Iranian Red Crescent Medical Journal
Volume:9 Issue: 4, 2007

Not much information is available about the effect of smoking and hypertension on the number and severity of vessel involvement and left ventricular ejection fraction (LVEF) at coronary angiography of young patients with coronary artery disease. The present study describes the relative importance and comparative effect of smoking and hypertension on severity of premature coronary artery disease. The study comprised 240 consecutive patients under the age of 45 years, with a diagnosis of acute myocardial infarction (AMI), unstable angina or stable angina, who underwent coronary angiography. Other aspects investigated included evaluation of smoking profile and HTN in each patient, LVEF, the number and type of vessel involvement as well as the severity of stenosis. Of 216 patients, 142 (approximately 60%) were smoker and 74 (31%) were hypertensive. Left anterior descending coronary artery (LAD) involvement was more common in smoker young patients who had moresevere stenosis of LAD vessel and lower LVEF than hypertensive young subjects. Higher frequency of right coronary artery (RCA) involvement and more severe stenosis of this vessel were found in hypertensive young individuals compared to smoker young patients. Our study indicated that smoking was more prevalent and also a more important risk factor in coronary artery disease of young adults. Smoker young patients tended to have more LAD involvement, more severe stenosis of this vessel and also lower LVEF, compared to hypertensive young patients.

Despite advances in antiemetic treatment, complications are still problematic for a significantnumber of patients after chemotherapy. This study was performed to determine the efficacy of transcutaneouselectrical nerve stimulation(TENS) in the control of nausea and vomiting in patients undergoing chemotherapy at Nemazee Hospital inShiraz, southern Iran. 32 subjects with cancer from Outpatients Depatment in Nemazee Hospital affiliated to Shiraz Universityof Medical Sciences, in Shiraz, southern Iran were enrolled. The patients were randomly divided into twoequal groups of TENS and placebo. Patients in both groups were matched for age, severity of nausea and vomitingand type of malignancy. Cisplatin or cyclophosphamide was used for chemotherapy and granistron along withdexametasone were used as antiemetic agents. In the test group, the p6 acupuncture point (acupoint) was stimulatedby TENS when the antiemetic agent was administered and continued during wakening every 2 hours for 72hours after chemotherapy. The placebo group was similarly treated but with an off mode stimulator. In regard to the severity of nausea, no statistically significant difference was observed between the twogroups in the first 24 hours of chemotherapy but the intensity of nausea in the TENS group was significantlylower than those of the placebo group during 48 and 72 hours of chemotherapy. The mean frequency of vomitingduring first, second and third 24 hours was significantly lower in the control group. TENS can be used as an adjunct with antiemetics for controlling nausea and vomiting induced by chemotherapy.

Several methods have been used to estimate adiposity with high precision, but BMI has become the most common marker in identifying overweight and obese subjects. This study was performed to present reference data for body mass index (BMI) of school children aged 6.5-11.5 years in Shiraz, southern Iran. The data of present study are based on a random multi stage sample survey of 2397 healthy school children in Shiraz, southern Iran. The participants were 1268 boys and 1129 girls and their heights and weights were measured in 2002-2003 academic year. Joint height-weight measurements were available for 2195 (91.6%) including 1138 boys (89.7%) and 1057 girls (93.6%). Healy-Rasbash-Yang (HRY) distribution-free method was applied to estimate BMI age-related centiles. Cubic polynomials in age are shown to adequately fit the BMI data (on log scale). Children are now heavier than those born over ten years earlier. Boys BMI lie above girls to around 10 years of age, which is subsequently reversed for overweight and obese centiles. Comparison of these BMI curves with those of CDC charts showed substantial differences at every age and suggested the necessity for the use of locally based BMI norms for assessing body mass index of children in Shiraz, Southern Iran. Also, a positive secular trend in BMI is seen during the past decade in Iran.

Spina bifida aperta is a lesion that communicates with the external environment; and includesmeningomyelocele and meningocele. We investigated all clinical presentations in meningomyelocele and meningocelepatients in Shiraz, southern Iran. Patients’ files of spina bifida aperta who were admitted from 1989 through 2005 to Nemazee Hospitalwere reviewed for meningomyelocele and meningocele in Shiraz, southern Iran. CSF shunting by ventriculoperitoneal(VP) shunt was also performed. Out of 580000 patients, 100 cases of spina bifida aperta were registered. In 67 patients with meningomyeloceleand 33 with meningocele with male and lumbar and lumbosacral areas predominance, cystic masswas more common. 35% of patients showed congenital anomalies including talipes equinovarus and congenitalhip dislocation that were more in meningomyelocele patients. 10% of the patients were operated in the first 72hours and the others 1 month to 1 year after birth. CSF shunt insertion was more in meningomyelocele patients.Among meningomyelocele patients, mortality occurred in 3 patients (meningitis in 2 and post-operative pneumoniain one case). It seems that water-thigh dural closure and use of dural patch could decrease the rate of postoperativeCSF leakage. Our results resembled the pattern in other series, except the low prevalence of hydrocephalusand a male predominance. Earlier referral of spina bifida aperta patients should be encouraged, becauseit could lower the complications and lead to better outcomes.

Non-steroidal anti-inflammatory drugs (NSAIDs) remain as the initial approach to thepharmacologic management in juvenile rheumatoid arthritis (JRA). Gastrointestinal (GI) damage associated withNSAIDs is common in adults, but there are few studies available in children. This study was performed todetermine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinicallyand by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of MedicalSciences in Shiraz, southern Iran from June 1999 to June 2003.. The mean age of the patients was 9.8 years (11 females), and the mean duration under NSAIDsmanagement was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant differencebetween the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopicendoscopic lesions were found in 85.7% and infection of Helicobacter pylori (Hp) in 14.3% of cases. There wasno significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship tothe duration of treatment. There were also a high number of children with GI damage and without any clinicalcomplaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints,and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibilityof GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and preventionmeasures are suggested.

Burn injury according to severity, extent and organ involvement leads to different mortalitiesand morbidities. Considering burn injuries of similar extent, the mortality related to lower extremity seems tobe higher than that of upper extremity. This study was performed to compare the mortality and mean hospitalstay between two groups of burn patients with upper and lower extremities admitted to Ghotbeddin Hospitalduring a two years period. The present retrospective study encompassed 322 patients aged from 15-40 years with 45% femalesand 55% males and burns of 15%-40% during a two years period. Depending on 2/3 or more of total burns; theywere divided into two groups with burns in the upper and lower extremities. Upon comparison of the mean hospital stay and mortality rate, it was shown that the mean hospital stayin those with burns of lower extremity was two weeks, which was longer than that in patients with upper extremityburns. Mortality in lower extremity burns was about 10% more than that of upper extremity. It seems that treatment of lower extremity burns along with appropriate planning for intensive careof this organ would help reduce mortality, save time and lower costs.

Due to increasing unresponsiveness and significant side effects associated with antimonial compounds,alternative therapeutic modalities are suggested. Recently oral zinc sulphate has been reported to beeffective in the treatment of CL. The aim of this study was to evaluate the efficacy of oral zinc sulphate in thetreatment of CL. The present study comprised 31 patients with clinical diagnosis of dry type leishmaniasis and parasitologicallyproven cutaneous leishmaniasis of which 22 patients received a full course of treatment. Patients weretreated with 10 mg/Kg/day of oral zinc sulphate for 45 days and were followed through 20 and 45 days of treatmentas well as 45 days after cessation of therapy. Only 2 (9%) of 22 patients were cured after 45 days of treatment with zinc sulphate. The administration of zinc sulphate for the treatment of CL seemed to be of inadequate therapeutic value.

Colorectal cancer is the second leading cause of cancer-related mortality and represents a majorpublic health problem in developed countries. The objective of present investigation was to determine the epidemiologicaspects and clinical characteristics of colorectal cancer in Shiraz, southern Iran. This was a retrospective study carried out during 2000-2005, and comprised 491 subjects with pathologicallydocumented colorectal cancer. They were registered in Fars Cancer Registry, affiliated to Shiraz Universityof Medical Sciences, southern Iran. A questionnaire including data on demographic information, histologicaltypes of cancer, site of primary cancer and metastasis were completed by trained interviewers. Among 491 subjects, 57.2% were male and the most common age was 65-75 years. Patients under45 years of age represented 22.8% of all colorectal cancer cases while 32% were over 65 years old. Thosewith a history of cancer in their first-degree relatives included 26.9% of the patients. Adenocarcinoma was themost common reported histological type of cancer (96.1%). Among all subjects, 60.7% suffered from abdominalpain, 28.4% abdominal distention and 28.0% rectal bleeding. Other symptoms included diarrhea/constipation, nausea/vomiting, urogenital problems and mass sensation. The most common sites ofmetastasis were lung, brain and ovary. The incidence of colorectal cancer showed a remarkable increase in our region that might be dueto changes in life style, decreased physical activity, heavy smoking habits, dietary changes and increased prevalenceof obesity. Considering the elderly as the most vulnerable and the growing trend towards involvement ofyounger subjects, more studies and screening seems to be essential.

Testicular microlithiasis is a rare condition characterized by deposition of calcium in the Lamina of semineferoustubules of testis. The ultrasound of testicular microlithiasis shows bright 1-3 mm echogenic foci in parenchyma.Herein, we report a first case of testicular microlithiasis in major beta thalassemia that was demonstrated intesticle’s ultrasound

Incidental vaginotomy, a potentially severe complication, has occasionally been reported in cesarean sectionsperformed after prolonged second stage labor. There is controversy on the significance of vaginotomy and itsconsequences in cesarean section. Ureteral injury has been reported as a possible complication of cesareansection. Herein, we present a case of anterior vaginal incision instead of lower uterine segment, where the rightureter had been obstructed by sutures. The injury was detected and corrected during the operation. Thus incidentalvaginotomy in cesarean section must be taken seriously and avoided as far as possible. It is also crucialto inspect and preserve the integrity of ureters in such cases.

Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple organ involvements and abdominalpain as the most common gastrointestinal symptom.Herein, we describe a case of SLE presented with abdominal pain and massive ascites that had a good response tothe high dose of prednisolone.

Anaplastic thyroid carcinomas are undifferentiated and highly aggressive tumors of the thyroid follicular epithelium,with a disease-specific mortality approaching 100 percent. This study reports ten cases with advancedanaplastic thyroid carcinoma with ineffective surgical interventions. Between 2001-2006, we treated 10 patientswith anaplastic carcinoma of the thyroid. All patients presented with advanced phase and were documented bypathological study. The surgical intervention was thyroidectomy in 3 cases, debunking surgery in other three, justtracheostomy in three cases, and only biopsy in one patient. All of our patients died in 4 days to 8 months aftersurgery. Surgical intervention had no benefit in treatment of advanced anaplastic carcinoma of the thyroid andthe suitable surgical intervention was to maintain an open airway. Early recognition of the disease is essential toallow prompt initiation of therapy. There is no cure for advanced situations, and surgery, radiotherapy, and chemotherapyplay no important role in the treatment.

Serological markers of past or present HBV infectionwere reported in 4-90% of HIV infected patients1and a significant association was reported betweenserologically positive HIV infection and detectableHBS Ag and anti-HBC.2,3 As HIV positive men withHBV infection are at increasing risk of liver relatedmortality,4 the present study was conducted to determinethe seroprevalence of HBS Ag in patients withHIV infection in Shiraz, southern