Medical Journal Of the Islamic Republic of Iran
Volume:25 Issue: 4, Winter 2011

Pain relief during labour is an important determinant of a women’s birth experience. There are numerous pain relief techniques which can be used either with or without pain medication. The aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. After obtaining informed consent and approval of hospital ethics committee, 40 women with gestational age between 38 and 42 weeks gestation in early labour were recruited for this study. They were randomly allocated into two groups: group RK (20 cases) received 25 μg remifentanil as a starting dose and continuous infusion of 0.06 μg/kg/min remifentanil plus 0.5 mg/kg/h ketamine for 4 hours via pump and group R (20 cases) received 25 μg remifentanil as a starting dose and continous infusion of 0.06 μg/kg/min remifentanil. The baseline of pain scores were similar in both groups (5.75 ± 2.51 vs 7 ± 2.45, p= 0.12) but after 30 minutes to 120 minutes the VAS scores were significantly higher in R group (p< 0.001). The rate of patients who were satisfied (excellent and very good) in RK was 80% but in R group was 45% (p = 0.03). Nausea and vomiting were significantly higher in R group (p<0.05). The remifentanil plus ketamine produced better pain relief during labour with continous monitoring than continous remifentanil with no adverse effects for mothers and infants.

Honey has been used as a nutraceutical in many traditional and ancient remedies. Considering well documented benefits of honey to accelerate wound healing, for the first time we aimed to assess intra oral surgical wound healing process with honey. We designed a pilot randomized placebo controlled cross-over clinical trial. Patients who required bilateral Modified Widman Flap (MWF) surgery randomly assigned to receive either 15 cc topical Persian Thymus Vulgaris concentrated honey three times a day or normal saline as placebo with the same amount at the site of the surgery for seven consecutive days. After a 35-day wash-out period the study groups were crossed. The primary efficacy outcome was changes in healing index (Landry index) and the secondary efficacy outcome were changes in gingival and plaque indices (Loe & Sillness, Sillness & Loe indices). It also includes safety issues consisting of any allergic reaction, delayed healing or wound dehiscence. Ten patients enrolled with the mean age of 36 (±1.5) ranged between 35-40 yrs. There was a significant improvement in wound healing considering time and treatment effects in both groups, although faster wound healing observed in honey treated patients (P<0.001). In both groups gingival indices were noticed to be improved by the time during the first phase of the study. Both groups displayed aggravated Plaque formation; nevertheless it was merely statistically significant in the control group [F (3, 27) =12.88, P value < 0.001]. All wounds healed normally and no adverse events recorded. Our study established the safety, efficacy and feasibility of topical honey to promote periodontal surgical wound healing. (IRCT138901192547N2)

Investigators were suspicious of tyrosine-methionine-aspartate-aspartate (YMDD) mutations occurred only in patients who were treated by lamivudine. However, YMDD mutations of hepatitis B virus gene (HBV DNA) in patients with chronic hepatitis B (CHB) untreated with antiviral medicines was reported in some studies. The aim of this study was to evaluate YMDD mutations in Iranian Patients with chronic hepatitis B (CHB) untreated with antiviral medicines. In a cross sectional study, 151 adult patients with positive Hepatitis B surface antigen (HBsAg) (78 asymptomatic hepatitis B virus carriers, 73 active chronic hepatitis B patients or cirrhosis patients) were evaluated for YMDD mutants. The patients who were treated with interferon and Lamivudine or Adfovier in one year prior to the study were excluded. YMDD mutations of HBV DNA were detected by PCR-RFLP (PCR Restriction Fragment Length Polymorphism) in a single laboratory. The mean (±SD) age of patients was 37±4 years. Eighty one (54%) cases were male and 70 (46%) were female. Eight cases (5.3%) out of 151 had YMDD mutations. The type of mutation in all of these patients was YSDD. There was no significant relationship between YMDD mutation and viral load and HDV Ab (p>0.05). The mutant strains of the YMDD motif of HBV polymerase can be found in some patients without lamivudine treatment. However, in view of rather clinically insignificant YMDD mutation frequency, routine testing for YMDD mutations prior to antiviral therapy is not recommended in these patients.

Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such discharges. A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were DAMA; Odd ratio, OR=2.8; 95% Confidence Interval, CI= 1.26, 6.20). Majority (65.4%) of the signatories to the discharge documents were the child’s fathers. In only 5.5% of cases were the child’s mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. DAMA is a common social pediatric health problem, especially among infants and has multifactorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence.

Chronic urticaria (CU) is a common dermatological disease that induces a substantial burden on individuals’ life. Also if one’s self-image changes (which usually happen in patients with dermatological diseases), it leads to anxiety or other various symptoms. We aimed to compare the psychological scales in patients with CU with non-dermatological individuals with the purpose of early diagnosis and appropriate psychiatric consult. In this study, psychological status of 30 patients with the diagnosis of chronic urticaria (lasting for more than 6 weeks) and 30 controls, chosen among the hospital staff were evaluated. Evaluation was carried out by using standard General Health Questionnaire (GHQ-28). Psychosomatic disorders, anxiety, depression and social functions were assessed. Data were analyzed by SPSS version 16, and the frequency indices and Chi- Square test. Although from 30 patients with CU, 63.3% suffered from psychological disorders, this prevalence was estimated 46.6% in the control group. Altogether, psychological disorders in patients with CU were significantly (p=0.007) more prevalent than individuals without dermatological problems. Anxiety was the most common reported disorder. In our study, the most prevalent psychiatric disorders included anxiety, psychosomatic disorders, social dysfunction and depression, sequentially. It seems that depression is the least significant psychiatric disorder among patients who suffer from urticaria. Also, anxiety was the most reported disorder among them, which may be considered as the primary cause of the disease or it may be secondary to the disease process. This theory clarifies the importance of dermatologists and psychiatrists cooperation.

The measurement of hand grip strength has several clinical applications to evaluate chronic hand disability, response to treatment, and work capacity after hand injury. We measured hand grip strength of 41 adults and compared their maximum strength with radiographic indices. There was a significant relationship between hand grip strength and carpal height, third metacarpal and capitate length (All p-values<0.05). In addition to established factors such as sex, upper limb muscle and joint status, wrist radiographic indices are significantly determinants of hand power grip.

One of the important sites for extrapulmonary TB involvement is the skeleton. Tuberculous spondylitis (Pott’s disease) comprises 50-70% of the skeletal tuberculosis. In this case series study, we prospectively investigated the result of anterior surgery alone (anterior debridement, fusion and instrumentation) in the patients with spinal tuberculosis. The patients with immature skeleton, long segment disease or kyphosis more than 50° were excluded. All the cases were followed for at least 2 years (mean 31.4+/-6.4 months). This study comprised of 23 (13 male and 10 female) cases with a mean age of 35.8 (SD=7.8) years old. Segmental kyphosis was corrected from +11.9° (SD=13.8°) preoperatively to -3.8° (SD=8.9°) after surgery that was mainly maintained at the last follow up visit. Bony union was achieved in all cases but one. Our results showed that in selected cases of tuberculous spondylitis, anterior surgery alone could be encouraging.

Spinal muscular atrophy (SMA) is the second most common lethal autosomal recessive disease. It is a neuromuscular disorder caused by degenerative of lower motor neurons and occasionally bulbar neurons leading to progressive limb paralysis and muscular atrophy. The SMN1 gene is recognized as a SMA causing gene while NAIP has been characterized as a modifying factor for the clinical severity and age at disease onset in SMA patients (SMA subtypes). The relationship between NAIP deletion and type of SMA remains to be clarified; we investigated this gene alteration in all types of SMA patients. Molecular analysis was performed on fifty patients with a clinical diagnosis of SMA in Khuzestan province. In addition to common PCR-RFLP analysis for exon 7 and 8 of SMN1 gene, as an internal control we analysed NAIP deletion with PCR of exon 5 of this gene in a multiplex PCR with exon 13 of it. Homozygous-deletion frequency rate for the telomeric copy of SMN (SMN1) exon 7 in all types (type I, II, Ш) of SMA was approximately 90% and the frequency of deletion in exon 7 and 8 together in all types estimated about 70%. Moreover NAIP gene was deleted in about 60% of these patients and this shows deletion in 91% of type I SMA patients. The correlation between NAIP-deletion and SMN1 mutation showed a high frequency rate. In this study, high frequency of NAIP gene deletion in all type of disease shows the importance role of it in disease pathogenesis. High frequency of NAIP deletion in SMA type I, also shows the importance of the gene in type and severity of disease so it may be a modifier factor in severity of disease.

As a major responsibility, health authorities must control rational prescription of drugs (RUD). A way to analyze the regional status of drug prescription is the WHO’s recommended indices. The purpose of the study was to determine the status of drug prescriptions in pharmacies of healthcare centers under the authority of Tehran University of Medical Sciences based on the WHO indices. In this study, 28 pharmacies of health care centers under the supervision of Tehran University of Medical Sciences were selected and 3420 drug prescriptions were examined. the study revealed that the average number of drug per prescription was 3.03 (SD=0.72). 56.49% of prescriptions contained at least one antibiotic. Moreover, at least one injectable drug was prescribed in 28.96% of prescriptions. Health authorities must play pivotal role in improving rational use of drugs. General practitioners are the major chain in RUD cycle. Results showed that we need to design some educational programs such as holding workshops on the RUD for physicians, public education and also producing related printed materials and advertising in the Media. These programs may improve the status based on the WHO indices which for example refers to the percentage of prescription of antibiotics & injections in the region.