Iranian Red Crescent Medical Journal
Volume:12 Issue: 2, 2010

Rheumatoid Factor (RF) occurs in 70- 90% of patients with established rheumatoid arthritis (RA). Anti-cyclic citrullinated peptide antibody (Anti-CCP) detection may be used to confirm the diagnosis of RA in patients with uncharacterized chronic inflammatory arthritis. This study is an attempt to evaluate the role of RF and anti-CCP in the diagnosis and prognosis of rheumatoid arthritis. Blood samples were obtained from 55 patients with established RA and 55 healthy controls. Anti-CCP and RF were measured by ELISA and nephelometry. The patient''s demographics, disease duration, DMARDs usage, ESR and radiographic abnormalities were recorded. Fifty five RA patients and 55 healthy age and sex matched controls were enrolled. Odd ratio (OR) was 87.42 (CI=11.2-680.1) for RF and 27.48 (6/08-124/09) for Anti- CCP. Five patients had used more than 3 DMARDs; all of them were RF positive and 4 were also anti-CCP positive. Eleven patients had erosions in their radiographs; 10 of them were seropositive for RF and 9 positive for anti-CCP. Our study suggests that despite lack of specificity, RF continues to be a central part of the definition of RA due to favorable sensitivity profile and the combined use of RF. Also, anti-CCP is a more powerful diagnostic and prognostic tool.

In patellofemoral pain syndrome (PFPS) as a common cause of knee pain in athletes, muscle weakness is proposed to contribute to its pain and dysfunction. This study was conducted to determine whether hip and knee muscles strengthening can accordingly reduce pain. In a single blinded, randomized clinical trial, 32 females (52 knees) with PFPS were randomly divided into a case and a control group. All the hip muscles and knee extensor in the case group and only the knee extensor in the control group were tested. In the case of recognizing weakness, they underwent a 4-week strengthening exercise program, after which a retest was taken. Pain as indicated on a visual analogue scale was recorded before and after the intervention. Both groups revealed pain reduction, although the amount of reduction was significantly greater in the cases compared to the subjects in the control group. Among the muscles selected for strengthening, only the hip flexors, abductors, and external rotators were found related to successful treatment as defined by at least 15% pain reduction on a pain visual analogue scale. Despite the current concept of focusing on quadriceps strengthening exercise in PFPS in the attempt to reduce pain and dysfunction, the results of this study did not support this idea. More attention should be shifted toward the hip muscles, if a long term and more efficient treatment is targeted.

Hirsutism is a distressing problem especially among girls. This study was conducted to evaluate the prevalence of hirsutism and other hyper-androgenic symptoms in adolescent girls in Yazd, central Iran. Nine hundred high school girls (mean age of 17.26 and range of 15-19 years) were evaluated for prevalence of hirsutism and other hyper-androgenic syndromes. The selected girls were examined for the presence of hirsutism, acne, hypertrichosis, history of menstruation, and family history of known cases of hirsutism. Hirsutism was determined by the modified Ferriman-Gallwey index. Laboratory tests and ultrasound were requested for hirsute only. Among girls, 10.8% suffered from hirsutism. Other accompanying hyper-androgenic disorders were separately studied in two groups of hirsute and non-hirsute subjects. The most prevalent accompanying disorders were acne (42.7% vs 38.4%), hypertrichosis (42% vs 18.3%), first degree relatives’ family history of hirsutism (25.5% vs. 7%), and menstrual irregularity (14.6% vs. 10.2%), respectively. In the hirsute group, based on the hormonal and ultrasound tests, the most prevalent revealed causes were polycystic ovary syndrome (60.8%), hyper-prolactinoma (7.2%), idiopathic hirsutism (28.9%), and undetermined (3.1%). A high prevalence of hirsutism was observed which was more prevalent at higher ages in comparison to other societies showing that definition and scoring system of hirsutism need to be based on racial differences.

The prevalence of chronic constipation in children has been reported between 0.3 and 28%. This study was conducted in southern Iran to compare the effect of a balanced and high fiber diet in children with chronic functional constipation. During summer 2007, all children (60) who referred to the Pediatric Department of Mottahari Clinic affiliated to Shiraz University of Medical Sciences and were diagnosed with chronic functional constipation entered this study. A questionnaire on the child’s routine dietary regime was filled in for each child through face to face interviews with the parents. The questionnaire included demographic information, food habits, physical exam, and the para-clinical results of each participant. 30 parents were trained to supply a high fiber diet for their children, and its effect on chronic functional constipation was followed after two months. The children of these parents were considered as the case group and the other 30 children were considered as the control group. Before the parents were educated, the amount of fiber intake from fruits and vegetables by the children was 7.6±2.1 gr. in the case group which increased to 24.25±2.3 gr. after 2 months of training. The amount of water intake was 280 ml before training which increased to 600 ml afterwards and that of milk and yoghurt intake was 280 and 240 ml which decreased to 60 and 200 ml after training, respectively. The amount of beverage and fruit juice intake was 280 and 220 ml while after training it decreased to 100 and 60 ml, respectively. In the case group, 10% of the children had 3 to 6 times defecation per week before the intervention while this increased significantly to 56.7% of the children after the training. The stool consistency significantly changed from very firm to normal and soft consistency after training and the times of stool defecation increased significantly, too. The children’s nutrition status changed from a poor state to a good status after training. Drug treatment was more effective in children that consumed high-fiber diet. It was shown that some of these changes were significant. The difference between the two groups was not, of course, significant which might be due to the small sample size

Osteoporosis is a major health problem, but testing low bone mineral density is not practical for screening all postmenopausal women. The objective of this study was to evaluate the efficiency of the clinical tools to help clinicians to identify the Iranian women at an increased risk for osteoporosis. The popular osteoporosis screening tools were evaluated in 341 postmenopausal women without secondary cause for osteoporosis, using data from a bone densitometry centre, and compared the results with their bone mineral density. National Osteoporosis Foundation recommendations had only a sensitivity of 48% for screening patients with low bone mass but the Osteoporosis Risk Assessment Instrument and the Simple Calculated Osteoporosis Risk Assessment Estimation with a sensitivity of 70.9% and 87.2%, respectively, showed better results in respect to the screening for osteoporosis of postmenopausal women. The efficiency of these osteoporosis screening tools in our Iranian patients was relatively similar to that of other populations, and these screening tools accurately identify the vast majority of postmenopausal women likely to have low bone mineral density.

Considering the effect of leptin and different hormones on energy homeostasis, metabolism and weight changes, the relationship between these variables and sport activities have been taken into consideration by researchers. This study was conducted to determine the effect of aerobic and resistance exercises (weight training) on hormonal changes of leptin, insulin, cortisol, thridotironine and thyroxin levels in non-athlete students at Shiraz University, southern Iran. Sixty non-athlete male students at Shiraz University were randomly divided into 3 groups of control, aerobic and resistance exercises. The exercise programs were continued for 8 weeks, 3 sessions each week. Participants were bled between 8 and 10 o''clock in the morning in a fasting state. Leptin, insulin, cortisol, thridotironin and Thyroxin levels of plasma were measured in 5 phases (before the beginning of exercise, at the end of the second, fourth, sixth, and eighth weeks of exercise). In the aerobic group, the mean leptin and insulin levels decreased significantly during the 5 measurement phases but the cortisol and thyroxin levels increased significantly. In the resistance exercise group, there was a significant decrease in leptin and insulin levels. When the mean levels of cortisol, thridotironine and thyroxin increased, these changes were not significant. Exercise can change hormonal concentration of insulin, cortisol, growth hormone, catecholamine, testosterone, etc. and the metabolism of free fatty acids, lactic acid, triglyceride, etc and reduce the amount of adipose tissue and energy consumption.

The concept of internet addiction, also called internet addictive disorder or pathological internet use, entered the medical lexicon in 1995. This study was performed to investigate the prevalence of internet addiction among north Iranian internet users and to explore the epidemiological features associated with internet addiction. 1856 internet user volunteers'' from Mazandaran Province cities were surveyed, using Farsi version of Young''s Internet Addiction Questionnaire during 2005-2006. 424 dependent users were enrolled. The incidence rate of internet addiction was 22.8%. Dependent users spent a mean of 14.4 hours per week (SD=13.7) compared to non-dependent users who spent a mean of 9.0 hours per week (SD=10.4). The dependent users were 256 males and 165 females. Dependent users predominantly used the two-way communication functions available on the internet like chat rooms. The present study suggests that internet addiction is common among northern Iranian internet users. In addition, chat rooms are most addictive web environment among this population.

Regarding the increase in expenses for health care services in inpatient settings, much effort has been made to compare the performance of hospitals in recent years and measure their efficiency. In this study, Data Envelopment Analysis (DEA) is applied to measure the technical, scale and economic efficiency of the general public hospitals in Fars Province, southern Iran. Twenty one general public hospitals in Fars province, southern Iran in the first and second six months of the years 2005 and 2006 were enrolled. There was an attempt to compare their rate of development or otherwise, using Malmequist index and also to determine their return to scale and rank during these years. The data were collected through a questionnaire by interview and the existing documents were analyzed separately for each year by Algebraic Modeling System (GAMS) software. Fifteen hospitals (71.4%) were technically efficient and in the next three periods, 14 hospitals proved to be efficient. With respect to scale efficiency in the first 6 months of 2005, 7 hospitals were completely efficient (33.3%), but in the second 6 months of the same year, the number of efficient hospitals was reduced from 7 to 5. In the next two periods, 4 hospitals (19%) were recognized as highly efficient systems. As to the economic efficiency in all 4 studied periods, 4 hospitals (19%) were recognized as completely efficient. As to the average technical efficiency, state-run public hospitals in Fars Province are in a higher level as compared with those in other studies. However, their average of the scale efficiency is less than that reported in other studies. It seems that the hospitals under the study do not seek profitability since they are public; therefore, they lack any motivation to select a combination of inputs in order to minimize the expenses. It is recommended that hospital managers and decision makers should use DEA to determine the best method of using the available resources.

Despite the wide application of fiberglass, its respiratory effects have not been extensively studied. The purpose of this study was to further examine this issue among a group of workers occupationally exposed to this compound. This is a historical-cohort study in which the respiratory health of 49 workers exposed to fiberglass as well as 42 unexposed employees as the referent group from a local fiberglass industry was evaluated. A standardized respiratory questionnaire was used. The subjects underwent chest x-ray and were examined by a physician for any possible respiratory abnormalities. Furthermore, pulmonary function tests were performed just before the work shift. Moreover, to assess the extent to which subjects had been exposed to fiberglass dust, respirable dust concentrations were measured in different dusty work sites, using standard methods. The average age of the exposed subjects and the duration of exposure were 39.6±7.34 and 11.2±5.59 years, respectively. Atmospheric concentrations of respirable fraction of fiberglass dust in dusty work sites, namely Line and Tissue units, were found to be 44.5 and 6.27 mg/m3, respectively. The prevalence of respiratory symptoms and abnormalities in the chest x-ray of the exposed and unexposed subjects was not significantly different. Lung function parameters, i.e., vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and percentage ratio of FEV1 to FVC in the exposed workers were comparable with those of the control subjects. Significant associations between the length of exposure to fiberglass and age with FEV1/FVC ratio were noted. The results support that exposure to fiberglass dust is unlikely to be associated with respiratory symptoms, abnormal radiographic changes or functional impairments of the lungs.

Different parasitic diseases may be transfered from laboratory animals to human (zoonoses). The current study was designed to determine the helminthic infections in animal house of Shiraz University of Medical Sciences to prevent the possible transmission of zoonotic ones from laboratory animals to the staff and researchers. Sixty laboratory animals including mouse, rats, Guinea pigs and rabbits were randomly selected and examined for any helminthic infections. 83.33% rats were infected with Syphacia muris and Aspiculuris tetraptera, 100% of Guinea pigs were infected with Paraspidodera uncinata, rabbits were infected with Passalurus ambiguous (40%), inbred BALB/C mice were infected with Hymenolepis nana (50%), Aspiculuris tetraptera (90%) and Syphacia obvelata (90%), outbred BALB/C mice were infected with Hymenolepis nana (50%), Aspiculuris tetraptera (90%), Syphacia obvelata (90%) and C57BL/6 mice were infected with Hymenolepis nana (66%), Aspiculuris tetraptera (100%) and Syphacia obvelata (100%). Our study was revealed minimum and maximum infection frequency in rabbits and guinea pigs respectively. It seems that low and unsuitable space of infected animals in mentioned research center was the main cause of distribution of infection among rats and mice in Animal House of Shiraz University of Medical Sciences.

Cell culture has been used to study the cytotoxicity of denture base resins. Indeed, denture cleansers and their effects on the resin cytotoxicity need deep concern. The aim of the present in vitro study was to investigate the cytotoxic effect of a heat cured denture base resin treated with two denture cleansers on mouse L-929 fibroblasts. Under aseptic conditions, sample disks of a heat treated resin were prepared, following manufacturers’ instruction and divided into 12 groups of ten as follows: I) soaking in 1% sodium hypochlorite, II) soaking in alkaline peroxide solution, and III) soaking in water bath for 1, 24, 72 hours and a week. Suspensions of the fibroblasts with acrylic disks were put in 24-well culture plates, and the culture media containing RPMI-1640 environment plus antibiotics and 10% fetal bovine serum were added. After incubation of the plates at considered time intervals, cytotoxicity of the resin was carried out by MTT assay. A significant difference was noticed for solutions in relation to the biocompatibility of the acrylic resin samples at determined time intervals. The cleansers’ soaking samples showed higher cytotoxicity in comparison to those immersed in water at each time interval. The difference between cytotoxic effects of the samples immersed in water or cleansers were significant after 72 hours and one week. Overnight immersion in alkaline peroxide and 1% hypochlorite solutions increased the cytotoxicity of the heat cured acrylic resin, but water storage improved the biocompatibility of the material tested.

Blood infections are life-threatening if not detected and managed properly. This study investigates the correlation between fever and previous antibiotics therapy with differential time to positivity (DTP) at admitted patients at Nemazee Hospital in Shiraz, southern Iran. From January 2005 to December 2006, 985 positive blood samples in Bactec bottles from the admitted patients at Nemazee Hospital were analyzed. Sensitivity patterns of the bacteria to a panel of antibiotics were determined by the disk diffusion method. S. epidermidis, S. aureus and Acinetobacter were the most prevalent isolates respectively. However, only 100 (20.7%) S. epidermidis samples were the true infections. The most susceptible Gram positive and negative bacteria were S. viridance, S. aureus, H. influenzae, and Brucella spp., respectively. Imipenem, amikacin and ciprofloxacin were the effective ones against Gram negative bacteria, while vancomycin, co-amoxiclav and chloramphenicol were effective against Gram positive ones. Cefuroxime and penicillin G were less effective antibiotics against both Gram negative and positive bacteria. As demonstrated, the combined prescription of vancomycin and imipenem seems to cover the majority of infective agents in the blood whenever an empirical therapy is to be initiated. Moreover, periodic surveillance of antibacterial susceptibility patterns is warranted.

Tracheal extubation is a critical stage and expensive practice in patients undergoing major operations such as liver transplantation. This study was carried out to determine factors affecting extubation time in liver transplant patients. From 2003 to 2006, all patients undergoing liver transplantation in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. All patients were anesthetized identically and the time of extubation was based on standard protocol of extubation. The patients were divided into two groups of extubated after admission in less (Group 1) and more than (Group 2) six hours. The effect of 19 pre and post operative factors on extubation was also evaluated. Two hundred patients (Group 1=121; Group 2=79) entered the study. A significant correlation was noticed for bleeding during operation, abnormal blood pressure more than 30 minutes at the end of surgery and duration of operation. A rise in extubation time was observed when duration of surgery increased. In ICU, 37 patients needed reintubation among them 23 were in Group 2 and 14 in Group 1. The most common causes of reintubation were insufficient oxygenation, repeated laparatomy and decrease in consciousness level. The mean hospitalization in early and late extubation groups were 4.16 and 6.04 days (p=0.001). It seems that duration of surgery, bleeding during operation and an abnormal blood pressure may delay the time of extubation. An early extubation may result into a decrease in duration of ICU admission too.

Varicella zoster virus (VZV) causes varicella and, later in the life of the infected person, can reactivate to cause Herpes zoster (HZ). The objective of this study was the investigation of anti Varicella zoster virus IgG antibodies in infants and adults in Shiraz, southern Iran. A cross-sectional, age and population-based seroprevalence study was conducted in 2008 on 843 subjects, ages ranging from 1 to 70 years old. IgG antibodies against VZV were measured with a commercially available enzyme-linked immunosorbent assay (ELISA). The seroprevalence of Varicella zoster antibodies increased with age, being 25.3% in 1-5 year age group, 43.1% in 6-10 year group, 73.5% in 11-15 year group and 86% in adult population. The majority of VZV infections occurred during childhood. The best policy to prevent the circulation of wild type VZV in the population and reduction of the rate of complicated cases is the immunization of 5 year old children and those younger. VZV vaccine should be incorporated in the conventional childhood vaccination plan in Iran.

Drug utilization research (DUR) is an effective program to identify variability in drug use and to support interventions that will improve patient outcomes. The appropriate use of aminophylline/theophylline was evaluated in Shiraz, southern Iran. A prospective DUR study was conducted in Ali-Asghar Hospital from April 2005 to April 2007. All inpatient cases of asthma or COPD who were started on IV loading dose of aminophylline were included in the study. A blood sample was provided from the patients at steady state condition just before the next dose, in order to determine the trough serum concentration of the drug. Demographic characteristics of patients, along with clinical and paraclinical findings, lab data, drug history, and adverse drug events were recorded using their files and a face to face interview. One hundred patients were enrolled among them, 57% (n=57) were female and 43% (n=43) were male. The age range was 16-90 years with mean age±SD of 65.63±14.7. Diagnosis was asthma in 46% and COPD in 54% of patients. Theophylline serum concentration range was 0-37 mcg/ml (7.94±5.4). Ninety eight percent of patients had at least one adverse event due to aminophyline or theophylline use. 14 items were evaluated for aminophylline/theophyline administration and compared to a standard guideline. The mean score for 100 patients included in the study was 8 out of 14. The most considerable problem in aminophylline/theophylline usage in our hospital was ignorance to the important role of pharmacokinetics in optimizing aminophylline/theophylline therapeutic response and minimizing ADEs and the cost of hospitalization. Training of the healthcare providers is recommended. Performing population pharmacokinetic studies will be a good guidance for improving aminophylline/theophylline usage in our population.

The incidence of retained products of conception (RPOC) has been reported as 1-3% and ultrasound has an important role in their diagnosis and selection of patients for surgical management. The aim of this study is to identify that ultrasound is a predictor of the presence of retained product of conception (RPOC) within the uterine cavity in women with the clinical diagnosis of incomplete first trimester abortion. One hundred patients with a diagnosis of incomplete abortion and RPOC based on clinical and sonographic findings were enrolled. The gold standard test was pathologic reports of samples obtained during dilatation and curettage. Endometrial thickness and homogenesity of the endometer were determined by sonography. The sensitivity and specificity of the measurements for detecting RPOC were assessed. Histopathological reports confirmed the diagnosis of RPOC in 71 patients (71%). Mean endometrial thickness with RPOC was 16.3 mm versus 12.1 mm without RPOC. Heterogenic endometrium was seen in 56 out of 71 patients (78 %). The sensitivity and specificity of the endometrial thickness greater than 11.25mm for detecting RPOC were 81% and 45%, respectively. Regarding the endometrial thickness and heterogenic endometer, 13.5 mm had the best performance criteria with 60% and 63% sensitivity and specificity, respectively. An endometrial thickness of 11.25 mm or more detected by sonography had the best diagnostic efficacy, considering the heterogenecity with the thickness of the endometrium, 13.5 mm had the best performance criteria for detection of RPOC following first trimester spontaneous abortion.

Bone hydatid disease is endemic in several regions worldwide and lacks a typical clinical appearance and image characteristics; therefore, its diagnosis is very difficult. A 49-year-old rural woman was referred with purulent discharge from sinus tract in the left ilium. X-ray and CT scan showed multiple lytic lesions with cortical destruction. She was scheduled for sequestrectomy with impression of chronic osteomyelitis but destroyed hydatid cysts were detected intraoperatively. Iliac wing excision from the iliac crest to the sacroiliac joint and supraacetabulum area was performed. Pathologic findings were in favor of bone hydatidosis. Postoperatively, albendazole and antibiotics were prescribed.

Acute pancreatitis is an uncommon cause of abdominal pain during pregnancy that may become severe and rarely progresses to a necrotizing form with a high maternofetal mortality even in young patients.1,2 A small number of pregnant women with acute pancreatitis have an associated hyperlipidemia, usually hypertriglyceridemia while in all these cases, pancreatitis is mild in severity and is responsive to conservative medical management.2,3 We present a case of necrotizing pancreatitis in a 25 years old pregnant woman at 34 weeks of gestation, who presented with acute abdominal pain, nausea and vomiting that required operative management.