مجله مطالعات علوم پزشکی
سال بیستم شماره 2 (تابستان 1388)

Rheumatoid arthritis is an autoimmune disorder with unknown aetiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the aetiology and pathogenesis of rheumatoid arthritis. The aim of this study was to investigate plasma concentrations of vitamin E, vitamin A, and activities of catalase and sign of disease in sixty patients.

In this case-control study, sixty 18-75 year-old patients with rheumatoid arthritis and sixty healthy, sex age-matched controls were studied. Catalase activity was measured by determining the constant rate of hydrogen peroxide decomposition and specterophptometry. Vitamin E and vitamin A were determined using HPLC and reactive protein; rheumatoid factor values were determined with immunotorbidometry test. Haemoglobin content with Cyanomethemoglobin and ESR with westegren method was determined. Statistical analyses were carried out by the SPSS program (version 11.5) using unpaired student t-test for comparison of the two groups.

The plasma activity of catalase (p<0.001), concentration of vitamin E and vitamin A (p<0.01) were significantly lower in patients with rheumatoid arthritis than in controls. There was a negative significant relation between C reactive protein, rheumatoid factor values and the plasma activity of catalase, concentration of vitamin E, and vitamin A, (p<0.05), Vitamin A with Vitamin E, Hb and Hct and Catalase with Hb, Hct and ESR. There was a negative significant relation between, concentration of vitamin E and morning stiffness, the number of swollen joints and disease duration (p<0.05).

These results suggested that oxidant stress plays a very important role in the inflammation and pathogenesis of rheumatoid arthritis.

Ischemic optic neuropathy due to occlusion of posterior cilliary artery is one of the most common causes of visual loss in people over the age of 50. The most common cause of this syndrome is carotid atherosclerosis in the setting of poor controlled diabetes and hypertension. There are many diagnostic tools for diagnosis of this syndrome which transcranial Doppler sonography is unique for its rapidity, easier performance, and noninvasiveness.

In this study, the results of transcranial Doppler sonography of 9 patients with Ischemic optic neuropathy over 1 year were evaluated that were referred by ophthalmologists.

The flow indices of middle cerebral artery in both sides of all patients were within normal limits. In %66 of the patients, the flow velocity decreased in ophthalmic artery correlating with partial stenosis of ipsilateral internal carotid artery. The documented results by magnetic resonance angiography and the results of both methods were well correlated.

The results of this research like other similar analysis demonstrate the importance of transcranial Doppler sonography for diagnosis of Ischemic optic neuropathy.

Prolonged jaundice has been reported as a clinical sign of urinary tract infection in newborns. The aim of the present study was the evaluation of the incidence of urinary tract infection in neonates with prolonged unconjugated hyperbilirubinemia. 1244 neonates hospitalized at Ekbatan neonatal department, from September 2002 to September 2006 were evaluated in this descriptive study. The age of the neonates was 14-31 days. Term neonates with bilirubin concentration more than 16 mg/dl and preterm neonates with bilirubin more than 14 mg/dl whose icter lasted more than 14 days were in the study. Exclusion criteria were: direct bilirubin >%15 TSB; body temperature >37.5 0C; diarrhea; emesis; poor feeding and tachypnea. Urine analysis, Hb, Hct, blood group and maternal and neonatal Rh, reticulocyte count, direct coomb’s, G6PD deficiency test, T4, and TSH were done for all neonates. Suprapubic sampling was done for neonates with urinary infection. 316 neonates with prolonged unconjugated icter were evaluated; urine culture (with urine bag sampling) was positive in 36 neonates (11.4%). If the pathogen count was more than 105 colonies in the sample, suprapubic sampling was done. Suprapubic samples were positive in 21 neonates (6.6%). The most common pathogen was E.coli (80.9%). 7.6% of boys had urinary infection while 5.3% of girls had urinary infection which was not significant (P>0.05). The incidence of urinary infection in preterm neonates was significantly higher than term neonates (P<0.05). The incidence of urinary infection in low birth weight neonates was significantly higher than normal weight neonates (P<0.05). This study shows that urinary tract infection rate in neonates with prolonged unconjucated icter is 6.6%.

Cancer is a serious problem for human being. A necessary prerequisite for any therapeutic modality is early diagnosis. Fractal dimension measurement of nuclear boundary of cancer cells can be used as a feature extraction in the field of automated cancer diagnosis. 41 positive urine cytology and 33 negative ones were selected randomly. Digitalized images prepared using objective 100X and a digital video head preprocessed subsequently and the fractal dimension of nuclear boundaries was measured by a software. Findings revealed a statistically significant difference between fractal dimensions of nuclear boundaries of cancerous versus non-cancerous in urinary smears. Selecting a proper cut off point (1.732 ± 0.006 in this study) can discriminate malignant and non-malignant epithelial cells in urinary smears. Based on diagnostic accuracy measures (sensitivity and specificity), probability of disease measures (predictive value of a positive and negative test results), and likelihood ratio of positive and negative tests, it seems fractal dimension of nuclear cell boundaries in urinary smears can be used as a feature extraction in the field of automated cancer diagnosis.

Uterine smooth muscle tumors are the most common human neoplasm. They are divided clinically as benign and malignant but there is another group of lesions which is difficult to place in these two categories, so-called STUMP and differentiation of these tumors on the basis of H&E staining is difficult. The goal of this study is to find distinguishing objective biomarker and a survey of proliferation markers comparing these three groups of tumors. Twenty one cases in each group of the above mentioned tumors were selected randomly from pathobiology laboratories and studied by using IHC staining for Ki_67 expression and AgNOR method. Ki_67 was expressed in 63.15% of leiomyosarcomas, 4.76% of STUMPs and 0% of leiomyoma group. Ki_67 expression between leiomyosarcoma and STUMP, and also between leiomyosarcom and leiomyoma were significant (P<0.0001). Mean AgNOR dots were 2.55 ± 0.03, 4.04 ± 0.66 and 8.12 ± 0.13 in leiomyoma, STUMP and leiomyosarcoma, respectively. Significant differences between three groups were observed (P<0.0001). AgNOR and Ki_67 (MIB1) proliferation markers expression between leiomyosarcoma and STUMP showed significant differences. Due to difficulty in differention of leiomyosarcoma from STUMP, finding objective biomarker is necessary. For this purpose, the present study recommends Ki_67 and AgNOR staining for this purpose and seems to be a reliable, simple, and rapid method.

Tubal and peritoneal pathology is among the most common causes of infertility (approximately 30-35%). HSG and laparoscopy are the 2 classic methods for evaluation of tubal patency in infertile women and are complementary rather than mutually exclusive; each provides useful information that the other does not and each has both advantages and disadvantages. Compared with laparoscopy as a test of tubal patency HSG has only moderate sensitivity. The clinical implications are that when HSG reveals obstruction there is still a relatively high probability (approximately 60%) that the tube is in fact open. Laparoscopy is more invasive, usually requires general anesthesia, and provides no information regarding the uterine cavity and risks complications including accidental injury to the bowel or blood vessels. Sonohysterography is an accurate screen for patent tubes, reflected in its high positive predictive value compared to lap and dye. Sonohysterography is technically feasible and acceptable for patients in an outpatient setting. Also the patient is not exposed to x-rays or iodinated contrast media and well-tolerated technique that has a low rate of side effects and rare complications. Forty two women with proximal tubal obstruction on the HSG were selected; sonohysterography was performed by instilling saline into the uterine cavity through an intra cervical balloon catheter, there was concurrent vaginal sonographyic visualization in all cases. After sonohysterography showed tubal obstruction, laparoscopy was performed. Tubal obstruction was detected in 8 of 40 sonohysterographic examinations. Six of 8 cases with tubal obstruction were confirmed by laparoscopy. Sonohysterography is an accurate screen for patent tubes. That is a simple, safe and well-tolerated technique that has a low rate of side effects and rare complications.

Reviewing pediatric malpractice litigation cases that have referred to Urmia medical council for characteristics of the patients, physicians, type of medical malpractice, and the outcome of claims is done to increase the experience of other pediatricians in favor of prevention of errors and defaults. In a retrospective-descriptive cross-sectional study all malpractice claims against pediatricians in Urmia medical council in a ten year interval were reviewed; various data about characteristics of the patients, involved physicians, type of malpractice occurred, type of damages to the patients, and finally the outcome of claims were extracted and recorded in checklists and analyzed by SPSS software. During the 10 year period (1375-1385) 37 cases of pediatric malpractice claims (3.4% of total claims) are registered in Urmia medical council. 78% of cases are related to children below 2 year age. 70% of patients are male. In 65% of cases the families of patients are city dweller. In all of cases the fathers were complainant. 28 claims are against pediatricians, 8 claims are against pediatric sub specialists and only in one case from pediatric residents. Most of the claims are from physicians involved in private practice (42%), secondary to death of the patients (52%), and from the patients who are hospitalized (57%). Most of negligence’s are related to disregarding of governmental provisions. Among these 90% are due to non attendance of on call physician in hospital at ordered time and finally from 37 case of malpractice claims 29 cases are terminated by exoneration of the involved physician. The results of this study revealed that children below 2 years old, male, hospitalized, and having a critical underlying disease are in the high risk group for malpractice claims. So it is recommended that pediatricians involved in treatment of this group of children in addition to paying more attention in the management and performing regular hospital visits if necessary, with establishment of intimate communication with family of the children along with offering adequate information try to increase the insight of family about disease of their child and it’s a natural course of disease. In this regard it seems to emphasize more often on continuous education of medical students and residents during training process and it is worthwhile for pediatricians to be in codified educational programs.

Caustic ingestion became a significant concern when lye product got available as household cleaners. Accidental ingestion of these products led to serious upper digestive and respiratory tract and esophageal injuries in children. The aims of this study were to evaluate patients with caustic agent ingestion, symptoms, clinical history and complications and compare these findings. All children hospitalized for caustic ingestion, in the age group of 0-12 years old were evaluated for clinical history, endoscopic findings, method of treatment and the complications were observed. Out of 51 children, 8 consumed acidic and 43 alkaline materials. The average age of the children was 35.9±18 months. 34(66.7%) of 51 patients were male and 17(33.3%) were female. In endoscopic survey, 37.2% of patients had grade1 and 62.8% had a burning intensity of grade2 or higher. During the follow-up, esophageal stricture developed in 5 cases and gastric outlet obstruction in 1 case. Two of 5 patients with stricture were treated by endoscopic dilation, 3 of them underwent colon transposition surgery. The patient with gastric outlet obstruction underwent gastrectomy. One patient died. Although caustic ingestion is potentially preventable, if ingestion occurs early endoscopy is recommended to evaluate the severity of lesions and the morbidity of patients. The role of prevention as a comprehensive strategy promoted by medical councils and the mass media is imperative.

The latest estimates of the World Health Organization (WHO) indicate that there are 161 million visually impaired people worldwide, 37 million of which are blind, with a yearly increase of 1 to 2 million; it means approximately 0.85% of the world population. Another 135 million show visual impairment. This research was performed to determine the frequency of ocular diseases in ophthalmic patients of Urmia Imam Khomeini Hospital. This cross sectional and descriptive study was performed on 500 patients who referred to Imam Khomeini Hospital of Urmia. Samples were selected randomly. Data collected by using questioner and the results were analyzed using SPSS software. 146 (29.2%) right eye, 143 (28.6%) left eye, and 211 (42.2%) both eyes of patients affected by diseases. In this study ocular diseases frequencies were: cataract 104 (20.8%), refractive errors 96 cases (19.2%), conjunctivitis 50 cases (10%), e yelid disease 46 cases (9.2%), pterygium 28 cases (5.6%), glaucoma 13 cases (2.6%), c ornea d isease 12 cases (2.4%), Amblyopia 5 cases (1%), Dry Eye 4 cases(0.8%), Strabismus 2 cases (0.4%). This research was performed to determine the frequency of ocular diseases in low size samples to be incomparable with other researches that were performed to determine the prevalence of ocular diseases in high size samples. We suggest more studies be performed to determine the prevalence of ocular diseases in high size samples.

Malfunction of arteriovenous fistulas in dialysis patients has many complications such as cardiovascular complications which increases morbidity in these patients. The purpose of this study is to evaluate the blood flow in dialysis patients´ fistulas. From November 2007 to March 2008, we studied on 100 dialysis patients having had AVF, and gathered the necessary data such as the type of fistula, the blood flow of fistula, the age, and the sex of the patients, after that we processed all data. From 100 patients, 56 were male and 44 female. Among the 56 male patients of our study, 29 of them (51/8%) and among the 44 female patients, 27 of them (61/4%) and overall 56% of all the patients had high flow fistulas. Generally, among the 37 brachial fistulas, 30 of them (81/08%) and among the 63 radial fistulas 26 of them (41/3%) had high flow rates. The mean flow rate of all the fistulas was 1741 ml/min. There is a high level of abnormalities in arteriovenous fistulas of dialysis patients such as high flow rates, especially in brachial fistulas which leads to many serious complications but fortunately, by means of color-Doppler ultrasound we can help the surgeon to operate a more standard fistula and also detect the abnormalities earlier and select the best treatment for them.

With the rapid advancement and broad range of applications of invasive cardiovascular procedures, the rate of complications from such techniques including intravascular foreign bodies are on the rise. These complications can lead to various other adverse outcomes, such as thrombus formation, migration of the foreign body to other vital organs, cardiac arrhythmia and infections. Removal of such objects is performed by either surgery or interventional techniques, with the latter being preferred. The patient was a 60-year old woman presented with dyspnea, nausea and hemorrhage from a permanent jugular catheter that had been used for hemodialysis, because her AV fistula has been mal-functioning. Her past medical history included chronic renal failure. As part of the work up, a blood culture was performed that turned positive for coagulase positive staphylococcus aureus. This led to decision to remove the jugular catheter. During the procedure, the catheter was broken and a long segment of it was embolized through the superior vena cava to the heart. Patient is transferred to the angiography unit. The two ends of a 0-014” guide wire are passed through the two orifices of an NIH catheter. By passing the two ends of the guide wire at the tip of the NIH catheter an adjustable loop is formed that can trap the foreign body. Using a pigtail catheter, the broken piece is pulled into the IVC. The NIH catheter was then used to successfully pull the object out of the femoral vein.A literature survey revealed that the incidence of catheter fracture is about 0% to 2.1%. Emboilization of fractured catheter maybe fatal. The chosen technique to remove fractured particle is a catheter based method (interventional).A commercially available device, called snare, can be used to retrieve the fractured catheter. Since the conventional snare was not available, a similar device was built using NIH catheter and guide wire. In cases with high risk of complication in snaring of fractured catheter, the loose particle should be repositioned by a pigtail and then retrieved by snare.