مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال شصت و نهم شماره 8 (پیاپی 128، آبان 1390)

Acute gastroenteritis is a major cause of morbidity and mortality among children in developing countries. Rotaviruses are recognized as the most common etiologic factors of gastroenteritis. In this study, we determined the epidemiologic features, clinical symptoms and molecular structure of rotavirus VP4(P) genotypes in children with acute diarrhea in Bahrami Hospital in Tehran Iran, during 2009 for justifying the routine use of rotavirus vaccines in children. One hundred fifty fecal samples from 150 children with acute diarrhea in Bahrami Pediatric Hospital in Tehran, Iran were collected from January to December 2009. The patients’ mean age was 20.90+18.19 years (ranging from 1 month to 14 years). Fecal samples were transported on ice to the laboratory of virology department of Pasture Institute of Iran. The demographic and clinical data for each case were entered in an author-devised questionnaire. Group A rotavirus was detected by dsRNA-PAGE. Subsequently, rotavirus genotyping (VP4) was performed by semi-nested multiple RT-PCR and the phylogenetic tree of the Rotavirus nucleotides was constructed. The data were analyzed by statistical tests including Wilcoxon signed and Mann-Whitney U. Rotavirus was isolated in 19.3% of the samples, more than 90% of which had long RNA patterns. The predominant genotype (VP4) was P[8] (86%) and other genotypes respectively were P[6] (6.9%) and P[4] (6.9%). A high prevalence of the P[8] genotype was found to be the cause of acute diarrhea. The analysis of P[8] genotype sequence showed a high level of similarity of the virus in this study with those of other Asian countries.

Previous studies were suggestive of a good prognosis in patients with acute coronary syndrome (ACS) and absence of any critical stenosis in coronary angiography but recent limited reports have revealed that patients with non-obstructive acute coronary syndrome are at a higher risk of future clinical coronary events.

A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive coronary artery disease were regarded as the exposed group. Coronary events were recorded within one year of follow-up. Prognostic factors were evaluated at baseline by using a standardized protocol.

Of the 337 patients with ACS, 191 (56.6%) were female. Coronary events in female patients after one year of follow-up were: ST EMI 3 (1.6%), unstable angina pectoris 22 (11.5%), Q-wave MI 1 (0.5%) and no syncope. In male patients the outcomes were: ST EMI 4 (2.7%), unstable angina pectoris 29 (19.9%), Q-wave MI 1 (0.7%), and syncope 1 (0.7%). Multivariate adjusted relationships revealed that physical inactivity (P=0.035), dyslipidemia (P=0.001), low ankle brachial index (P=0.024) and age between 40-50 years (P=0.004) were significantly associated with coronary events in women. In male patients, body mass index of 30-39.99 (P=0.011) was associated with a higher rate of ST-segment elevated MI.

Prognostically, coronary events and clinical endpoints were significantly different between men and women with acute coronary syndrome. Persistence of symptoms over one year seems to relate to the development and progression of coronary atherosclerosis.

Distinguishing the origin of ventricular tachycardia (VT) by electrocardiogram (ECG) which is performed in all patients, helps to diagnose the cause of VT before trying invasive procedures. The aim of this study was to compare the ECG findings in patients with VT originating from Right or Left Ventricular Outflow Tracts (RVOT or LVOT).

Fifty nine patients with VT originating from LVOT or RVOT were selected for this cross-sectional study. The patients were recruited while they were attending Shahid Rajaei Hospital in Tehran, Iran in 2009-2010 for catheter ablation. The participants were evaluated for the prevalence of LVOT and RVOT and were compared for the success rate of radiofrequency catheter ablation.

Out of 59 patients, 44.1% were male and 55.9% were female. The mean age of the participants was 41.67 (SD=13.76) years. QRS transition and notch in ECGs were significantly different (respectively, P=0.027 and P=0.007) between patients with LVOT and RVOT. R-to-QRS duration in precordial leads was significantly longer in patients with LVOT than those with RVOT [0.81 (SD=0.06) ms vs. 0.69 (SD=0.16), P=0.015]. Successful ablation was performed in 73.2% of patients with RVOT versus 93.3% of those with LVOT, but despite a higher rate the differences were not statistically significant (P=0.215).

In this study, RF catheter ablation was successful like other studies on patients with ventricular tachycardia and RVOT VT and LVOT VT had significant differences in notch, QRS transition and R-to-QRS duration in precordial leads which are important in differentiating between the two conditions.

Isolated pulmonary valve stenosis represents 8-10% of congenital cardiac anomalies. This study was performed to evaluate the late outcomes of Balloon Pulmonary Valvuloplasty (BPV) in children with residual infundibular stenosis. Seventy-eight patients underwent BPV in Rajaee Heart Center in Tehran Iran, from 2008-2010. The patients were divided into two groups: with and without infundibular stenosis. The group with infundibular stenosis was subdivided into two groups: with and without propranolol administration. Gradient measurement follow-ups by Doppler echocardiography were done on the first day and 1, 3, 6 and 12 months afterwards. Thirty five (44.9%) patients were male and 43 (55.1%) were female. The mean age of participants was 4.29±3.5 years and the mean weight 16.18±8.8 kg 33 patients (43%) did not show residual infundibular stenosis but 45 (57%) did so in the evaluations. There were no significant differences between the two groups regarding age, weight, sex, kind of balloon valvuplasty, balloon to body surface area ratio and pulmonary regurgitation (PR). Propranolol was administered to 27 (60%) patients with residual stenosis for six months but 18 (40%) did not receive the medication. In both groups, the gradient significantly decreased immediately after BPV (P<0.0001). In the propranolol group a constant decrease in residual gradient was seen. There was a significant relationship between balloon to body surface area ratio (387±94mm2/m2) with moderate to severe PR (P<0.015). BPV is a safe and effective procedure to treat PS. Residual infundibular gradient after BPV decreases over time and propranolol helps decrease the gradient.

Sleep and sleep deprivation plays a major role in EEG abnormalities and also idiopathic and symptomatic seizures. The aims of this study were to compare baseline EEG findings with waking and sleep EEGs after sleep deprivation in patients with sleep seizure. In this cross-sectional study, 33 patients with sleep seizure attending the Neurology Clinic of Sina Hospital in Tehran, Iran, during year 2009 were enrolled. After a baseline EEG, patients were asked to remain awake for 24 hours before taking a waking and a sleep EEG. Finally, the baseline EEGs were compared with findings from waking and sleep EEGs after sleep deprivation. From 33 patients with sleep seizure, sixteen (48.5%) patients were female and seventeen (51.5%) were male. Patients aged from 7 to 49 years and the mean age of the participants was 26.83 (SD=10.69) years. Twenty patients had no family histories of seizure contrary to 13 patients with a positive history for the disease. There was statistically significant differences between the baseline and waking EEGs after sleep deprivation (P=0.042) as there was between baseline and sleep EEGs (P=0.041). Moreover, there was significant differences between waking and sleep EEGs after sleep deprivation (P=0.048). This study demonstrated the effects of sleep deprivation on EEG findings in patients with sleep seizure. In patients with sleep seizure, waking and sleep EEGs could be better demonstrated after sleep deprivation than routine waking EEGs. According to the results of this study, waking EEGs taken after a period of sleep deprivation is superior to sleep EEGs after the deprivation.

The aim of this study was to compare operating time and short-term complications of laparoscopic transabdominal preperitoneal hernia repair during reperitonealization in Trendelenburg versus reverse-Trendelenburg positions.

Thirty-nine patients with inguinal hernia were enrolled in this clinical trial. Study was done in Milad and Rasoul Akram hospitals in Tehran, Iran, during 2008-2010. The patients neither were pregnant nor did they have any signs of peritonitis, strangulation, perforation or infection. Moreover, they had a Body Mass Index (BMI) below 35 kg/m2 and were physically fit for general anesthesia. The participants were divided into two groups by block randomization. The first (20) and the second (19) groups of patients underwent laparoscopic herniorrhaphy in Trendelenburg and reverse-Trendelenburg positions. Respectively all the operations were performed by one surgeon. The patients were visited one day and one week after the surgery.

Most frequent complications were rupture in peritoneal repair in 9 patients (23%), skin site bleeding in one patient (2.6%), and peritoneal tension in 33 patients (84.6%) patients. Duration of surgery and peritoneal repair took a significantly longer time in Trendelenburg versus the reverse-Trendelenburg position. There were no differences in duration for returning to work or resumption of daily activities between the two groups. Pain in the first day following surgery was statistically more severe in the Trendelenburg group.

This study demonstrated that reverse-Trendelenburg position took less time for herniorrhaphy and peritoneal repair than Trendelenburg position, although the complications were the same.

Hemorrhoid is among the most common anorectal diseases and patients with high-grade disease conditions need surgical treatment. Many surgical procedures are available to treat the disease. The aim of this study was to compare the operative time and outcomes, (post-operative pain and complications) of LigaSure hemorrhoidectomy with those of the open conventional method. This randomized single-blind clinical trial included 57 patients (28 in LigaSure and 29 in the open group). The primary variable was the operative time for the excision of a single hemorrhoidal packet. The other variables were post-operative pain measured by morphine doses administered to control pain, scores of visual analogue scale (VAS) used to measure pain severity, pain during home stay measured by doses of oral ibuprofen and the mean daily VAS scores, early complications including bleeding and urinary retention, longer-term complications and time to return to work. The demographic data were comparatively the same between the two groups. The average time to excise a single packet of hemorrhoid was significantly shorter in the LigaSure group (8.91 min vs. 17.35 min, P<0.001). Post-operative pain measurements (morphine doses and VAS scores) were lower in the LigaSure group, but the differences were not statistically significant (P=0.055 and 0.077, respectively). Complications of the two procedures were also comparable. Neither of the groups returned to work in a shorter time. LigaSure hemorrhoidectomy seems to be a safe method and it can reduce the operative time significantly. It may also have a modest effect on post-operative pain.

Neutrophil Gelatinase Associated Lipocalin (NGAL) is a new biomarker which can predict acute kidney injury (AKI) in critically ill patients. Usefulness of NGAL in the early diagnosis of all types of AKI is under question. We hypothesized NGAL is an early predictive biomarker of contrast-induced nephropathy (CIN). In this process evaluation study, we enrolled 122 patients (Mean age 59.7±10.8 years) undergoing elective angiography/angioplasty with contrast media during April to September 2009. Serial urine samples were analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay. CIN was defined as a 25% increase in baseline serum creatinine. The prevalence of CIN was 30.3%. Significant elevations in urinary NGAL concentrations were noted within 12-h and 24-h after the procedure in patients with CIN. NGAL concentrations after 12 hours was 90.62±105.63 vs. 27.6±45.8 ng/ml in patients with and without CIN, respectively P=0.0001, and 79.78±117.7 vs. 30.92±52.84 ng/ml, 24 hours afterwards P=0.002. Some patients had AKI after five days of exposure rather than the second day (P=0.0001). We found using a cut-off point of 8 ng/ml with a sensitivity, specificity, negative predictive value and area under the ROC curve 94%, 25%, 91% and 0.75 respectively are good for the prediction of CIN in 12-h urinary NGAL and a cut-off point of 5.5 ng/ml with respective values of 97%, 24%, 95% and 0.70 for 24-h urinary NGAL. Urine NGAL may represent a sensitive early biomarker of acute AKI after angiography/angioplasty. We recommend the routine measurement of NGAL in high risk patients receiving contrast agents.

The goal of this study was to compare the efficacy of botulinum toxin type A (BTX-A) injection in the hamstring and calf muscles with and without ankle serial casting in the improvement of gait in children with cerebral palsy (CP).

This double-blind prospective clinical trial was performed on 25, 2 to 8-year-old children with hemiplegic or diplegic CP in Tehran, Iran in 2010. The participants were chosen by simple randomized sampling and were matched for age, gross motor function classification system (GMFCS) and type of CP and were randomly divided into two groups: children in the first group (13) only received BTX-A injection, but the second group (12) received BTX-A and serial foot casting starting one week after the injection.

Comparison of the gross motor function, right and left knee spasticities and passive ROM of both knees between the two groups before and 1, 3, 6 and 12 months after the injections were not statistically significant (P>0.1). Furthermore, comparison of the right and left ankle spasticities and passive ROM before the injections and in1 and 3-month follow-ups did not show a statistically significant difference (P>0.1), but the differences were significant in 6 and 12-month follow-ups (P<0.05).

BTX-A injection with serial foot casting vs. BTX-A alone was more effective in decreasing spasticity and improving passive ROM in the ankle of children with CP, but such injections in the hamstrings were not useful in these regards.

Syndactyly is the most common congenital malformation of the hand, with an incidence of 1 in 2000-2500 live births. In this study we evaluated the surgical outcomes and complications of patients with syndactyly. The surgical outcomes and complications of 42 patients, 27 male and 15, female, undergoing surgery for syndactyly were evaluated. The study took place in Imam Khomeini Hospital, in Tehran, Iran during 1996 to 2011. Having had the inclusion criteria, the patients were assessed for function, cosmetic outcome, sensation and occurrence of complications. The patients were followed-up for at least 3 years. The mean age of patients was 4.4 years. There was a positive familial history for the disease in 8 patients. 71.4%, 90.4% and 73.8% of the participants had good results regarding cosmetic outcome, sensation and function, respectively. The overall results of surgery for syndactyly in this study were interpreted as good in 78.5%, moderate in 12.5% and fair in 8.4% of the patients. This study confirmed better surgical outcomes in patients older than 18 months.