Archives of Iranian Medicine
Volume:13 Issue: 4, Jul 2010

There is no consensus in the treatment of de Quervain’s tenosynovitis, but wrist support with or without local corticosteroid injection has been considered as an effective treatment modality. Some patients have expressed reluctance for steroid injections because of the fear of probable adverse reactions. This study was performed to compare the outcome of methylprednisolone acetate injection plus thumb spica cast versus cast alone for the treatment of de Quervain’s tenosynovitis. This randomized prospective study was conducted from January 2005 to July 2008 in the orthopedic clinics of our hospital and private offices. A total of 73 patients with de Quervain’s tenosynovitis were managed with either of these 1) injection of methylpredmisolone acetate in the first dorsal compartment of the wrist followed by wrist thumb spica cast. 2) casting alone. Wrist casting duration in both groups was one month and the patients were followed for 6 months. In the first group, a total of 37 patients were included (injection plus wrist immobilization by cast), and 36 patients in the second group (wrist casting alone). The mean age was 32.6 years (21 – 61 years) in all patients. There were 63 women and 10 men. Overall success rate was 86.5% in the first and 36.1% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P<0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in 40% of patients. Despite this adverse reaction which was related to methylprednisolone injection, a higher success rate was seen in the injection group in comparison to patients treated solely by casting. Support of the wrist with casting alone had less favorable outcome in de Quervain’s tenosynovitis. Adding methylprednisolone acetate injection into the first dorsal compartment of the wrist is necessary for more optimal results

Perinatal asphyxia is a major cause of neurologic morbidity and mortality. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) count per 100 white blood cells (WBC) and absolute NRBC/mm3 in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. A prospective (case-control) study was undertaken between October 2006 and December 2008, in the Neonatal Intensive Care Unit, Ghaem Hospital, Mashhad, Iran. A total of 91 infants completed the study. Levels of nucleated red blood cell per 100 white blood cells and absolute nucleated red blood cell counts in venous blood were compared for 42 asphyxiated (case group) and 49 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. The NRBC/100 WBC and absolute nucleated red blood cell levels in the blood of newborns in the control group were 3.87±5.06 and 58.21±87.57/mm3, respectively; whereas the corresponding values in the cases were 18.63±16.63 and 634.04±1002/mm3, respectively (P<0.001). A statistically significant negative correlation existed between nucleated red blood cell level and indicators of the severity of perinatal asphyxia, first minute Apgar score and blood pH (P<0.001), respectively. A positive correlation was demonstrated between these parameters and severity of asphyxia, acidosis, and poor outcome (P<0.05). The NRBC/100 WBC and/or absolute nucleated red blood cell are simple markers for assessment of severity and early outcomes of perinatal asphyxia.

Mucocutaneous candidiasis (almost endogenous) is one of the most common manifestations of human immunodeficiency virus (HIV) infection. The aim of this study was the investigation of colonization patterns of Candida species, particularly C. dubliniensis, among mucosal sites of HIV-positive patients and determining corresponding in vitro susceptibility patterns to the antifungals. From July 2006 to May 2008, specimens from the mucosal sites of 273 seropositive HIV patients were collected for Candida colonization. All isolates were identified by standard methods and carbohydrate assimilation patterns. Isolates phenotypically identified as C. albicans or C. dubliniensis were subjected to molecular identification. Susceptibility patterns of the isolated species to seven antifungal agents were determined using the broth microdilution method. The 359 samples from mucosal sites which consisted of 273 oral and 86 vaginal were collected and evaluated for Candida species distributions and their corresponding susceptibility patterns. The most commonly isolated species were: C. albicans (50%) followed by C. glabrata (21.4%), C. dubliniensis (13.3%, reported for the first time in Iran), C. krusei (9.8%), C. kefyr (3.1%), C. parapsilosis (1.6%), and C. tropicalis (0.8%). All species were sensitive to amphotencin B, ketoconazole, nystatin, voriconazole, and caspofungin. In some isolates, resistance to fluconazole and itraconazole was noted. As demonstrated, resistance to fluconazole and itraconazole, the most frequent antifungals in use in the region suggests regular investigation into antifungal resistance in medical centers should be undertaken in order to promote the effective management of invasive candidiasis in HIV/AIDS patients.

To compare the clinical efficacy of acupressure with treatment induced by ondansetron and metoclopramide on reduction of the severity of postoperative nausea and vomiting (PONV) after strabismus surgery. There were 200 patients with ASA classes I-II, ages 10 to 60 years old, who underwent strabismus surgery that were included in this randomized, prospective, double-blind, placebo-controlled trial. Group I was the control, group II received metoclopramide 0.2 mg/kg, and group III received ondansetron 0.15 mg/kg intravenously immediately prior to anesthesia induction. In Group IV, acupressure wristbands were applied at the P6 points. Acupressure wrist bands were not placed appropriately for subjects of groups I-III. The acupressure wrist bands were applied 30 minutes before anesthesia induction and removed six hours after surgery completion. Anesthesia was standardized. PONV was evaluated within 0 – 2 hours and 2 – 24 hours after surgery by a blinded observer. Results were analyzed by the Chi-square or Fisher exact test. A P value of <0.05 was considered significant. The incidence of PONV was not significantly different among acupressure, metoclopramide and ondansetron groups during 24 hours. Also, the severity of PONV was not significantly different between acupressure, metoclopramide, and ondansetron in the recovery and ward. Acupressure at the P6 point causes a significant reduction in the incidence and severity of PONV 24 hours after strabismus surgery as well as metoclopramide (0.2 mg/kg) and ondansetron (0.15 mg/kg) intravenous for patients aged 10 or older. (Irct ID: IRCT138807152556N1)

Morphine, as a narcotic analgesic drug, can suppress the immune system including the spleen and lymph node during long-term administration. Quantitative studies can be an appropriate indicator for the assessment of organ disturbances. As such, this study aimed to determine the effect of chronic morphine treatment on the histological parameters of the spleen and lymph node, with the use of stereological methods. Nineteen male mice were divided into two groups, experimental and control. Addiction was induced by administration of 0.5% morphine solution in the experimental group. On day 71, after a physical dependency test, the animals were deeply anesthetized, dissected and their spleens and inguinal lymph nodes were removed. After histological preparation, the sections with a constant distance were selected and stained with hematoxilin-eosin. The total volume, red pulp, white pulp, and trabecular volume of the spleen as well as the total volume, cortex, nodule, medulla, medullary cord, and medullary sinus of the inguinal lymph node were calculated by Cavalieri’s and point-counting methods. Data were analyzed with the Mann-Whitney U test The mean total volume 34.87±6.74 mm³, mean white 9.57±2.66 mm³ and red pulp volume 24.10±4.65 mm³ of the spleen in the experimental group decreased significantly [~44% (P<0.001), ~43% (P<0.003), and ~39.5% (P<0.001), respectively]. The mean cortex 4.37±1.39 mm³ and nodule volume 1.67±0.70 mm³ of the inguinal lymph node in the experimental group decreased significantly (P<0.04; ~31% and ~29.5%, respectively). In addition, the white blood cell count decreased in the experimental group 7.12±2.7 (~21%). Long-term use of morphine can suppress the immune system by reducing both the spleen and inguinal lymph node volume, and white blood cells.

The prevalence of celiac disease is common in Iran. The aim of the present study was to determine the prevalence of celiac disease in apparently healthy blood donors of Sistan and Balouchestan Province, southeastern Iran. Serum samples of 1600 consecutive apparently healthy blood donors at Zahedan Blood Donation Center were assayed for anti-tissue transglutaminase (tTG) antibody. The levels of IgG antibodies against tTG were screened for all subjects with IgA deficiency. All subjects with positive anti-tTG IgA or IgG were offered upper gastrointestinal endoscopy and duodenal mucosal biopsies. IgA deficiency was found in 28:1600 (1.8%) of the subjects, among whom 4 cases were positive for IgG-class tTG antibody. Meanwhile, 10 blood donors were positive for anti-tTG IgA antibody. With the exception of 2 subjects who had normal small bowel biopsies, the remainder of the subjects’ biopsy findings were compatible with celiac disease. The prevalence of celiac disease was found to be 0.88% (1/114) based on tTGA positivity. The prevalence of celiac disease among the southeastern Iranian population is high and comparable with other parts of Iran as well as many other countries.

To evaluate the safety and effectiveness of locally produced pegylated interferon-α2a in treatment-naïve patients with chronic hepatitis C. All treatment-naïve patients diagnosed with chronic hepatitis C who referred to two university based outpatient clinics in Tehran from December 2007 to May 2008 were enrolled. Exclusion criteria included the presence of a debilitating disease, decompensated cirrhosis, or refusal to participate in the study. Patients were treated with 180 μg pegylated interferon-α2a (Pegaferon) weekly and 800 – 1200 mg ribavirin daily for 24 or 48 weeks depending on genotype and weight. Viral and biochemical response and adverse drug reactions were recorded. A total of 108 patients were enrolled; 63 with genotype 1 and 45 with genotypes 2 and 3. The mean age of the patients was 39 years (range: 19 – 65). Ninety-seven patients completed the study and 76 achieved sustained viral response. The sustained viral response among patients completing the study was 67% for genotype 1 and 95% for genotypes 2 and 3. Adverse events were well tolerated and none led to discontinuation of treatment, however dose adjustment was necessitated in 16 patients. The most common adverse events were fatigue (73.5%), poor appetite (66.2%), and feverishness (57.4%). The mean hemoglobin drop was 2.9 g/dL. Locally produced PEG-IFN in Iran is safe and effective in treatment-naïve chronic hepatitis C. ClinicalTrials.gov identifier: NCT01137383

The number of medical universities and their faculty members has significantly increased in Iran during the last 30 years. This development has led to the training of a large number of healthcare professionals. But, its effect on medical sciences productivity has not yet been fully analyzed. Here, we use a bibliometric analysis to assess the current status of Iranian medical sciences production in different subject areas. The bibliographic data of Iranian medical subjects during the years 1978 – 2008 were collected from the Science Citation Index Expanded database and analyzed according to publication number, different medical subject areas, citations and the annual Iranian mid-year population. It was shown that Iranian scientists have established good collaboration with developed countries. The numbers of medical publications, even after normalization to the population size, and citations of these publications have significantly increased in recent years. It has also been shown that pharmacologic research constitutes the major theme in the Iranian medical research system and thus enjoys the highest rate of growth. Strengthening of the non-pharmacologic research infra-structure is advised for both basic and clinical departments, keeping in mind the existing successful research model of pharmacology in Iran.

Aim of the study was to evaluate the HIV and hepatitis C virus (HCV) coinfection and associated risk behaviors among Injection Drug Users in Detention, Tehran, Iran. A cross-sectional survey included 499 male Injection Drug Users arrested by police during a predetermined police sweep in Tehran (February, 2006). At the temporary detention center, they were screened using a urine test and a physical examination for injection marks. Those who were identified as injectors were sent to the rehabilitation center for 3 months. A questionnaire was filled out for each individual by interview. Blood specimens were collected for HIV and HCV testing. The variables associated with HIV/HCV coinfection at a significance level of P<0.10 were considered in multivariate analysis. Of the 417 participants, 100 (24.0%) had HIV/HCV coinfection (95%CI 19.9 – 28.4). Factors independently associated with HIV/HCV coinfection included history of using opioid in jail, and age (P<0.05).There were not any association between other demographic characteristics (marital status, birthplace, residence, and education), type and years of drug abuse, age of first injection, years of injection, sharing needles inside and outside of jail, injection in jail, history of tattooing, any sexual behavior, and history of sexually transmitted diseases with HIV/HCV coinfection (P>0.05). This study supports that incarceration is contributing to the increased spread of HIV/HCV coinfection. So, there is urgent need for effective harm reduction programs, particularly among incarcerated Injection Drug Users.

To examine the association between alcohol misuse and depression symptoms as it varies among male and female patients. This was a cross-sectional survey of 412 randomly selected adult patients who sought care in the emergency department. The main predictor variables of alcohol misuse were created from AUDIT, RAPS4, binge drinking, alcohol abuse, and alcohol dependence measures. The outcome variable of depression symptoms was measured by the Center for Epidemiological Studies Depression Scale (CES-D, ≥16). There were 41% of women and 35% of men who reported greater depression and 34.1% of men and 9.2% of women reported alcohol misuse. Alcohol misuse, stress, and education level all correlated with greater depression in men whereas age was most significant for women. Men who misused alcohol were 2.5 times more likely to report greater depression (OR=2.47, 95%CI=1.37 – 4.45, P≤0.05). In women, a 10-year increase in age was associated with a 36% increase in the odds of depression (OR=1.55, 95%CI=1.12 – 2.13, P≤0.05). While it may be unrealistic to expect emergency department providers to fully attend to all the mental health needs of their patients, they should use windows of opportunity to identify patients who present with symptoms of depression and/or alcohol misuse for potential intervention.

Iran has gone through sharp demographic changes in the past three decades. Presently, in Iran, there is a lack of health promotional activities targeting the elderly which can lead to a decrease in their quality of life and an increase in their disability rates. Those most vulnerable amongst the elderly are females, who have low education and low socioeconomic status. For them and others, few social services, accessible housing options and long-term care facilities exist. Data was gathered using population projections over an 80-year period (1975 – 2055), facilitated by spectrum software prepared by the USAID/Health Policy Initiative with data source derived from projections of the United Nations, World Population Prospects. Projections derived were on the expected population, the median age of the population, population pyramids, total fertility rates, life expectancy, and dependency ratio. Projections showed that by the middle of this century approximately one fifth of the population will be over 60, with the median age of the population almost doubling from what it is today and the dependency ratio increasing steadily. Currently, the resources are not sufficient to address the special needs of an elderly population and are at risk for becoming even more strained over the 80 year span. Iran must begin to prepare itself for the impact that a massive ageing population will have in the ensuing years. Recommendations suggest developing policies supportive of accessible and affordable housing and care facilities, establishing community health programs that aid the elderly in continuing to live at home, and strengthening the availability of pension plans.

Chronic non-communicable diseases cause substantial morbidity and mortality in both developed and developing countries. Current studies indicate an increasing burden of chronic diseases in the near future, especially in developing countries. Chronic diseases have received much less attention than infectious diseases in Iran''s health care system, which is a major cause for concern. Data on the dimensions of the epidemic and its health impact and financial burden in Iran are not adequate. A comprehensive action plan should start with a comprehensive research plan and should end in a multi-faceted intervention plan, involving the entire health network in Iran. Studies in some developed countries have demonstrated that a comprehensive intervention will lead to a reduction in the burden of chronic diseases in a relatively short time. The effect of such interventions and the methods to implement them should be tested in Iran''s health system too.

Car accidents and gun-shot injuries are the most common causes of spinal cord injury. Five percent of those patients who have a complete spinal cord injury will experience improvement, to some extent. The lack of specific data in the literature regarding the outcome of earthquake related spinal cord injury justified us to design this study where we evaluated the neurological outcome and related factors of SCI in the Bam earthquake.We retrospectively evaluated the neurological outcome of patients with spinal cord injury who survived the Bam earthquake. In this study all patients with spinal cord injury that resulted from the Bam earthquake who registered in the Welfare Organization of Kerman were studied. The neurological conditions of patients eighteen months after the earthquake were compared with their neurological conditions at the time of the earthquake. A total of 17 (23.9%) patients with grade A impairment based on ASIA impairment Scale (AIS) at the time of the earthquake had significant neurological recovery. In addition, younger patients had better neurological outcomes. Those who had fracture dislocations had a worse outcome. Spinal cord injuries that are due to earthquakes have a better neurological outcome in comparison with other causes of this injury. The patients’ ages and types of spinal fractures were significantly related to the neurological outcome.

Progressive periodontal disease in leukocyte adhesion deficiency children may lead to severe systemic infections and even death. A five-year-old Iranian male child with leukocyte adhesion deficiency I was first seen in December 2005 at the Pediatric Dentistry Department of Shahid Beheshti Medical University and diagnosed with periodontitis as a manifestation of systemic disease. The treatment approach was based on assessing plaque index, oral prophylaxis, periodic supra and subgingival scaling, in addition to strict oral hygiene instruction with a chlorhexidine prescription and restoration of decayed teeth. The patient attended two dental visits at a one month interval. At the second session, an improvement was seen in the plaque index. Gingival inflammation and bleeding were decreased. Unfortunately he did not regularly attend treatment sessions and at the following examination, progression of periodontitis and bone destruction occurred. The present case emphasizes the need for cooperation between medical and dental professionals, parents and the pediatric patient in order to achieve treatment goals in controlling oral infection in these patients.

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier’s gangrene in a 21 day old male neonate who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gives good results and probably in our setting, to some extent, it is a preventable condition.

Aneurysm of the interventricular membranous septum is a very rare cardiac anomaly in the absence of ventricular septal defect. We report the case of a 22-year-old man with aneurysm of the interventricular membranous septum incidentally determined during aortic valve surgery. The patient underwent successful aortic valve replacement and aneurysm repair.Patients with the aneurysm of the interventricular membranous septum who are asymptomatic must be followed closely in terms of potential cardiac complications.