Journal of Kermanshah University of Medical Sciences
Volume:11 Issue: 1, 2007

Hypertension as a major coronary artery disease (CAD) risk factor is more prevalent in Iran. In recent years, the effect of antioxidants in reducing CAD and their risk factors has been considered. Therefore, this triple blind placebo-controlled clinical trial was performed to determine the effects of antioxidant vitamin E on blood pressure in patients with mild hypertension. 70 subjects with mild hypertension (SBP: 140-160 mmHg, DBP: 90-100) and without secondary hypertension who were referred to hypertension unit in Isfahan Cardiovascular Research Center were recruited. All subjects were aged between 20 and 60 years old with only one cardiovascular risk factor. They were divided randomly into two sub-groups of supplement or placebo. Two sub-groups were matched for confounding factors such as job, age, sex, religion and education level. Supplement group was received 200 IU/day vitamin E tablet and placebo group was received a placebo tablet per day for 27 weeks. At the beginning and at the end of the study, the vitamin E level was measured using Hansen & Warwick method by flourometric method in all subjects. Blood pressure and heart rate were measured at the beginning; during and at the end of the study by a physician using the same sphygmomanometer. At the end of the study, it was found that the vitamin E supplement decreased 24% systolic blood pressure compare to 1.6% in placebo group (p<0.05. Diastolic blood pressure was decreased 12.5% in supplement and 6.2% in placebo group after 27 weeks (P<0.05). It is concluded that 200 IU/day vitamin E supplement as decreases mild hypertension may be the cause of increasing long term availability of nitric oxide and its influences to monitor blood pressure.

Accurate estimation of gestational age (GA) early in pregnancy is necessary for obstetric care decisions and for determining fetal growth and other conditions that may need intervention or delivery. This study was aimed to compare menstrual versus ultrasound scan-based gestational age estimates of GA in Kermanshsh during 2004-2005. A diagnostic study was done on 15 to 40 weeks pregnant women with reliable and regular menstrual period who referred to Motazedi Hospital of Kermanshah. At first GA history based on last menstrual period (LMP) was recorded by a Radiologist. Then another Radiologist estimated GA based on Transverse Cerebella Diameter (TCD), Biparietal Diameter (PD) and Femur Length using ultrasound scan. The data were analyzed using descriptive and analytical statistics. The results showed that mothers age were between 17 to 40 years old. 48.7%of subjects were primi-gravida and 7.5% were five and over multi-gravida. GA results were 29.11 5.4, 28.93 5.3, 29.31 5.4 and 29.38 5.4 weeks based on TCD, BD, FL and LMP measurements respectively. The sensitivity of FL was more than other methods (86.9%) and Kappa coefficient agreement was 0.976. This study confirmed that using femur length method in clinical ultrasound scan has more sensitivity and it is better to use for estimating GA. Further study of standardization of femur length in Iranian fetus is highly recommended.

Acute rejection of renal transplant is a serious and common systemic inflammatory disorder which leads to decreasing half-life of transplant organ. Current diagnoses method is an invasive biopsy procedure on allogtraft kidney. Therefore, applying a novel and noninvasive diagnostic method such as Granzym B level in acute renal transplantation could help patients and improves survival of transplanted tissue. This study was an analytical descriptive one in which 32 patients, who underwent kidney transplantation from May to August 2003 in Uremia - Iran were studied. Five sequential blood samples from each patient between day 2 and day 20 after renal transplantation were obtained continuously. Serum levels of granzyme B were measured using immunoassay method. In addition, in case of uncertain acute rejection, needle biopsies of kidney were performed. Patients were followed up to 9 - 12 months to control function of transplanted tissue. It was shown that 13 patients (40.5 %) with mean age of 33 years and 18 months duration of hemodialysis showed stable function of transplanted tissue. The mean serum levels of granzyme B in these patients were 148+ unit/ml. 19 patients (59.9 %), mean age of 43.74 years and mean hemodialysis duration 27 months, showed unstable function of transplanted tissue. 6 patients (19%) showed acute transplant rejection and 13 patients showed other etiological reaction. The mean serum levels of granzyme B in acute rejection in the first sample was 250.20 + 46.25 units/ml (day 2-5) in the second sample was 286.50+49.92 units/m (day 6-8), in the third sample was 275.60+68.40 units/ml (day 9-11) and in the forth sample was 253.17+86.14 units/ml (day 12-16). In relation to other two groups, the difference was statistically significant (p< 0.05). The mean serum levels of granzyme B in acute rejection group, in the fifth sample was 158.17+29 units/ml (day 17-20), and there was no statistical significant difference between two groups. The study confirmed that continuous measurement of granzyme B in whole blood by immunoassay methods within three weeks after renal transplantation could be a rapid and noninvasive diagnostic method for renal transplant rejection evaluation. Significant decrease of granzyme B at the end of third week after transplantation and after treatment with anti-acute rejection medicines could be helpful to evaluate response to anti-rejection treatment of transplantation. In conclusions, measurement granzyme B offers a noninvasive diagnosing acute rejection of renal allografts.

There are two basic types of vein occlusion, Branch Retinal Vein Occlusion (BRVO), in which one of the branches of the main vein is blocked, and Central Retinal Vein Occlusion (CRVO) in which the main vein of the eye is blocked. Vein occlusions are associated with various illnesses and often occur in elderly. The etiological causes of these diseases in the young people remained controversial. The aim of this study was to investigate causes of central and branch retinal vein occlusion in young individuals. 20 patients (under 50 years old) with BRVO and CRVO were studied in Kermanshah - Iran during 1999-2003. They were referred to internal specialist for further systemic and metabolic assessment after having been diagnosed by ophthalmologist. The most common associated diseases found in these patients were hypertension, hyperlipidemia and diabetes. There was no observation of any causes in one subject. BRVO was found in 8 eyes (72.7%) with supratemporal involvement, one eye (9.1%) with inferonasal involvement, and four eyes (36.4%) with inferotemporal involvement, but no eye was found with superatemporal involvement. It was concluded that hypertension and hyperlipidemia are common causes in BRVO and CRVO diseases among young individuals in Kermanshah.

Measuring tools in each study must be evaluated themselves. The goal of present study was designing, validating, and determining the reliability of some scales, which are used for measuring concepts of behavior change theory/models. This study was a descriptive one in which, at first literature review and need assessment were done. Then designed tools were validated by face and content method. For reliability of scales 3 methods were done: 1) test-retest method for knowledge questionnaire, 2) internal consistency method for attitudinal scales, and 3) agreement method for checklists. Validity of tools was confirmed by 15 experts, and reliability coefficients (r, alpha, and kappa) for all scales of this study were high and acceptable. In most studies, designing, validating and determining the reliability of data gathering tools are time consuming and costly and if there are valid and reliable tools in different topics, we could avoid repetitious works in researches.

Serratia marcescens is a serious death-causing factor especially for premature and low birth weighted neonates, and has become an important cause of nosocomial infection over the last years. It is a motile, non-sporulating gram-negative bacillus classified in the family enterobacteriacea. This group of bacteria affect on immune system mainly in newborns. In this report, we describe the course of the outbreak we had experienced and the measures taken to control it. All of the medical records and other associated variables of patients suffered from serratia marcescens infection were studied.. Also certain procedures including cell cultures of medical equipments, water supply, sanitation of medical personels and patients, were done to find sources of the outbreak in neonatal ward (Kermanshah – Iran). 565 hospitalized patients from September 2000 till March 2001 was studied.33 patients showed positive infection results with Serration Marcescens and confirmed using blood culture (68.8%), in cerebro-spinal fluid culture (23.2%) and both methods (6.8). 13 out of 33 (39.4%) patients have died. Finally it was found that the source of infection could derive from hospital water supply since after taking preventive steps such as controlling consumed water no cases were found with Serration marcescens. This study showed that outbreak of serratia marcescens would lead to serious in the newborn infants. Marcessence infection in newborn wards is difficult to manage and may temporarily need closure of units to new admissions and care should be exercised to control the spread. Awareness of the danger for the presence of this organism in a newborn unit and controlling its spread will be necessary to prevent life threatening infection in the high risk newborn in the future.

Prevalence of traffic accident in Iran is reported to be higher than in the other countries. Health implication, social and economical costs of these accidental traumas has not been studied and documented in Kashan-Iran. The present research was conducted to determine epidemiological prevalence of traumatic patients who were referred to Naghavi Hospital of Kashan in 2005. Demographic, economic, type of trauma and number of death cases of 6415 traumatic referred patients were studied. Data was collected using questionnaire based on existing data and face-to-face interview and coded in accordance with World Health Organization classification. 4992 traumatic patients were men (77.8%) and 1423 women (22.2%)aged 27.7 ± 17.1. Traffic accident caused 47.5% of traumas of which motorcycle accident was more common (60.6%). 15-25 years old age group was more affected than the other age groups (32.7%). 36.4% of injuries was located in hand and arm regions. Majority (79.2%) of death was caused by traffic accident and the average treatment cost was 1630000 Rial ($250). The study confirmed that the most common factor of trauma was traffic accident. Traumatic accidents caused by motorcycles affect young males more frequently. It is recommended that health traffic management organization need to focus on young generation and motorcyclists to reduce traumatic accidents.

Continuing medical education (CME) is part of the process of lifelong learning that all physicians undertake. It has traditionally viewed by the medical profession in terms of updating their knowledge. Nowadays, in order to practice effectively in the National Health System, doctors need skills that extend their medical knowledge beyond updating. Educational need assessment is the most important base of planning CME program. The aim of this study was to determine the relationship between CME program and skills need of GPs. 208 GPs working in Kermanshah – Iran were selected using random systematic sampling method. Validity and reliability of questionnaire were checked before using for data collection. Skill needs arranged in 12 questions and divided into diagnostic, therapeutic and health care needs sections. Responses ranking were designed in five levels based on Likert Scale. 70% of general physician was male and 30% was female. More than 70% of participants been attended one CME program during last two years. Only 21% of CME programs were completely satisfied diagnostic needs, 25% therapeutic needs and 16.8% health care needs of attended GPs. The study showed that CME program conformity with skill needs of GPs was intermediate. It is necessary to revise CME programs, which has been done many years ego. The challenge for CME providers is to provide programs to cover skill needs for promoting community-based health view in general practitioner on the subject of improving community health and patients treatment rather than repeating traditional programs.

Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy in occupational medicine. It may be presented with numbness, tingling, and motor weakness of the hand. Repetitive hand finger motions, repeated extreme bending of the wrist as well as forceful gripping, and repeated forces on the base of the palm and wrist are occupational risk factors associated with CTS. This study was conducted to evaluate occupations of patients underwent operation for CTS in Kashan (2001-3). 75 subjects with CTS for whom operation had been performed from 2001 to 2003 were studied retrospectively. Age, sex and occupation of the subjects and their address and phone number obtained from hospital records. Additional data on their job types and daily working duration were collected by face-to-face interview. 66 of the patients (88%) were female and 9 (12%) male. Mean age of women was 43± 20 years. 64 (97%) of women were carpet weaver, and 47(71%) of them have worked more than 8 hours per day. They were weaving carpet for 20± 7 years. Seven of the men were labor and their tasks included forceful gripping. According to findings of this study CTS should be considered as a common occupational disease in carpet weavers. As carpet weaving is a traditional and common profession in Iran, further researches on relationship between CTS and carpet weaving is highly recommended.

Scoliosis is the lateral deviation of spinal column accompanied with the rotation & twisting of vertebrae on perpendiculars axis and it is one of the most common diseases in children. The importance of scoliosis as a health problem has been known in school aged children. Extensive screening programs have been implemented or are being implemented in different regions in the world. Regarding the importance of the topic and lack of such studies in the region, this study was aimed to determine the prevalence of this disease in secondary school children. This descriptive cross-sectional study was carried out on both male & female secondary school children in Kermanshah during the years 2003-4. 2194 children were selected using the randomized clustered sampling method. Then, the children were examined and doubtful subjects were referred to clinical specialist for further examinations. Collected data were analized using descriptive statistics. From 2194 studied children, 1100 children (50.1%) were male and 1094 (49.9%) were female. The mean age was 13.39±1.05 years. 95 children (4.3%) in the first stage of screening were identified as suspicious subjects. After clinical examinations, the scoliosis prevalence was confirmed in 1.05% and by adding the revised cases were 1.41%. The scoliosis prevalence was higher among girls than boys. Comparing with other area, the scoliosis prevalence in Kermanshah secondary school children was lower, but there was unusual increase in scoliosis among girls than boys, which requires further researches.

Ovako Working Posture Analyzing System (OWAS) is a method for evaluating postural load during work. The OWAS method is based on a simple and systematic classification of work postures combined with observations of work tasks. The aim of this study was the assessment of various postures during the work in iron and steel industry, Navard Ahwas, using OWAS method. In this study 15 workstations were selected for research and 900 various postures were recorded. The observed data were recorded as a five – digit codes in which digit one two, three, four, five indicated, back, arm, leg posture, the load course of force and the work phase analyzed respectively. The data was analyzed using OWAS software. The results of this study showed that Drail Radial one post (with 50% frequency) have the most frequent and unsuitable postures. The most dangerous state was found in the post of Drail Radial two, which indicated very dangerous in OWAS coding table with code four. The results of this research showed that the position of legs and back area has a significant role in increasing the code in OWAS coding table. The balance between back and legs is an efficient way to achieve a better work posture. Increasing code range for the leg and the back area leads to maximizing the risk of inappropriate body posture.

Approximately, 30-40% of general population experience at least one episode of Low Back Pain (LBP) annually. Research on LBP in adolescents is of great value, as it seems to be a major contributing factor for LBP in adulthood. This study was designed to assess LBP characteristics and its disability in Mazandaran Province secondary school children in 2004. This cross-sectional study was carried out on secondary school children aged 11-14 years old. Random multistage sampling was performed and 5000 questionnaires were distributed among schoolchildren. The assessment of LBP characteristics and its related disability were assessed using two questionnaires. A 100 mm Visual Analogue Scale (VAS) was applied for measuring pain intensity and LBP disability was measured by the nine activities using the modified Hanover LBP Disability Questionnaire. Of the original sample, 4813 (96.2%) children returned the questionnaires. Results showed that point prevalence of LBP was 15% and with 95% confidence interval for similar communities was estimated to be 14 to 16 %. 7.7% of students suffered from radiating pain to their legs. Among those with LBP, 60.4% reported that symptoms lasted 1-12 hours. 19.3% of children reported at least one episode of LBP in their life. The mean pain intensity on VAS was 32.8±20.48 mm. Of those with LBP, 100% also reported having difficulty with at least one of the nine activities on the modified Hanover LBP disability questionnaire. Sitting on a chair lasting for 45 minutes in classroom (33%) and standing up from armchair at home (5.8%) were the most and the least disabling factors respectively. The results suggested that the prevalence and disability rate of LBP in secondary schoolchildren is high. Therefore, further studies looking at the effect of different preventive strategies at home and school is recommended.

Fibrolamellar Carcinoma (FLC), a subtype of hepatocellular carcinoma (HCC), is a rare primary hepatic malignancy. Several aspects of the clinical features and epidemiology of FLC remain unclear since most literature on FLC consists of case reports and small cases series with limited information on factors that affect survival. Majority of the tumors occurred in patients less than 40 years old. This is a case report from Kermanshah University of Medical sciences. Post-operative diagnosis was confirmed of FLC and HCC in the liver. Case Report: A 25 years old man presented abdominal mass and RUQ pain with liver mass in ultrasound and CT scanning. Right lobectomy of the liver performed based on fibrolamellar carcinoma (FLC) diagnoses. 9 months after the first operation, lymph nodes metastases were removed. Nine months after the first operation and chemotherapy, a recurrence occurred in the residual liver. Based on histopathological essays, the primary tumor was diagnosed as pure FLC, but the recurrent tumors in the residual liver showed characteristics of common HCC. Thus, during repeated recurrences, histopathological features of tumor have changed from pure FLC to common HCC. Fibrolamellar hepatocellular carcinoma is a variant of hepatocellular carcinoma with distinct clinicopathologic features. It occurs at a young age and is less common risk factors for hepatocellular carcinoma like viral hepatitis and cirrhosis. Elevated alpha-fetoprotein (AFP) level is infrequent. Physical signs like pain and mass are minimal and laboratory values such as liver enzymes and serum alpha-fetoprotein, are noncontributory. Actualy diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. This study confirmed the distinctive clinicopathologic features of fibrolamellar carcinoma as reported in literature. The tumors in fibrolamellar carcinoma case was significantly larger than conventional HCC, similar findings have been reported in literature.