Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 564 574 EN Zahid Hussain Khan Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 A complicated and controversial subject in obstetrics i.e., toxemia of pregnancy is looked upon, both from an anesthesiological and obstetrical point of view. As pre-eclampsia and eclampsia involve immediate treatment and obstetric considerations, the choice between epidural and general anesthesia becomes necessary when cesarean section is contemplated. Apart from the pathophysiology of the vessel spasm as it is induced by preeclampsia, the therapeutic managements of fluid administration, the drugs of choice to treat hypertension as well as the technical aspects of anesthesia are reviewed. https://acta.tums.ac.ir/index.php/acta/article/view/3797 https://acta.tums.ac.ir/index.php/acta/article/download/3797/3772

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 575 578 EN Fatemeh Nayeri Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Habib Soheili Department of Pediatrics, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mahbod Kaveh Department of Neonatal, Mirza Koochak Khan Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zohre Oloomi Yazdi Department of Pediatrics, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hosein Dalili Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10μg/kg/s.c. to neonates in group A and as 10μg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10μg/kg) was effective in treating neonatal septicemic neutropenia. https://acta.tums.ac.ir/index.php/acta/article/view/3798 https://acta.tums.ac.ir/index.php/acta/article/download/3798/3773

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 579 583 EN Mohammad Abbasinazari Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Houshang Mohammad Alizadeh Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Kamyar Moshiri Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Amin Pourhoseingholi Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Reza Zali Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2015 09 28 Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a frequent complication either for diagnosis or treatment of pancreatobiliary diseases. A number of pharmacological agents have been tried for prevention or alleviation of the complication. Allopurinol with free radical scavenger property has been considered as an effective prophylactic agent in some clinical trials. Administration of allopurinol in these trials was done in a long period before doing ERCP. Hence allopurinol converts to oxupurinol in the liver rapidly; it seems that clinical judgment about the net effect of allopurinol on prevention of post ERCP pancreatitis is doubtful. In this randomized double blind clinical trial, effect of allopurinol on prevention or alleviation of clinical and laboratory signs of pancreatitis has been evaluated in 74 patients undergoing ERCP. Results showed that there is not any difference between allopurinol and placebo in occurrence and severity of post ERCP pancreatitis (P=0.97). Also there is not any significant difference in amylase rises between 2 groups in 8 and 16 hours after ERCP (P=0.947, 0.287 respectively). Beneficial effects of allopurinol in some of the previous studies may be attributed to its active metabolite (oxypurinol). Further studies recommended about the net effect of allopurinol and oxypurinol in the complication. https://acta.tums.ac.ir/index.php/acta/article/view/3799 https://acta.tums.ac.ir/index.php/acta/article/download/3799/3774

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 584 587 EN Ali Asghar Alavi Department of Thoracic Surgery, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Eshraghi Department of Thoracic Surgery, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Bagher Rahim Department of Thoracic Surgery, Tehran University of Medical Sciences, Tehran, Iran. Ali Pasha Meysami Department of Social Medicine, Tehran University of Medical Sciences, Tehran, Iran. Afsaneh Morteza Farzan Clinical Research Institute, Tehran, Iran. Hanieh Hajian Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Malignant pleural effusion is a common complication in certain malignancies. Pleurodesis is the best option most of the time. The purpose of this study was to compare the choice of belomycin with povidone-iodine, which is not only determined by the efficacy of the agent but also by its cost, accessibility, safety, ease of administration and the number of administrations to achieve a complete response. We performed a randomized clinical trial on 39 patients presenting with symptomatic malignant pleural effusion. Patients were selected and randomly assigned to undergo chemical pleurodesis with either bleomycin or povidone-iodine. Primary characteristics of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. A complete response was obtained in 79% of belomycin group and 75% of povidone-iodine group which was not statistically significant. Patients on belomycin treatment had a significantly lower score for dyspnea in one month follow up. This was significant after controlling for age, pain score and dyspnea score after drainage, using general linear model. Due to similar effect and significant cost advantage between bleomycin and povidone-iodine, we conclude that povidone- iodine is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions. https://acta.tums.ac.ir/index.php/acta/article/view/3800 https://acta.tums.ac.ir/index.php/acta/article/download/3800/3775

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 588 591 EN Reza Nafisi-Moghadam Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mahrooz Malek Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran. Farzaneh Najafi Department of Nephrology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Behzad Shishehsaz Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2015 09 28 Urinary tract infection is a common pediatric problem and vesicoureteral reflux is its most common complication. Detection of this reflux has classically been achieved by voiding cystouretrography (VCUG). Ultrasonography for evaluation of vesicoureteral reflux is shown to be feasible but is not widely accepted. Our aim was to assess the value of routine sonography in detecting vesicoureteral reflux is young children with urinary tract infection. This study was carried out in 105 patients suffering from urinary tract infection admitted to Shahid Sadughi Hospital in Yazd, Iran. These patients were evaluated by two methods (sonography and VCUG). Overall sensitivity and specificity value of sonography in suggesting vesicoureteral reflux were 63% and 95% respectively. The most accurate results were obtained with high grades reflux (75% and 955). The results reconfirmed that sonography is reliable in the exclusion or verification of high grade reflux and it has a low sensitivity in low grade vesicoureteral reflux. https://acta.tums.ac.ir/index.php/acta/article/view/3801 https://acta.tums.ac.ir/index.php/acta/article/download/3801/3776

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 592 597 EN Firoozeh Sajedi Pediatric Neurorehabilitation Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran. Zahra Kashaninia Department of Nursing, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran. Samaneh Hoseinzadeh Department of Biostatistics, Tarbiat Modares University of Medical Sciences, Tehran, Iran. Akram Abedinipoor Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran. 2015 09 28 This study was conducted to determine the effect of Swedish massage on blood glucose level in children with diabetes mellitus (DM). It was prospective randomized controlled trial study that conducted on 36 children, 6-12 years old with DM, recruited from a hospital in Qom City, Iran. The children were randomly assigned to intervention and control groups. Swedish massage was performed 15 minutes, 3 times a week, for 3 months in intervention group. The blood glucose levels were evaluated immediately after every session of massage in two groups. The mean ages of children in the intervention (n=18) and control (n=18) groups were 9.05±1.55 and 9.83±2.03 years respectively. There was statistically no significant difference in blood glucose levels before intervention between two groups (P=0.586), but the blood glucose levels were lower significantly in intervention group in comparison with control group after intervention (P<0.0001). Addition of Swedish massage to daily routines; exercise, diet and medication regimens, is an effective intervention to reduce blood glucose level in diabetic children. https://acta.tums.ac.ir/index.php/acta/article/view/3802 https://acta.tums.ac.ir/index.php/acta/article/download/3802/3777

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 598 605 EN Mohammad Saleh Ganjavian Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamid Behtash Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Ameri Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Khakinahad Department of Spine Surgery Fellow, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis (AIS) and careful application of pads on apical segment of curve is very important for correction. Control of pads` appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases (182 female, 33 male) of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2±1.8 years (9-16) and mean duration of follow-up was, 16.1±16.4 months (0-114) that treated by 4 type of brace; 89 with type 1(Milwaukee with metal pads), 87 with type 2 (Milwaukee with simple pads), 17 with type 3 (Boston with metal pads) and 22 with type 4(Boston with simple pads). Cobb angle recorded at 5 stages (initial, best, wean, stop and final follow-up). Mean initial Cobb was 36.2˚, at stop stage, 35.2˚ and reached 38˚ at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients (27.4%) underwent spinal fusion that for brace type 1 to 4 , was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50˚, at follow-up, 12 were ≥50˚ or had spinal fusion. Correction of lumbar (P=0.008) and main thoracic curves (P=0.002) was better by Boston than Milwaukee, however, In general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use. https://acta.tums.ac.ir/index.php/acta/article/view/3803 https://acta.tums.ac.ir/index.php/acta/article/download/3803/3778

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 9 2011 09 15 606 611 EN Mohsen Akhavan SepaCenter for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. Alireza Abdollahi Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. Koosha Paydary Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. Pegah Valiollahi Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. SeyedAhmad SeyedAlinaghi Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. Maziar Parsa Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. Sirous Jafari Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6%) subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU) men and one was a rural woman. Considering both prevalence rates of Brucella infection (3%) and symptomatic brucellosis (0.1%) in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors. https://acta.tums.ac.ir/index.php/acta/article/view/3842 https://acta.tums.ac.ir/index.php/acta/article/download/3842/3817

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 12 2011 12 15 806 809 EN Mostafa Mirshams Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Razzaghi Department of Plastic Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Pedram Noormohammadpour Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zahra Naraghi Department of Pathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kambiz Kamyab Department of Pathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sara Sabouri Rad Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Squamous cell carcinoma (SCC) is the second most common type of skin cancer with potential risks for metastasis and recurrence if left untreated or incompletely excised. This case series study was designed to determine the frequency of incompletely excised SCCs and the related risk factors. A total of 273 SCCs (253 patients) excised in Razi dermatology hospital of Tehran from 2006-2008, were evaluated and were analyzed by Chi-square or t-test. The incidence of incomplete excision was 17.58 % and deep margin involvement was observed in 73% of lesions. Risk factors associated with incomplete excision of SCCs were being female, location of the tumors (in particular the lesions on lateral canthus, upper lip, foot, forehead, cheek, neck, nose and ear), large lesions and grafting method of repair. There was no statistically significant difference for the age, degree of histological differentiation, childhood history of radiotherapy for tinea capitis and the type of anesthesia. More care should be taken for high risk SCCs as complete excision avoids potential risk of recurrence and metastasis. https://acta.tums.ac.ir/index.php/acta/article/view/3843 https://acta.tums.ac.ir/index.php/acta/article/download/3843/3818

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 12 2011 12 15 810 813 EN Saeed Kargar Department of Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran. Hassan Salmanroughani Department of Gastrointestinal, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Science and Health Services, Yazd, Iran. Fariba Binesh Department of Pathology Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Science and Health Services, Yazd, Iran. Shokoh Taghipoor Department of Pathology Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Science and Health Services, Yazd, Iran. Shady Kargar Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran. 2015 09 28 Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management. https://acta.tums.ac.ir/index.php/acta/article/view/3844 https://acta.tums.ac.ir/index.php/acta/article/download/3844/3819

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 12 2011 12 15 814 817 EN Majid Nejati Reference Laboratory, School of Medicine, Kashan University of Medical Science, Kashan, Iran. Vahid Nejati Department of Cognitive Science, Faculty of Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Reza Mohammadi Department of Psychiatry, School of Medicine, Tehran University of Medical Science, Tehran, Iran. 2015 09 28 One of the main problems of the drug abusers is drug related attention bias, which causes craving, and as a result drive the drug abusers to take narcotics. Methadone is used as a maintenance treatment for drug abusers. The purpose of this study is evaluation of the effect of Methadone maintenance therapy (MMT) on selective attention and drug related attention bias. This study investigated drug cue-related attention bias and selective attention in 16 methadone-maintained patients before and 45 days after methadone therapy period. Stroop color-word test and addiction Stroop test were used as measurement methods. Results show less reaction time and higher accuracy in Color-Word Stroop Test after MMT and less delay for addict related word in addiction Stroop test. It is concluded that methadone can improve selective attention capability and reduce drug related attention bias. https://acta.tums.ac.ir/index.php/acta/article/view/3845 https://acta.tums.ac.ir/index.php/acta/article/download/3845/3820

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 49 12 2011 12 15 818 823 EN Heshmat Moayeri Department of Pediatric Endocrinology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zohreh Oloomi Department of Pediatric Hemato-Oncology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Saudatu A. Sambo School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Calcium metabolic disorders, such as hypercalcemia is a potentially life-threatening disorder especially when coupled with an already compromised condition. The aim of this study was to determine the prevalence of metabolic calcium disorders in childhood cancers of patients admitted to the pediatric ward of Vali-Asr Hospital from the year 2001-2008. The study was carried out by reviewing hospital records of these patients from the hospital archives. Range of age was between 1 and 18 years. Inclusion criteria for the study population were the presence of total serum calcium evaluated at least once; and for the hypercalcemia subgroup, at least two occasions of elevated calcium levels. The prevalence of hypercalcemia and other metabolic abnormalities of phosphorus, alkaline phosphatase, urea and creatinine; the prevalence of parameters such as age, gender, type and duration of cancer were determined within these groups. Median of elevated calcium levels was also determined to classify hypercalcemia into moderate and severe hypercalcemia. Median was 11.7 mg/dl, therefore, severe hypercalcemia was ≥11.7mg/dl and moderate hypercalcemia, a range between the upper limit of normal, 10.8 and 10.2 mg/dl for the child and adolescent respectively, and 11.7 mg/dl. Relationship between hypercalcemia and the other metabolic disorders and parameters were analyzed by the SPSS V.17 program. The population of study consisted of 148 cases. Hypercalcemia was found in 8 (5.4%) patients. Half of the cases were associated with severe hypercalcemia and acute lymphoblastic leukemia (ALL). Out of 148 cases, there were 92 (62%) boys and 56 (38%) girls. Mean and median ages were 10.9 and 11 years respectively. Mean duration of cancer was 12.8 and median 6 months. There were 57 (38.5%) cases of leukemia and 91 (61.5%) cases of solid tumors. The most common cancers were ALL, 44 cases (29.7%) followed by brain tumors, 19 cases (12.8%); non-Hodgkin's lymphoma, 16 cases (10.8%); 13 cases of acute myeloid leukemia (AML) (8.8%); 13 cases of Ewing sarcoma (8.8%); osteosarcoma, 9 cases (6.1%); Hodgkin's lymphoma, 6 cases (4.1%); others, 19.1%. There was no significant difference between hypercalcemia and the metabolic disorders and parameters. Metabolic calcium disorder, especially hypercalcemia, is not a rare finding in pediatric cancers. ALL, the commonest pediatric cancer, is most often associated with this disorder. https://acta.tums.ac.ir/index.php/acta/article/view/3846 https://acta.tums.ac.ir/index.php/acta/article/download/3846/3821

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