Acta Medica Iranica
Volume:46 Issue: 2, Feb-Mar 2008

We examined the demographic characteristics of couples, ovarian response and sperm quality to determine the predictors of clinical fertilization in IVF cycles. A descriptive and analytic study was conducted using data and biologic specimens obtained Fatemeh-Alzahra of Babol infertility center from 2004 to 2005. Only data from 315 women who had medical indication for conventional IVF treatment were included in the analysis. Treatment using ICSI was excluded. In the univariate analysis, the following variables affected on fertilization rate: the length of infertility, the number of IVF cycle, basal LH serum on 2 days, the number of administration of hMG, the duration of ovarian stimulation, the number of follicles, the number of oocytes retrieved, the number of oocytes stage II and III, sperm count, sperm motility, sperm grading III and IV. In the multivariate analysis, the strongest predictor of positive fertilization was the mean number of oocytes retrieved. Also, the mean number of oocytes stage II and stage III were positive predictors of fertilization. The mean of basal LH serum on day 2 and the mean duration of ovarian stimulation were negative predictors of fertilization Ovarian response to gonadotropins and the quality of oocytes were main predictors of fertilization. Although some parameters of sperm quality were significant variables of fertilization rate in univariate analysis, in multivariate analysis one''s effects were negligible. This information should be used when selecting couples for IVF cycles or oocytes for fertilization to raise the rate of clinical fertilization.

A significant reduction in arterial blood oxygen saturation during fiberoptic bronchoscopy has been proved but it is not yet known whether all patients need supplemental oxygen during this procedure. The aim of study is to examine the relationship between peak expiratory flow rate (PEFR) before bronchoscopy and oxygen desaturation during bronchoscopy. Measurement of PEFR (% predicted) performed before bronchoscopy and arterial O2 desaturation was assessed with a pulse oximeter during bronchoscopy. Study performed in 66 patients with a median age 53 years, who had been referred to our bronchoscopy unit. None of the patients received supplemental oxygen before the procedure. Thirty nine cases (59%) had an episode of O2 desaturation during bronchoscopy. Of them 25 cases (38%) had sustained O2 desaturation, requiring oxygen therapy while 14 cases (21%) had momentary desaturation (< 20s) not requiring O2 therapy. Oxygen therapy was administered in 58% of cases with PEFR % < 60 and in 83% of cases with PEFR % less than 45 (P, 0.008 and 0.001, respectively). We also observed a significant fall in mean O2 saturation during bronchoscopy (88 ± 4 %) compared to prebronchoscopy levels (95 ± 2 %) (P < 0.0001). It is concluded that PEFR < 60% and especially < 45% is a reliable predictor of hypoxemia and the need to O2 therapy during bronchoscopy.

Alzheimer''s disease is the most common degenerative disease of brain. Nowadays, the most common treatment being used to slow down disease progression, include Donepezil, Rivastigmine and Galantamine, which all of them act as inhibitors of acetyl cholinesterase. General purpose of our study was to show effects of treatment with Donepezil and Rivastigmine, as two drugs that commonly used for treatment of AD in Iran and to compare these effects between two drugs. Samples selected from patients who had Alzheimer` disease with DSM IV criteria and were candidate of receiving Donepezil or Rivastigmine, as treatment of AD, for the first time. We used four neuropsychological tests including MMSE, NPI, Clock and Bender to assess patient''s cognitive and behavioral changes during treatment with two drugs. Patients divided to two groups (each group 35 cases); Patients with plan of taking Donepezil entered into one of the groups and patients with plan of taking Rivastigmine entered into another. The four tests were completed once before starting treatment and then, 1 month, 3 months and 6 months after treatment with Donepezil and Rivastigmine. MMSE, 6 months after treatment with Donepezil, improved from 20.63 before treatment to 21.83, which is statistically significant (P = 0.04). Also, MMSE, 6 months after treatment with Rivastigmine, improved from 20.03 before treatment to 22.71, which was statistically significant (P = 0.007). About Clock test, there was a significant improvement from 5.74 before treatment to 6.4 after 6 months of treatment with Rivastigmine; while this significant improvement was not seen in patients receiving Donepezil. In two other tests, no significant differences were seen before and after treatment. Also, No significant difference was detected between two groups and so no different effects on these tests between Donepezil and Rivastigmine in 6 months period of treatment.

The identity of dead is an essential part of post-mortem examination. The identification of unknown human remnants begins with the creation of an anthropological profile, which includes sex, biological age, stature and individualizing features. The estimation of age at death is based on the bodily biological changes that occur throughout life. Closure of spheno occipital synchondrosis is one of factors used for age estimation although its importance and reliability has been challenged with different authors. We studied its closure time among Iranian 8 to 26 years old male cadavers with direct inspection during autopsy. We divided synchondrosis situation depending on its fusion state into three categories: open, semi closed and closed. During 2004-5, 106 cases studied. Mean age of open, semi closed and closed were 12.78, 16.86 and 21.36 years, respectively. Their difference was significant (p< 0.05). Partial fusion (semi closed) was seen at 12 years while complete fusion (closed) should be 15 years or above. Spearman''s correlation ratio coefficient showed linear correlation between age and suture situation (rho = 0.684, P < 0.05). Our results showed that closure of spheno occipital suture can be used as a good indicator for age estimation in males. With sensitivity of 88.31% and specificity of 79.31% males can be correctly grouped above or below 16 years.

Hematopoietic cell transplantation (HCT) is an accepted treatment for acute myeloid leukemia (AML) in first remission, the treatment of choice for chronic myeloid leukemia (CML) and high risk groups of ALL who relapse with conventional chemotherapy. We assessed results of HCT for pediatric leukemia in our center. A total of 92 children, 63 with diagnose of AML, 23 with ALL and 6 with CML received allogeneic transplantation from HLA full matched siblings (57.6%) and autologous transplantation (42.4%). Source of hematopoietic cells were peripheral blood 83.7%, bone marrow 15.2% and cord blood 1.6%. The median transplanted nucleated cells were 6.4 ± 4.7 ×108 /Kg (body weight of patients) and mononuclear cells were 5.5 ± 2.9×108/Kg. The most common conditioning regimens were cyclophosphamide + busulfan. Prophylaxis regimen for GVHD was cyclosporin ± methotrexate. GVHD occurred in 50 (54.3%) patients. Eighty five of children had engraftment, 26 (28.6%) relapsed and 57 (62%) are alive. The most common cause of death was relapse (68.6%). Five years overall survival of patients with AML and ALL were 49% and 44% respectively and disease free survival of them were 52% and 49%. One year overall survival and disease free survival of CML was 57%. Overall survival increased with increasing age of patients at transplantation time (P = 0.06). Longer survival significantly related to earlier WBC and platelet recovery (P < 0.0001 and P = 0.006 respectively). Considering acceptable overall and disease free survival of patients after HCT, we concluded that is a good modality in treatment of leukemia of children.

Foreign body aspiration of airways is very dangerous and sometimes fatal. Early diagnosis and rapid management is vital. The goal of this study was to determine the clinical characteristics, radiologic findings and the results of bronchoscopic treatment of children due to foreign body aspiration of airways. Medical records of 101 bronchoscopic proven foreign body inhalators were reviewed in Ghods children hospital an affiliate to Ghazvin Medical University from 1995 to 2005. All of foreign bodies were removed with a rigid bronchoscope under general anesthesia. Patients were analyzed for age, sex, symptoms, clinical manifestation, radiologic findings and results of bronchoscopic removal. Data were analyzed with statistical methods. There were 66 (65.3%) boys and 35 (34.7%) girls. The male to female ratio was 1.8:1. Their ages ranged from 9 months to 12 years and the mean was 44.5 ± 37 months. 73 (72.3%) of children were less than 3 years old. A clinical history of foreign body inhalation was obtained in 58(57.4%). The most frequent symptoms and physical findings were cough 91(90%), wheezing 40(39.6%) and decreased of pulmonary sounds 37(36.6%). 24(23.8%) of children had abnormal chest radiography. 86(85.1%) of the foreign bodies were of vegetative origin. Roasted seeds, almond and walnut were the most common. In 51(50.4%) of the cases the foreign bodies were located in the right bronchial tree. The mortality was 1(0.9%). This study revealed that the most common signs and symptoms of foreign body aspiration are cough, wheezing and decreased breath sounds. For definitive diagnosis bronchoscopy is necessary.

Veterans with Post Traumatic Stress Disorder (PTSD) suffer from distressing and disabling symptoms. Many studies have shown that PTSD symptoms can negatively influence quality of life of their partners. This study was designed to assess general health, marital satisfaction and self-esteem levels of partners of Iranian veterans with PTSD. We performed a case-control study. Cases were comprised of 40 partners of veterans with PTSD. Controls were comprised of 40 married women referred to general health center in Rasht city. Three self report psychometric inventories including General Health Questionnaire (GHQ28), Evaluating and Nurturing Relationship Issues, Communication and Happiness questionnaire (ENRICH) and Cooper-Smith inventory-adult form were applied assessing general health, marital satisfaction and self-esteem levels in our subjects. Mean score of GHQ28 questionnaire was 39.77 ± 20.96 in case group and 17.12 ± 9.08 in control group (P = 0.0001, t = 6.269). Average scores of ENRICH questionnaire in case and control groups were 133.7 ± 28.05 and 165.90 ± 31.10 respectively (P = 0.0001, t = 4.861). Mean score of Cooper-Smith test was 29.62 ± 7.89 in cases while it was 39.92 ± 6.36 between controls (P = 0.0001, t = 4.551). We concluded that partners of veterans with PTSD significantly showed lower levels of general health, marital satisfaction and self-esteem than other women. In general, our results demonstrated that partners of veterans with PTSD had lower levels of quality of life comparing other women.

Adverse lifestyle changes like rapid change in dietary habits coupled with decreased physical activity and increasing rates of alcohol and tobacco consumption can increase Coronary Artery Disease risk factors and its mortality even higher than the rates predicted. To evaluate the role of Adverse Lifestyle changes factors in the causation of CAD, a hospital based case-control study was conducted in an urban area of East Delhi from April 2002 to December 2003. A total of 500 subjects with age group 30-75 (250 cases and 250 controls), were included in this study. To obtain more validate comparisons, 250 controls also was selected from community of East Delhi. The tool of enquiry was a pre-tested and pre-coded questionnaire. A confidence level of 95% and study power of 80% were considered for the interpretation of possible significant findings. Sexwise stratified analysis was separately done for male and female subjects using Multiple Logistic Regression. Comparison of male cases with their counterparts in both control groups indicated that milk consumption, using saturated oils for cooking medium, and tobacco consumption could account for as CAD independent predictors (P < 0.001). The comparison of female cases with their counterparts in both control groups also showed that majority of those significantly were nuts consumer (P < 0.01). Male cases compared to males in hospital group and female cases compared with females in community control group significantly were nuts consumer and used saturated oils in their cookings respectively (P < 0.01). Our study showed that dietary factors such as consumption of milk, nuts, saturated oils and smoking, as misbehavior factor, could play an important role in the causation of Coronary Artery Diseases (CAD) in urban area of East Delhi, India.

Midgut malrotation is typically presented during the first few months of life but sometimes may encounter later in life, causing difficulties and mistakes in diagnosis. We reviewed records of eleven rare patients with midgut malrotation older than one year of age and extracted their clinical and paraclinical data. The most common presenting symptoms were bilious vomiting, recurrent abdominal pain and constipation. Five of eleven patients had presented from neonatal period. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Some of the patients had been undergone false treatments. Most cases were diagnosed by contrast studies (upper gastrointestinal series and barium enema). Diagnosing midgut malrotation in older children is often delayed. This anomaly should be suspected in all children with signs and symptoms of small bowel obstruction, chronic abdominal pain and vague abdominal discomfort and in all patients of any age with abdominal discomfort who do not respond to other therapies. Contrast studies may be necessary to rule out malrotation in suspected patients.

Life-long red blood transfusion remains the main treatment for severe thalassemia. The development of hemolytic alloantibodies and erythrocyte autoantibodies complicated transfusion therapy in thalassemia patients. The frequency causes and prevention of this phenomenon among 80 transfused thalassemia patients were evaluated in Ali Asghar Children''s Hospital during 1998-2004 in a cross-sectional study. In our study the mean age at the initiation of transfusion was 1.7 years (SD = 1.94) and mean interval of transfusion 33.73 day (SD = 20.74). Autoimmunization in 15 patients was positive and 8 patients had hemolytic reaction in transfusion. Our data show that alloimmunization to minor erythrocyte antigens and erythrocyte autoimmunization of significant clinical variables, are frequent findings in transfused thalassemia patients. However data suggest that prevalence of immunization in our patients is less than other Asian countries.

Adjustment of composition of body fluids and electrolytes is one of the most important aspects of patients care. Sodium and Potassium are the most important body cations, the improper adjustment of them will cause sever disorders in neuromuscular, gastrointestinal, respiratory and cardiovascular systems. Acute renal failure indicated by increase in creatinine and nitrogen urea, brings an accumulation of fluids, salts and metabolites of nitrogen in body. This study intends to assess the status of electrolyte abnormalities and mortality rates of the patients hospitalized in ICU wards in our country. This is a descriptive and retrospective study on the records of 378 patients hospitalized in ICU. A questionnaire was prepared and the data were entered in SPSS system. They were statistically analyzed by using chi-square and fisher''s Exact test methods. Out of 378 patients hospitalized in ICU, over 2/3 of them were male and over half of them were>45 years old. Frequency distribution of electrolyte abnormalities was as follows: Hyponatremia 59% hypernatremia 23% hypokalemia 37% hyperkalemia 28%, 35% and 21% of patients had respectively BUN and creatinine more than the normal range. 26% of patients hospitalized in ICU had nonsurgical problems and 74% of the patients had surgical problems. Average time of hospitalization in ICU was 85 days and mortality rate was 35%. The most common electrolyte abnormality was related to variation in serum sodium levels in the form of hyponatremia. And the highest prevalence electrolyte abnormality in dead patients was hyponatremia. This study proves that the prevalence of electrolyte abnormalities is directly related to mortality and increase in hospitalization period and those having undergone surgical operations during hospitalization in ICU, manifested more abnormalities.

Elevated total plasma homocysteine (tHcy) levels constitute a risk factor for coronary artery disease (CAD). A possible relationship was investigated between admission plasma homocysteine level and the angiographic severity and extension of coronary artery disease in patients with CAD. This study looks at the relationship between total plasma homocysteine and severity of coronary artery disease. From April 2006 to December 2006, 100 consecutive patients (65 male and 35 female) that referred to our institute for coronary artery bypass graft surgery enrolled. Fasting blood samples for homocysteine were obtained on admission. Plasma homocysteine concentration was measured with high-performance liquid chromatography (HPLC). Our patients presented in Group 1, total plasma homocysteine >12 micromoles per liter and Group 2, total plasma homocysteine =<12 micromoles per liter. Vessel score assessed the number of vessels with significant stenosis and grading of atherosclerosis (Extent Score) was intended to assess the atherosclerotic involvement of the entire arterial length and circumscribe. Our study was shown age > 60 years was correlated with high tHcy, but gender, hypertension, history of smoking, hypercholesterolemia, family history, and diabetes mellitus were not statistically difference between two groups. A positive correlation was found between abnormal plasma homocysteine level and vessel score (r = 0.35; p=0.002). Moreover, a positive correlation was also found with extent score (r = 0.46; p =0.002). As results of these scoring, there was a better correlation between the tHcy level and the extent of CAD when compared with the vessel score (r = 0.68, p < 0.001). Abnormal elevated homocysteine levels in patients with coronary artery disease correlated with the extent of atherosclerotic disease.

The mothers may be infected during pregnancy with infectious agents. Mumps induced myocarditis, especially endocardial fibroelastosis, was previously a common disease of infants but is rare now. A 25 day old male infant admitted to the intensive care of our hospital because of cardiogenic shock. Further studies revealed ischemic electrocardiograms, poor ventricular function, and positive results by polymerase chain reaction (PCR) technique for mumps virus. Regarding this case, although is very rare but mumps myocarditis should be included in the differential diagnosis of left ventricular dysfunction in neonatal period.

Appendicovesical fistula is an uncommon type of enterovesical fistula and a rare complication of unrecognized appendicitis. Appendicovesical fistula often presents with recurrent or persistent urinary tract infection, especially in men. The commonest causes are appendicitis, cecal diverticulitis, and cystadenocarcinoma or carcinoid tumors of appendix. Approximately 114 cases have been reported previously in the literature, the vast majority in young male patients. Our special case joins the other cases which have already been described in the international literature. This case is a middle-aged man and is the first who has large and multiple fecaliths. We reviewed other cases and contributed an additional one with hope that increased awareness of this entity may facilitate the correct diagnosis and avoid inappropriate management.

Cartilaginous tumors comprise 1% of all laryngeal masses. Since they grow slowly and metastasis is rare, long term survival is expected in cases of chondroma and chondrosarcoma. Thus, based on these facts and the fact that total salvage surgery after recurrence of previous tumor does not influence treatment outcomes, "Quality of Life" must be taken into great consideration. Based on 3 cases of limited condrosarcoma that we have successfully operated on using submucosal delivery through a parapharyngeal approach, after several years of recurrence free follow ups, authors determine this technique as an efficient method of approach to these tumors. Since this technique takes less time and there is no need for glottic incision and the patient is discharged in 2 days without insertion of endolaryngeal stent, we believe this method is superior to laryngofissure or total laryngectomy.