Shiraz Emedical Journal
Volume:10 Issue: 2, Apr 2009

During the Iraq-Iran war of 1980 -1988, the most commonly used chemical warfare agents (CWA) were nerve agents and sulfur mustard gas (SM). SM was used frequently as a chemical weapon by Iraq during the war against Iran, and had deleterious effects on Iranian military troops and the unprotected inhabitants of Sardasht, Iran and Halabche, Iraq. In this report, we review the scientific literature to develop an understanding of the health consequences that victims from both countries experienced as a result of exposure to SM. Currently, 45 000 Iranians are suffering from the long-term effects of mustard gas, which includes cutaneous, respiratory, cardiovascular, neuromuscular and ocular complications. Because many of the health consequences associated with SM exposure have a late onset, and because these effects can drastically reduce quality of life, it may be necessary to instruct military experts to equip and train local chemical and biological response teams in order to establish strategies for inhibiting the production and use of chemical weapons. In addition, it is highly recommended that any remaining chemical weapons existing around the world are safely destroyed.

Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal side effects. The aim of this study was to compare the effects of the combination of ephedrine crystalloid and prehydration with crystalloid alone on maternal blood pressure and neonatal outcome during cesarean section under spinal anesthesia. We enrolled 72 full term women weighing between 50 and 75 Kg, classified as ASA I, scheduled for elective caesarean section under spinal anesthesia. Participants were randomly allocated to either the ephedrine or crystalloid group. After arrival in the operating room and intravenous (IV) access, 10 ml/Kg of ringer solution was infused 10-15 minutes before the initiation of the spinal block, but in the ephedrine group, an additional 10mg of ephedrine was added to the solution for infusion. In the crystalloid group, a placebo was added to the solution. Hypotension occurred in 55.6% of patients in the crystalloid group and in 25% of patients in the ephedrine group. The difference between the two groups was found to be statistically significant (P = 0.008), however, there was no significant difference in mean systolic blood pressure between the two groups (105.61± 7.13 in crystalloid group vs. 107.89 ± 9.84 in ephedrine group). Apgar scores in newborns were above 8 in both groups. Prophylactic ephedrine given by infusion in combination with crystalloid was more effective than crystalloid prehydration in the prevention of hypotension during spinal anesthesia for elective caesarean section.

Despite the same complications for LD and triphasic pills, it seems as if the continuation times for the two birth control methods are different. To compare the continuation times and side effects of triphasic and monophasic LD use, and identify factors related to continuation and discontinuation.Methods and Materials: A historical cohort study was conducted in Isfahan, Iran to determine and compare the probability of 5 years continuation of low dose monophasic (223) and triphasic (163) use among 386 reproductive married women. Statistical analysis used: The continuation time of triphasic pill and LD pills were compared with Kaplan Meier by SPSS11.5 software. The cumulative proportion of continuation was significantly different between triphasic and LD groups in the first year of use [0.98 (LD) VS 0.84 (tri phsic)]. It was found that age, number of living children, education level and employment status didn’t have any role in choosing contraceptive method (p>0.05). In each group there was a significant relationship between these variables and median duration of OCP use. Despite similar complications and total discontinuation, 5 year continuation time of triphasic was lower than that observed for LD. It seems as though consumption of triphasic OCP requires more attention, as it should be taken on a regular schedule, and missing a dose for more than two hours reduces its efficacy. Therefore, health care professions should consider more factors before offering clients triphasic pills in order to reduce discontinuation time.

Preterm births (before 37 completed week gestation) account for approximately 5-10% of births and are the major cause of perinatal mortality in North America and Europe. This is largely because of a lack of standard treatments for this problem, therefore, the aim of this study was to compare glyceryl trinitrate with magnesium sulfate for their ability to suppress preterm labor. A clinical trial was performed at the Ali Ebne Abitaleb Hospital, in the Zahedan University of Medical Science. In total, 42 women with preterm labor and intact membranes with a gestational age between 27 and 37 weeks were divided into two groups at random. Patients in the experimental group received glyceryl trinitrate (5mgr transdermal patches /24 hours) and in the control group, magnesium sulfate (at first 4 gr infusion: 1gr/min and then 2gr/hour) was used until the suppression of preterm uterine contractions was observed. Results were obtained through observation and interview forms, and the resulting data was analyzed using chi square and T tests available in the SPSS statistical software (P <0.05). Mean duration of pregnancy prolongation was 14.87 days in the case group (min: 11 max: 59.38 SD: 14.28) and 13.44 days in the control group (min: 26 max: 36.63 SD: 14.77). There was no significant difference in the prolongation of pregnancy between glyceryl trinitrate and magnesium sulfate (P<0.05). Glyceryl trinitrate is a suitable substitute for magnesium sulfate in the suppression of preterm labor.

To evaluate the effects of sperm morphology on the success rate of IUI. This was a prospective study of 200 couples who underwent IUI in order to improve the likelihood of conception. The patients were divided into 2 groups, one consisting of 100 patients with a normal sperm morphology of ≤20%, and the other consisting of 100 patients with a normal semen morphology of >20%, and an otherwise normal semen analysis. A total of 59 clinical pregnancies were obtained for a pregnancy rate / cycle of 10.5%. No significant differences were found between the two groups examined. There are no substantial differences in the success of intrauterine insemination when normal sperm morphology in semen analysis is more than 20% compared to when it is less than 20%.

The case presented involves a thirty-eight year old woman with endometriosis, who was diagnosed by laparoscopic visualization and histopathological confirmation. After one year, and while the patient was on infertility work-up, she referred to a gastroenterologist from the gynecologic clinic because of palpable bulging and nodules discovered in a pelvic exam. Colonic involvement was detected by colonoscopy and endosonography. A pathology report of sections of the colonic mucosa revealed deciduosis (endometriosis). This incidence of this type of endometriosis is quite rare, and involves extensive involvement of colonic mucosa. We recommend careful pelvic examination and rectovaginal palpation in endometriosis patients even if they appear asymptomatic for gastrointestinal complications.

A review of the literature suggests a potential association between celiac disease and inflammatory bowel disease (IBD), which may explain why both disorders are often present concurrently in one patient or in her/his first-degree relatives. In addition, a wide spectrum of liver injuries in patients may be related to celiac disease, including: Reactive hepatitis, autoimmune liver diseases, acute liver failure, cryptogenic cirrhosis and hepatocellular carcinoma. Mangiagli et al (2) reported a case of celiac disease in an adolescent with thalassemia major characterised by anorexia, arrest of weight gain and short stature. Another case of celiac disease and thalassemia major was reported in a study performed by Acquaviva (1) in Italy. Revealing the association between celiac disease and β-thalassemia highlights why a low threshold for the diagnosis of celiac disease should be considered in β-thalassemia patients with a history and/or clinical indications that are suggestive of celiac disease. Likewise, it is also recommended that diagnosis thresholds are lowered for thalassemic patients who present with short stature. Patients with celiac disease have a greater predisposition to IBD and liver involvement. Therefore, we also recommend colonoscopy and screening for asymptomatic and symptomatic liver diseases in celiac patients, as well as screening for celiac disease in all patients with IBD and autoimmune or cryptogenic liver disorders.

Skin infiltration in leukemia occurs rarely. Leukemia cutis has a wide range of cutaneous manifestations from maculopapular to tumorous stage. Patients with Leukemia cutis usually have concomitant systemic leukemia, but occasionally skin involvement precedes the involvement of the bone marrow or peripheral blood. Complete remission could be achieved with chemotherapy, however, the long term prognosis is poor.