viability. In health care organization not only service cost- effectiveness is a major problem for productivity and organizational management but also customer-centred is in first priority. Because of these reasons, most of health organization trend to patient satisfaction for their viability. If complex process implemented for viability without attention to patient satisfaction, this is no success result. The FOCUS PDCA process is a new strategy for effectiveness of service quality. To this reason, the recent research done and its objective is to assess effect of FOCUS PDCA process strategy on patient satisfaction in surgery units of hospitals affiliated to Tehran Medical University. This research is a semi experimental with non- equivalent design. The sample was all of patients who hospitalized in two selected surgery units. Self-report was method of data gathering. Patient satisfaction assessed with questionnaire in pre and posttest. Then manipulation implemented as post-operation care process selected. Modelling and opportunity statement Diagrams prepared and improvement team organized. Flow process, convergences and cause- effect charts used to prepare list of items to be improved. Executive program was written. This include personnel training, standard implementation, election and training of quality control nurses (Q.C Ns), daily QC of caring and providing appropriate feed back to personnel, forming group session for determining corrective actions. Then after 1 month patient satisfaction was assessed. Statistical analysis shows this process increase patient satisfaction and it leads to care effectiveness. The findings of the pre-intervention phase indicated that the satisfaction level had been low in both groups and it is not significantly different in the two groups (P> 0.05). There was a significant difference before and after following intervention in the case study group (P>0.0001). FOCUS PDCA is effective method for access to various objectives especially patient satisfaction. it is suggested other researcher assess effects of this strategy for other indexes and total care process effectiveness.

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    Oral cancer is considered a great threat to public health. Tongue cancer accounts for nearly 30% of all oral cancers and usually seen in 50 to 60 year old men. Oropharyngeal cancers account for 3% of all cancers in Iran; as reported in 2003. The present study was designed to assess the epidemiologic and clinicopathologic characteristics of tongue cancer patients in two Tehran's referral university hospital between the years 2003 and 2008. In a retrospective study 87 files of pa¬tients, diagnosed with tongue cancer who were referred to Imam Khomeini and Loghman Hospitals and Iranian Cancer Iinstitute in Tehran-Iran from 2003 to 2008 were reviewed. Participants were selected from all the patients who had a record of their specimens in the pathology ward registry and their tongue cancer diagnosis was confirmed by a expert pathologist. Patients characteristics (age, gender and presence of risk factors) and chief complain at the time of diagnosis and their tumor related data (type of cancer, staging, grading, morphology and location of tumor) were recorded. Tongue cancer was most frequently seen in the eighth decade of life among both men and women, but had the lowest frequency among patients with less than 40 years of age. Squamous cell carcinoma had the highest prevalence in our patients. Tongue cancer was the most common cancer of oral cavity among Iranian patients and similar epidemiologic and clnicopathological characteristics of the disease were found in our patients. Assessing variables such as socioeconomic levels and religious believe require further studies with large sample sizes.

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    To determine the addition of value of neoadjuvant, concurrent and adjuvant chemotherapy to radiation in the treatment of nasopharyngeal carcinoma with regard to the overall survival (OS) and disease free survival (DFS) within a six year period in Tehran cancer institute. Files of all patients with nasopharyngeal carcinoma treated by radiotherapy with or without concurrent chemotherapy in a curative setting in Tehran cancer institute during the period of 1999-2005 were retrospectively reviewed.. A total of 103 patients with nasopharyngeal carcinoma had been treated during the study period with radiotherapy or chemoradiotherapy in our institute. There were 29 (28.2%) females and 74 (71.8%) males. The median age at the time of radiotherapy was 47 years old (range 9-75 years). The patients were followed 2 to 76 months with a median follow-up of 14 months. Time of first recurrence after treatment was 3-44 months with a median of 10 months.. Survival in 2 groups of patients treated with radiotherapy alone or chemoradiation did not have a significant difference (P>0.1). Two-year survival in patients treated with or without adjuvant chemotherapy and had local recurrence after treatment did not have significant difference (P>0.1). Two-year survival in patients with or without local recurrence after treatment did not have significant difference (P>0.1). A beneficial affect or a survival benefit of adjuvant/neoadjuvant chemotherapy and concurrent chemoradiation was not observed in Iranian patients.

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    Orofacial clefts, including cleft lip with or without cleft palate (CL (P)), are common congenital malformations, second only to clubfoot in frequency of occurrence. The epidemiology and genetics of this disorder have been studied extensively in various countries by several investigators. The objective of this study is to assess the epidemiology and some genetic aspects of orofacial clefting at Imam Khomeini Hospital in Tehran. This study was a 7-year case series (retrospective) study from 1999 to 2006. The setting for the study was Imam Khomeini Hospital in Tehran, and the participants were all consecutive surgical cases with orofacial clefts referred to this hospital. One hundred and 77 cases of cleft lip and/or cleft palate were recorded during these 7 years. Seventy four of them (41.8%) were female and 103(58.2%) were male (M/F Ratio=1.39). Of all patients, 40 persons (22.6%) had isolated CP, 45 (25.4%) had cleft lip without cleft palate, and 92 (52%) had cleft lip with cleft palate (CL+P). Their M/F ratios were 1.66, 0.6 and 1.96 respectively. Of all CL (P) probands, 41 patients (29.9%) were bilaterally affected. In unilateral cases, the left side was affected nearly twice as frequently as the right side. Among the patients, 23 cases (13%) had other malformations; most commonly head and face abnormalities and then congenital heart disease. Fifty-four patients (30.5%) had consanguine parents; 33 (18.6%) were first cousins, 7 (4%) were second cousins, and 14 (7.9%) were distant relatives. There was a positive family history for cleft syndrome in 23 cases; most commonly CL-P. Our study reveals that the epidemiologic aspects of oral clefts in Iran are very similar to other Caucasian populations. It also suggests that a routine screening such as echocardiography and ruling out skeletal, hearing and visual problems may be necessary in cleft patients especially in children. It seems that genetic counseling and karyotyping can be very useful in patients with multiple malformations.

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    Injection drug use has been the most growing rout of drug abuse in Iran in the past decade and it has been responsible for the transmission of HIV virus in more than two third of cases. The aim of the present study was to determine the prevalence of HIV and hepatitis B in a group of IDU cadavers and to compare the results to a group of cadavers of the normal population. In a case-control study the blood samples of the cadavers of 400 randomly chosen IDUS and 400 other cadavers as control group were checked for HBS antigen and Anti HIV antibody in the forensic medicine center of Tehran. The prevalence of HIV and HBV infection was compared in two groups according to their demographic characteristics. The number of HIV and HBV positive cadavers was significantly higher in the IDU group than the controls (6.25% vs 0.5%, P<0.001, 27.5% vs 3%, P<0.001). The risk of getting infected by HIV virus was 13.27 times greater in the IDU group and the risk of HBV infection was 12.26 times greater in this group as compared to the control group. The age distribution of IDU cadavers indicated that the percentage of IDU cadavers in the reproductive (21-40 years old) age was 80%. The greater prevalence of the HIV and HBV infection especially in the reproductive age of IDUS indicates a greater concern to the authorities for more attention to prevention and harm reduction programs.

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    Tubercle bacilli infect about one third of the world's population and over the past decade resurgence of tuberculosis has been a major health threat mainly due to increasing frequencies of immunosuppressive states and drug-resistant organisms. Although tuberculosis is essentially a lung disease, intracranial elements become involved in 5-10% of cases either as meningitis or tumour-like masses (tuberculoma). Tuberculoma is common in endemic areas but its occurrence during pregnancy is occasional and of particular interest is its intriguing clinical picture mimicking toxemia of pregnancy and brain tumor. In addition, the effects of pregnancy on tuberculosis or vice versa have been controversial. We present here a review of the recent literature and discuss a case coming to medical attention with manifestations of intracranial hypertension during 2 consecutive pregnancies; 4 years apart. On operation a dura-attached mass was detected that proved to be a tuberculoma. After 18 months of close observation and under drug therapy she obviously improved with no ensuing complication. Immunodeficiency state associated with pregnancy is likely to play a role in activation of infection. Tuberculoma should be considered in differential diagnosis of eclampsia and brain mass particularly in women coming from endemic areas for this infection even in the absence of pulmonary involvement.

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    The relationship between congenital heart disease (CHD) and growth retardation is well documented. We investigated the growth condition of Iranian children with several types of congenital heart disease (CHD) and compared it with worldwide researches. Growth condition was investigated in 469 patients with important CHD aged from 1 month to 18 years. The patients were divided into two groups; infants (aged 12 months or less), and children (1-18 yrs of age). Children with hemodynamically unimportant small VSDs or small ASDs were not studied. Other exclusion criteria were prematurity, known genetic disorders and neurologic disease affecting growthd. All patients' cardiac diagnoses were made on the basis of clinical and laboratory examinations; including electrocardiography, echocardiography, cardiac catheterization, and angiography. Body weight and height of all patients were measured using conventional methods and compared with standard growth charts. In all patients body weights and heights were significantly lower than normal population. This difference was greater in the weight of female children. Other risk factors for growth failure were large left-to-right intracardiac shunts, pulmonary hypertension and cyanosis. Iranian children with CHD have growth failure somewhat different from other countries. Lower body weights of cyanotic patients and female children indicated that these patients need more nutritional and psychosocial attention.