فهرست مطالب

Archives of Iranian Medicine
Volume:5 Issue: 2, Apr 2002

  • تاریخ انتشار: 1381/02/11
  • تعداد عناوین: 20
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  • Mohammad, Sadegh Massarrat Md•, Susan Tahaghoghi, Mehrizi Page 73
  • Fatemeh Ghaemmaghami * •_Ashraf Jamal *_Mohammad_Reza Soleimani Page 80
    Background- Considering the hazards of macrosomia and low birth weight, the estimation of birth weight before delivery is of paramount importance. An easy-to-do method of birth weight estimation is fundal height measurement using only a tape measure. In the present study, we determined the association between fundal height and actual birth weight and calculated the specificity, sensitivity and positive and negative predictive values for the method.Methods- Standard fundal height was measured on 450 pregnant women who were hospitalized in Imam Khomeini and Shariati Hospitals in Tehran, Iran, for delivery during a 6- month period in 2000. All measurements were performed within the 5 last days of pregnancy. Inclusion criteria were normal pregnancy, cephalic presentation of the fetus and maternal weight of less than 91 kg. The parturient patients with systemic disease, history of stillbirth, poly or oligohydramnios, placental abnormality, twin or multiple pregnancies and fetal congenital anomaly were excluded from the study. Linear regression analysis was used to determine the association of fundal height to actual birth weight.Results- A prospective linear regression was found between fundal height and actual birth weight (r = 0.88, p < 0.01) correct estimation of birth weight was obtained in 349 (77.5%) of cases. The specificity of estimated weight was 91.5% when the real birth weight was within the normal range.Conclusion- For actual birth weights in the normal range, our results showed that the normal range of fundal height was 27 to 35 centimeters. For a fundal height measurement outside of this range, an abnormal and a high-risk delivery should be expected.
  • Shahdokht Samangooei *•, Jallal Zamani *, Mohammad, Hadi Bagheri *, Homayoon Moosavi *, Anahita Amirpoor Page 84
    Background- This study was conducted to identify the frequency of vascular complications in patients with Behçet’s disease (BD) and to determine the average time period between disease onset and development of complications.Methods- Vascular findings of 343 patients with BD referred to the Behçet’s Disease Research Clinic of Namazee Hospital in Shiraz, South West Iran were assessed over a 6-year period. Data was extracted from the medical records of each consecutive patient. Doppler sonography, computed tomography, digital subtraction angiography and/or conventional angiography were done in cases of positive clinical findings.Results- The records of 343 patients (mean age, 34.4 ± 7.1 years, 235 females, 108 males) with BD were analyzed, and 113 vascular events in 48 (14%) patients (mean age, 31.5 ± 7.5 years, 16 females, 32 males) were assessed. The interval between the onset of BD and the appearance of vascular complications was 5.9 ± 5.1 years. Venous and arterial complications were found in 8.2% and 5.7% of patients, respectively. Combined arterial and venous complications were detected in 16 (4.6%) patients. Erythema nodosum-like skin lesions were seen in 69% of the patients with vascular involvement compared to 13.6% of patients without vascular involvement. The presence of one vascular complication increased the chance of developing another major vessel complication in the same patient (p < 0.001) with relative risks of 114 for arterial and 18 for venous sites.Conclusion- Vascular complications of BD are common and might occur on average 5_6 years after the onset of the disease. Both arteries and veins are involved and multiple vascular complications are common.
  • Seyed, Hossein Fakhraee Md•, Fatemeh Haji, Ebrahim, Tehrani Page 88
    Background- Jaundice is one of the presenting signs of sepsis and/or urinary tract infection (UTI) in newborns. Physicians who provide care to jaundiced but otherwise healthy neonates frequently wonder whether they should perform a sepsis work-up in this situation. This prospective study was performed to evaluate the incidence of sepsis and UTI in healthy neonates with jaundice, who were admitted to Mofid Children’s Hospital from September 1997 to August 1999 and to determine the importance of performing a sepsis work-up in this group of infants.Methods- Five hundred consecutive neonates with jaundice were enrolled in this study. One hundred of the neonates were excluded from the study due to at least one exclusion criterion. A single neonatologist performed all physical examinations and obtained all blood and urine specimes. The urine was collected via suprapubic aspiration. The blood and urine cultures were treated according to standard methods.Results- Of the 400 neonates entered into the study, none had positive blood culture and only two (0.5%) had positive urine cultures.Conclusion- Performing blood and urine cultures is not necessary and should not be considered as a routine procedure in the evaluation of jaundiced but otherwise healthy newborn infants.
  • Manouchehr Makvandi •, Reza Fiuzi Pharmd Page 91
    Background- The hen’s egg yolk possesses an immunoglobulin known as immunoglobulin (Ig) Y, with an advantage over conventional antibody production of certain antigens. The aims of this study were to produce anti-hepatitis B surface antigen (HBsAg) in the egg yolk of hens immunized with hepatitis B vaccine and to coat anti-HBsAg to the wells of an enzyme-linked immunosorbent assay (ELISA) plate for detection of HBsAg in the sera of patients with hepatitis B virus infection.Methods- A group of five hens were immunized intramuscularly with 10 µg of recombinant hepatitis B vaccine at zero, 21 and 80 days. Two weeks after the third dose of the vaccine, the egg yolks were collected. The anti-HBsAg (IgY) was purified using a two-step polyethylene glycol 6000 and one-step 4-M ammonium sulfate process, followed by column purification. The purified anti-HBsAg (5 µg/mL) was coated to the wells of ELISA plates for detection of HBsAg. Results- Two weeks after the third dose of vaccine, all the hens’ sera were positive for anti-HBsAg (IgY). The sensitivity and specificity were 73.1% and 85.7%, respectively. Conclusion- HBV vaccine was immunogenic in hens and ELISA using the purified anti-HBsAg from the egg yolks was able to detect the HBsAg in the sera of patients infected with hepatitis B virus.
  • Kavian Ghandehari Page 94
    Background- There are few data on the occurrence of microembolic signals (MES) in the acute phase of ischemic stroke. The aim of this study was to determine the frequency of MES in patients with middle cerebral artery (MCA) ischemic events and to evaluate the clinical value of MES. Methods- Twenty patients with an ischemic infarction in the MCA territory were investigated by transcranial Doppler technology within 24 hours of the onset of symptom. One-hour recording of MES was performed using an ultrasound device with a 2 MHz probe (Vingmed 800, Oslo, Norway) from the affected MCA. The criteria of MES identification were short duration (100-300 ms), 9 dB above the Doppler background frequency, typical chirp sound, occurring random in cardiac cycle and unilateral visual appearance on the spectral display. Early recurrent stroke was investigated during the observation period.Results- Among the 20 patients completing the study, three (15%) showed MES in their recording and had a definite cardioembolic source. One patient developed a minor ischemic event despite heparinization. In five patients with lacunar stroke and four patients with atherosclerotic carotid artery stenosis, no MES was found. Early recurrent stroke was absent in the patients without MES.Conclusion- There seems to be an association between MES in the acute phase of stroke and a definite cardioembolic sources. Larger studies are needed to confirm these preliminary results.
  • Mohammad, Reza Hassanjani, Roshan *•, Hassan Taheri Page 97
    Background- Hepatitis B virus (HBV) infection is a major worldwide health problem. Most of the patients are asymptomatic and at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. The aim of the present study was to determine the frequency of chronic active hepatitis in asymptomatic HBV carriers in Babol, northern Iran.Methods- This study was performed in 410 HBV carriers older than 15 years who were diagnosed by positive serum hepatitis B surface antigen (HBsAg) from January 1998 to September 2000. Family members of infected patients were also screened. For each patient, HBsAg, hepatitis B early antigen (HBeAg), hepatitis B early antibody (HBeAb) and alanine aminotransferase (ALT) were measured at the time of screening and again 6 months later. In patients with raised ALT, liver biopsy was performed and a Knodell score ≥ 4 was considered as chronic active hepatitis. Proportions were then analyzed using the chi-square test.Results- Of the 410 patients, 229 (53.3%) were males and 181 (46.5%) were females. Mean age ± standard deviation (SD) was 28 ± 12.7 years. Of these, 362 (88.3%) were HBeAb-positive and 48 (11.7%) were HBeAg-positive. ALT was elevated in 73 (17.8%) of patients. Chronic active hepatitis was found in 8% and 10.4% of the HBeAb-positive and HBeAg-positive cases, respectively (p = 0.57). Chronic hepatitis was significantly higher in males than females (p = 0.0001)Conclusion- The results show that the frequency of chronic active hepatitis is high in asymptomatic HBV carriers. It is almost equal in HBeAb-positive and HBeAg-positive cases and is higher in males than females. Assessment of HBV precore mutants in anti-HBeAg- positive cases is highly recommended.
  • Khalil Alizadeh *, Seyed, Mohammad Tavangar Page 100
    Background- Carpal tunnel syndrome is a common disease with multifactorial etiology. The study of histologic findings of the disease can help us identify its etiologic factor(s). The purpose of this study was to determine whether there are any typical or consistent histologic changes in the transverse carpal ligament or flexor tenosynovium, which contribute to idiopathic carpal tunnel syndrome.Methods- Two hundred and nine consecutive operations for carpal tunnel syndrome between December 1995 and December 2000 were reviewed retrospectively. All patients had no history of systemic disease and no anatomic anomaly. Using hematoxylin-eosin and Congo red dyes, the sections were stained and reviewed histopathologically.Results- A total of 176 (84%) patients had benign fibrous tissue, 31 (15%) showed amyloid deposits and 2 (1%) showed mild vascular proliferation.Conclusion- In idiopathic carpal tunnel syndrome, the ligament and tenosynovium often showed normal histology and there were no typical changes. We believe that inflammation is not a part of the pathophysiologic process in idiopathic carpal tunnel syndrome.
  • Mohammad Hossein Boskabady •, Batool Shirmohammadi Page 103
    Background- Previous studies have demonstrated the relaxant, anticholinergic (functional antagonism) and antihistaminic effects of Nigella sativa on guinea pig tracheal chains. Mechanisms responsible for the relaxant effect of this plant on tracheal chains were examined in this study.Methods- The calcium-antagonistic effects of three increment concentrations of the aqueous extracts of Nigella sativa and the calcium channel blocker diltiazem in comparison with saline were tested by measuring the cumulative concentration response curves of CaCl2-induced contractions of isolated guinea pig tracheal chains in the presence of calcium-free Krebs-Henseleit solution and 60 mM of KCl under each experimental condition (n = 7). Results-A rightward shift in the CaCl2 response curves was obtained in the presence of two different concentrations of diltiazem (1 and 5 μM) and the aqueous extract compared to the saline control curves. The effective concentration of CaCl2 causing 50% of maximum response (EC50) in the presence of two concentrations of aqueous extract and diltiazem was significantly higher than that of saline (p < 0.05 to p < 0.02). However, the maximum response to CaCl2 obtained in the presence of the final concentrations of aqueous extract and diltiazem was lower than of saline (p < 0.05 and p < 0.005 for aqueous extract and diltiazem, respectively).Conclusion-The results suggest a calcium antagonistic effect of N. sativa in isolated tracheal chains of guinea pigs.
  • Mohammad Ahangarzadeh Rezaee *, Qorban Behzadiyan, Nejad *, Shahin Najjar Pirayeh *, Parviz Owlia *● Page 108
    Background- Pseudomonas aeruginosa is an important opportunistic pathogen. The mucoid strains of this organism produce a hyperviscous glycocalyx (alginate) that provides a barrier against antimicrobial agents and the immune system, thereby increasing its virulence and antibiotic resistance.Methods- The in vitro activities of gentamicin, tobramycin and amikacin against 133 clinical isolates of Pseudomonas aeruginosa were tested by a disk diffusion method. The Muir method was used for capsule staining and identifying mucoid and non-mucoid strains. Results- The mucoid strains (n = 43) were statistically significantly more resistant to amikacin, gentamicin and tobramycin than the non-mucoid strains (n = 90) (p = 0.001, 0.0002 and 0.009, respectively).Conclusion- Mucoid strains of Pseudomonas aeruginosa were more resistant to gentamicin, amikacin and tobramycin than non-mucoid strains. Therefore, these antimicrobial agents should be avoided in the treatment of mucoid Pseudomonas aeruginosa infections.
  • Beman, Ali Jalali *•, Hassan Mozaffari *, Mohammad Hosain Dashti ** Page 111
    Background- Lipoprotein (a) [Lp (a)] is a cholesterol-rich and atherogenic particle in human plasma. Its elevation in plasma is an independent risk factor for coronary artery disease. The purpose of the present study was to determine the plasma level of Lp (a) and to evaluate its relationship to other serum lipids in Afghan immigrants.Methods- Serum Lp (a) in a group of Afghan immigrants (81 males, 86 females) living in Yazd, was measured using the electroimmunodiffusion method. Specific anti-Lp (a) antibodies were prepared by immunization of rabbits with Lp (a) and purified by affinity chromatography.Results- The mean Lp (a) value was 0.43 ± 0.45 g/L (mean ± standard deviation [SD]) and there was no difference between the sexes. Lp (a) levels did not correlate significantly with age, total cholesterol, triglycerides or high-density and low-density lipoprotein cholesterol. The frequency distributions of Lp (a) were skewed toward lower values.Conclusion- In comparison to most other ethnic groups, this Afghan population had high plasma Lp (a) concentrations.
  • Saeed Rad Page 115
    Background- Defecography, along with other radiologic modalities, can be used to evaluate rectal abnormalities such as functional disorders of the rectum. It appears that ethnic habits can influence the evacuative function of the rectum. The main goal of this study was to compare Iranian and European habits of bowel evacuation on defecographic measurements.Methods- Thirty Iranian patients (21 male, 9 female) referred for barium enema were enrolled in the study. The patients were instructed to defecate using two types of toilet: an unraised, ground-level style (common in Iran), and a bowl with attached tank style (common in Western countries). Radiographs were taken of each patient while defecating into both types of toilet, during which the anorectal angle and other defecographic indices were measured.Results- Use of the Iranian-style toilet yielded a much wider anorectal angle, and a larger distance between the perineum and the horizontal plane of the pelvic floor than the European style. Bowel evacuation was also more complete using the Iranian-style toilet.Conclusion- Use of the Iranian-style toilet seems to be more a more comfortable and efficient method of bowel evacuation than the European style. Further studies are needed to ascertain the optimal approximation of the measurements to standard height of toilets for ordinary use.
  • Jamshid Ahmadi Md•, Ahmad Fakoor , Parisa Pezeshkian , Reza Khoshnood , Ahmad Malekpour Page 118
    Background-Little is known about the relationship between substance use and the onset of psychiatric disorders, and studies examining this relationship have been inconclusive. The goal of the current study was to present and discuss data concerning substance use among patients with mental disorders in Iran.Methods-A sample of 205 psychiatric patients (70 women, 135 men; mean age, 35 years [SD = 10.4, range, 16–69]). was randomly chosen. The subjects, who had schizophrenia or mood disorders, were evaluated by interview using a confidential questionnaire. Results-Of the participants, 76% of the men and 34% of the women admitted to substance use at any time: cigarettes (men 74%, women 31.4%), opioids (men 31.9%, women 4.3%), alcohol (men 23.7%, women 3.4%), hashish (men 8.9%, women 0%), marijuana (men 3.7%, women 0%), and cocaine or LSD (0%). Only 27% of the women and 63% of the men reported still using a substance regularly (some reported using more than one). Of those, 61.8% of the schizophrenics, 20% of those with unipolar depression, and 37.5% of bipolar patients reported current use. The reasons for substance use in order of frequency were, for men: 1) release of tension; 2) pleasure seeking; and 3) need (to avoid withdrawal symptoms). For women, they were: 1) habit; 2) pleasure seeking; and 3) need. Conclusion-Substance use should be a major focus of risk assessment for psychiatric settings. These findings can be considered for therapeutic and preventive programs for substance users among psychiatric patients.
  • Jalal Ziaie Md• Page 122
    Meralgia paresthetica syndrome is a rare neuropathic disease that usually occurs spontaneously and is occasionally caused by compression of the lateral femoral cutaneous nerve. The most important clinical features include sensory loss, numbness and dysesthesia in the area of innervation of the anterolateral femoral cutaneous nerve, as well as pain sensation during walking. These signs and symptoms disappear within 6 months and seldom require surgery. During the past 2 years, 1,550 patients undergoing transfemoral coronary angiography in affiliated cardiology centers of Isfahan University of Medical Sciences were prospectively identified and examined for meralgia paresthetica following the procedure. Of 26 suspected cases, five cases of unilateral meralgia paresthetica were confirmed using electromyography and nerve conduction velocity study. Transfemoral coronary angiography is an increasingly used modality that may cause meralgia paresthetica syndrome.
  • Shapour Shirani Md• Page 124
    Wandering spleen is a clinical entity in which a long pedicle causes the spleen to lie in an abnormal location. Here we report the clinical and imaging findings of a rare case in which torsion of a wandering spleen was associated with torsion of the tail of pancreas.
  • S.M. Hesami Page 129
  • Page 135
  • Reza Malekzadeh , Pejman Azarmina Page 136