Journal of Research in Medical Sciences
Volume:18 Issue: 12, Dec 2013

Blood loss during spinal decompression and fusion is high as much or more than the patient’s total estimated blood. It is possible that increased blood loss increased the risks of morbidity and eventually length of hospital stay (LOS). The aim of this study was Identification the predictors of blood transfusion in major spine surgery. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included. The number of level fused (mainly more than three segments) had significant correlation with intraoperative blood loss (IBL). Intraoperative mean SBP was the second momentous variable subsequent to the number of level fused. It appears diminishing intraoperative mean SBP could directly proportional to decreased IBL, need of red cell transfusion, short operation time and eventually decreased LOS. Length of operation was important as intraoperative SBP in predicting IBL and eventually LOS. In this study, we observed that number of instruments (especially more than six screws) had significant correlation with IBL though in logistic analysis it was not useful predictor for IBL. Factors included: increasing age, length of surgery, increased intraoperative mean SBP, more level of laminectomy and furthermore the number of instruments could positively predict IBL. Operation length, level of fused, intraoperative mean SBP and preoperative Hb value could be useful predictor for blood transfusion. Also, age>50y, the volume of IBL (especially more than 500cc), operation length (particularly more than 180 minute), increased level of fused (mainly more than 3 levels) and the number of comorbid conditions could predict increasing LOS. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included.

Iraq fought three wars in three consecutive decades, Iran-Iraq war (1980-1988), Persian Gulf War in 1991, and the Iraq’s war in 2003. In the nineties of the last century and up to the present time, there have been anecdotal reports of increase in cancer in Ninawa as in all provinces of Iraq, possibly as a result of exposure to depleted uranium used by American troops in the last two wars.This paper deals with cancer incidence in Ninawa, the most importance province in Iraq, where many of her sons were soldiers in the Iraqi army, and they have participated in the wars. The data was derived from the Directorate of Health in Ninawa. The data was divided into three sub periods: 1980-1990, 1991-2000, and 2001-2010. The analyses are performed using Poisson regressions. The response variable is the cancer incidence number. Cancer cases, age, sex, and years were considered as the explanatory variables. The logarithm of the population of Ninawa is used as an offset. The aim of this paper is to model the cancer incidence data and estimate the cancer incidence rate ratio (IRR) to illustrate the changes that have occurred of incidence cancer in Ninawa in these three periods. There is evidence of a reduction in the cancer IRR in Ninawa in the third period as well as in the second period. Our analyses found that breast cancer remained the first common cancer; while the lung, trachea, and bronchus the second in spite of decreasing as dramatically. Modest increases in incidence of prostate, penis, and other male genitals for the duration of the study period and stability in incidence of colon in the second and third periods. Modest increases in incidence of placenta and metastatic tumors, while the highest increase was in leukemia in the third period relates to the second period but not to the first period. The cancer IRR in men was decreased from more than 33% than those of females in the first period, more than 39% in the second period, and regressed to 9.56% in the third period. Our paper confirms the media reports that there are increases in the number of cancer cases, but when it analyzed statistically with population growth in the Ninawa province, there are decreases in incidence rates in most cancer types.

Predicting life expectancy is an important component of public health, in that, it may affect policy making in fields such as social security and medical care., To estimate the life expectancy and the average years of life lost (AYLL) of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-infected population, compared with that of the general population, and also to assess the impact of the CD4 count, risk factors of transmission, marital status, and employment status on life expectancy. This study is a population-based cohort study. The sample consisted of HIV/AIDS-infected patients receiving care from 2001-2011. The patients were all adults (20-64 years) who were recruited from the Counseling Center of Behavioral Diseases. Life expectancy was measured based on an abridged life table, according to age-specific mortality rates and average years of life lost (AYLL) during the study period. Forty-three of the 205 eligible patients died during 853 personyears follow-up. Compared to the general population, the life expectancy for patients with HIV infection at age 20 is about 36 years less. We have found that out a total of 1597 years of life lost during 2001-2011, compared to an overall AYLL for all HIV/AIDS, the deaths had occurred 36 years earlier than the life expectancy. Life expectancy in HIV/AIDS-infected patients is about 38 years less than that of the general population at the exact age of 20. The deaths caused by HIV/AIDS occurred about 36 years before what was expected in the general population at ages 20-64, and many of these years of life lost could be saved if the health care system was implemented against the risk factors of HIV/AIDS.

There are inter-observer disagreements between papillary thyroid carcinoma (PTC) with other follicular lesions of thyroid in aspect of diagnosis. CD56 is present on follicular epithelial cells of the normal thyroid. We evaluated the diagnostic value of CD56 expression in PTC, follicular thyroid lesions, and follicular thyroid neoplasms. Seventythree cases diagnosed as follicular lesions and 73 cases diagnosed as PTC were stained with CD56 marker. A positive membranousimmunostaining in more than 10% of the neoplastic cells qualified the case as “positive (+)” for CD56. CD56 expression was seen in 70 samples of non-papillary carcinoma lesion (95.8%) versus one case of PTC (1.3%) (P < 0.001, Chi-square). Therefore,CD56 was 98.6% sensitive and 95.8% specific in distinguishing PTC from other follicular thyroid lesions. CD56 is both a sensitive and specific marker for differentiating PTC from other follicular lesions of thyroid singly but it may be better to use a combination of markers for clinical evaluation of patients.

Developmental dysplasia of hip (DDH) is one of the congenital anomalies in newborns that if not diagnosed and treated on time can lead to a severe disability. Although clinical examination is a very useful way for screening, but in some patients, a confirmatory diagnostic method such as ultrasonography is needed. The aim of the present study is to compare the sensitivity and specificity of clinical examination and ultrasonography in early detecting of DDH. A total of 5800 of newborns were examined by orthopedic surgeon as a screening method. The newborns with risk factors or suspicious on clinical examination were introduced to repeat clinical and ultrasonographic examination of hip. The results were collected and recorded by a check list and then the sensitivity and specificity of clinical examination were calculated. Of 5701 newborns (11402 hips) who were studied by two methods of clinical examination and ultrasonography (by Graf method), the overall incidence of DDH was 29 per 1000. Only 94 hips (13.5%) of 694 disordered ones according to clinical examination were involved on ultrasonographic evaluation. A total of 240 hips of 334 (72%) involved hips according to ultrasonography (Graf type IIb or more) were diagnosed normal on clinical examination, considering ultrasonography as a gold standard method of evaluating DDH, the sensitivity and specificity of clinical examination were calculated 28.1% and 94.5%, respectively. According to the present study, ultrasonogeraphic examination has a high valuable in screening of DDH and the clinical examination done by an experienced orthopedic surgeon has an acceptable value in primary screening of DDH in developing countries for detecting of healthy neonates, but if the newborn has a risk factor or is suspicious on clinical examination, it will be necessary to get assistance from ultrasonography by an experienced sonographer.

Helicobacter pylori (H. pylori) resistance to antibiotics has become a global problem and is an important factor in determining the outcome of treatment of infected patients. The purpose of this study was to determine the H. pylori resistance to clarithromycin, metronidazole, and amoxicillin in gastrointestinal disorders patients. In this study, a total of 260 gastric antrum biopsy specimens were collected from patients with gastrointestinal disorders who referred to Endoscopy Section of the Isfahan Hospitals. The E-test and Modified Disk Diffusion Method (MDDM) were used to verify the prevalence of antibiotic resistance in 78 H. pylori isolates to the clarithromycin, metronidazole, and amoxicillin. H. pylori resistance to clarithromycin, metronidazole, and amoxicillin were 15.3, 55.1, and 6.4%, respectively. In this study¸ we had one multidrug resistance (MDR) isolates from patient with gastritis and peptic ulcer disease. Information on antibiotic susceptibility profile plays an important role in empiric antibiotic treatment and management of refractive cases. According to the results obtained in this study, H. pylori resistance to clarithromycin and metronidazole was relatively high. MDR strains are emerging and will have an effect on the combination therapy.

The purpose of this study is to investigate the relationship between the cognitive impairment and NAA/Cr and Cho/Cr ratios in the proton magnetic resonance spectroscopy (1HMRS), and to assess the importance of 1HMRS in the early diagnosis of cognitive impairment in patients with ischemic white matter lesions (WMLs). A total of 45 patients (23males and 22 females) with the ischemic WML were divided into mild WML group (n = 15), moderate WML group (n = 15), and severe WML group (n = 15). A total of 15 healthy controls (8 males and 7 females) with no WML on magnetic resonance imaging were included. 1HMRS focusing on the frontal lobe white matter around the anterior horn of the lateral ventricle and Montreal Cognitive Assessment (MoCA) were conducted. Patients with more severe WML had lower MoCA scores. The NAA/Cr ratio in 1HMRS was reduced in all the patients and was strongly correlated with the total MoCA scores (r = 0.845, P < 0.001). The Cho/Cr ratio in 1HMRS was increased in mild and moderate patients, was negatively correlated with the total MoCA scores (r = 0.907, P < 0.001). The Cho/Cr ratio was reduced in the severe patients and was positively correlated with the total MoCA scores(r = 0.937, P < 0.001). In addition, NAA/Cr and Cho/Cr ratios in 1HMRS were changed in patients with the mild WML whose total MoCA scores were similar to the controls. Our results suggest that NAA/Cr and Cho/Cr ratios in 1HMRS are useful indicators for early diagnosis of ischemic WML and cognitive impairment in patients with ischemic WML.

The effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. The air samples obtained from 66 stable asthmaticsand 35 control subject’shouses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed both groups. The temperature and humidity of each house were measured. The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m3 and 34.3 CFU/m3, respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass and weeds and molds. Spending childhood in a village was more common among atopics. Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma.

National Institute of Environmental Health Sciences (NIEHS) scientists shows that long-term exposure to air pollutants increases the risk of respiratory diseases such as allergies, asthma, chronic obstructive pulmonary disease, and lung cancer. Children and the elderly are particularly vulnerable to the health effects of ozone, fine particles, and other airborne toxicants. Air pollutionn factors are considered as one of the underlying causes of respiratory diseases. This study aimed to determine the association of respiratory diseases documented in medical records and air pollution (Map distribution) of accumulation in Isfahan province, Iran.By plotting the prevalence and spatial distribution maps, important differences from different points can be observed. The geographic information system (GIS), pollutant standards index (PSI) measurements, and remote Sensing (RS) technology were used after entering data in the mapping information table; spatial distribution was mapped and distribution of Geographical Epidemiology of Respiratory Diseases in Isfahan province (Iran) was determined in this case study from 2005 to 2009. Space with tracing the distribution of respiratory diseases was scattered based on the distribution of air pollution in the points is an important part of this type of diseases in Isfahan province where air pollution was more abundant. The findings of this study emphasis on the importance of preventing the exposure to air pollution, and to control air pollution product industries, to improve work environmental health, and to increase the health professionals and public knowledge in this regard.

This study aims at investigating the possible effects of different daily doses of green tea (GT) intake for eight weeks on certain anthropometric, metabolic, and oxidative stress biomarkers of diabetic patients. This randomized clinical trial included 63 patients with type 2 diabetes (30 males and 33 females). After a two-week run-in period without green tea, they were randomly assigned into one of the three groups, with a different daily intake of green tea; four cups of green tea per day (n = 24),two cups of green tea per day (n = 25), and the control group (n = 14) with no green tea intake for two months. At baseline and after the intervention, blood tests, dietary, and anthropometric variables were assessed. The patients were instructed to maintain their usual dietary intake and normal physical activity. Consumption of four cups of GT per day caused a significant decrease in body weight (73.2 to 71.9) (P < 0.001), body mass index (27.4 to 26.9) (P < 0.001), waist circumference (95.8 to 91.5) (P < 0.001), and systolic blood pressure (126.2 to 118.6) (P < 0.05) in this group. No significant change was seen in the other groups and between group comparisons. The metabolic and oxidative stress parameters did not show any significant differences within and between groups. Drinking four cups of green tea led to a significant reduction in weight and systolic blood pressure.

Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. The most frequent age group was 20-29 years (44.5%). The floating knee injuries were more common in males (85.5%). Type (D) according to “the classification of Letts and Vincent” was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%). The most common associated injury was pelvic fractures (86.8%). Open reduction and internal fixation was the common type of treatment (70%). The most common early and late complications were knee hemarthrosis in 31 cases (14%) and knee osteoarthritis in 30 cases (13.6%), respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%). There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05). This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it.

High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients,there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO). A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009–2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery. The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 ± 3.05° vs. 3.93± 0.66°, 79.13 ± 3.4° v s. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion(ROM) near knee and ankle was not observed. DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time.

Aspiration pneumonia is a potentially preventable illness requiring attention to small details of patient care. The type, management, and care of feeding should be carried out properly. Materials and This is a prospective clinical study of enteral feeding on patients admitted to hospital with aspiration pneumonia. The known enteral nutritional methods, advantages,and disadvantages were told to the patient or proxy. If they didn’t accept Percutaneous endoscopic gastrostomy (PEG), nasojejunal tube (NJT) was advised. If they denied all of the procedures, oral feeding education was given. A total of 94 patients were enrolled to the study, 29 of them accepted PEG, 42 preferred NJT, and 23 preferred oral route. A total of 94 patients with a mean age of 77.84, standard deviation 10.784; 95% confidence interval (CI) 75.63-80.03 were enrolled to the study of which 27 (28.7%) patients had a history of aspiration pneumonia. Oral feeding was prominently preferred for patients nursed by a relative (15; 65.2% of Oral feeding group and 16% of total) or a caregiver (7; 30.4% of Oral feeding group and 7.4% of total) while only 1 (4.3% of Oral feeding group and 1.1% of total) with a health-care worker (P = 0.001). Overall re-aspiration rates at the 6th month were 58%, 78%, 91% in EG,NJT, oral groups, respectively. Sixth months’ survival rates of the different feeding groups were not significantly divergent from each other. History of aspiration was also found to be a significant contributor of mortality. In aspiration pneumonia patients’ long-term survival rates of the different feeding groups were not significantly divergent from each other.

The links between disasters and violence either self-directed or interpersonal are now more recognized. Nevertheless, the amount of research is limited. This article discusses the underlying association of disasters and violence and it also outlines a systematic review of the literature from 1976 to 2011. Finally, it concludes and recommends particular approaches for further epidemiological research.

Flecainide has been known to cause torsades de pointes (TdP) in patients with structural heart disease and its mechanism has been attributed to use-dependency. We present a patient with flecainide-induced TdP in the absence of any other precipitating factors.This case highlights potential reverse use dependence associated with flecainide resulting in TdP.

Squamous cell carcinoma (SCC) of the buccal mucosa accounts for 23% to 37% of all intraoral cancers, the prognosis is generally poor. we reported a case of Local invasion of buccal squamous cell carcinoma. A 32-year-old man referred to the clinic with a chief complaint of swelling in the right cheek region that initiated from 6 months ago and rapidly grow from one month ago. History of the patient revealed that he was undergoing a surgery for buccal Squamous cell carcinoma (SCC) lesion 2 years ago. Computed tomography (CT) and Magnetic resonance(MRI) images showed a heterogenous mass in the right maxillary, palate and mandibular regions that was histopathologically diagnosed as recurrence with locoregional invasion of SCC.

Paragangliomas are tumors that originate from extra-adrenal medullary neural crest derivatives. They are rarely located in retroperitoneal space. These tumors are often discovered incidentally during imaging studies performed for other reasons.Periampullary cancers include adenocarcinomas arising from the pancreas, ampulla of Vater, duodenum or distal common bile duct. The exact site of origin of periampullary tumors is often difficult to ascertain pre-operatively. We report the case of a patient who had a retroperitoneal non-functional paraganglioma, concurrent with periampullary adenocarcinoma. An 81-year-old woman was admitted with progressive abdominal fullness. There was an upper paramedian, left sided, large, palpable mass on the physical examination.Laboratory investigations showed an increase in liver enzyme levels. On abdominal computed tomography the patient found to have a large retroperitoneal mass and dilation in biliary tract, which was confirmed by magnetic resonance cholangiopancreatography. She had a tumoral papi in Endoscopic Retrograde cholangiopancreatography. Which biopsy revealed adenocarcinoma. She underwent surgery for excision of abdominal mass and pancreaticoduodenectomy. And pathologic study showed paraganglioma. This is the first ever reported case of concurrent paraganglioma and periampullary adenocarcinoma.