مجله علمی پزشکی جندی شاپور
سال ششم شماره 1 (پیاپی 52، بهار 1386)

Seizure is the most common neurological medical emergency. Early treatment before admission to hospital is best achieved with an effective and safely administered medication. The aim of this stuy was to compare the efficacy, time to control of seizure and side effects of rectal diazepam with intranasal midazolam in the treatment of children with acute seizure. One hundred and fitten patients were enrolled at the medicla centre. Their ages were between two months to 14 years. Continuous seizures of more than 5 minutes duration were randomly treated with rectal diazepam or intranasal midazolam. These preparations were made extramputaously from ampoule fomulations forcedly for non-existence of rectal diazepam and intranasal midazolam products at time of the study. If the seizure did not stop within ten minutes, additional medication chosen by the pediatric residents was administered. We monitored and checked oxygen saturation, blood pressure, pulse rate, respiratory rate and body temperature for 60 minutes after treatment. The main outcome measures were efficacy, time from drug administration to stoppage of seizure and incidence of adverse cardio respiratory events. Rectal diazepam was used to treat 56 seizure episodes and intranasal midazolam in 59 ones. Rectal diazepam stopped 32 (57%) of 56 episodes. Intranasal midazolam stopped 49 (83%) of 59 episodes (p<0.001). The mean time to control of seizures was significantly faster in midazolam group (2.9  1.89 minutes, 95% confidence interval: 2.3 to 3.4 minutes) than the diazepam group (4.6  2.34 minutes, 95% confidence interval: 3.8 to 5.5 minutes). No significant difference in side effects was observed in either group. In diazepam group, a 4 months old infant with opioid poisoning died and in midazolam group, a 13-year old adolescent with cerebral palsy developed transient apnea. We concluded that intranasal midazolam is more effective than rectal diazepam in the treatment of acute seizures. Seizures were controlled more quickly with intranasal midazolam than rectal diazepam. Nasally administration is more socially acceptable and convenient. With appropriate instructions, families may be able to administer it to their children with recurrent seizures outside hospital.

Inguinal hernia is one of the most common diseases in general surgery. It is seen 25 times in males than in females. It is also more common after 40 years of age. There are several techniques for repair of hernia and the choice depends on the age of the patient and the surgeon's experience. The aim of the present study was to assess the clinical features and the recurrence rate of inguinal hernia among our patients in two major educational hospitals in Ahwaz. This study is cognitive and retrospective study. We evaluated age, sex, type and recurrence rate with regarding three major techniques employed in hernia repair namely: simple ligature in pediatric group; tissue repair (Bassini method) and mesh repair in adult group among 150 patients in Imam Khomeini and Razi hospitals over one year from (1997-1998). The patients were followed up for 2 years. Analysis of data was carried out by SPSS software. Ninety two % of cases were males and the most common age (24 %) was in 40 to 50 years old group. For repairing the hernia 20 % of patient underwent only high ligation, 37.5 % with tissue repair and in 42.5 % by mesh repair. Overall there were 8 % recurrences. \The recurrence rate with Bassini repair was 16 %, while only 3 % of recurrences occurred following either mesh repair and with high ligation techniques. The finding from this study showed that recurrence rates in educational centers for simple ligature of sac in pediatric group and mesh repair in adult group are lower than global studies. However, the recurrence rate in tissue repair is higher than global studies. We therefore recommend that more detailed training of mesh repair technique to be provided for residents of surgery courses.

The hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are rare disorders characterized by intravascular platelet aggregation and widespread thrombus formation in the microcirculation with resulting tissue ischemia. In spite of several studies on these disorders all over the world, their basic epidemiology and clinical aspects are still obscure in Southwest of Iran. We conducted a retrospective analysis of 136 patients with HUS or TTP hospitalized from April 1991 through March 2004 in 3 large hospitals of Shiraz (the largest referral city in Southwest of Iran) to evaluate their epidemiological aspects, clinical characteristics and laboratory findings. One hundred and one cases of HUS (49 females and 52 males) and 35 cases of TTP (21 females and 14 males) were identified. The mean age was 3.5 years for HUS, and 30.8 years for TTP. The mean annual incidence rate of HUS decreased significantly from 8 cases in 1993 to 1.1 cases per 1,000,000 child in 2003 (p< 0.001). While the incidence rate of TTP increased from 0.6 cases in 1992 to 5.2 cases per 1,000,000 residents in 2003 (p< 0.05), a seasonal pattern was noted for both TTP and HUS cases, with the highest incidence in summer months. Twenty patients with HUS and 16 with TTP died, resulting in a case fatality rate of 19.8 and 45.7%. No prognostic factor was identified for TTP, while the presence of signs of neurological impairment and high leukocyte counts had an adverse effect on the prognosis of HUS patients. In contrast to other countries, in Southwestern Iran the incidence rate of HUS has a decreasing trend, which is probably related to the decrease in gastrointestinal diarrheal infections (especially E.coli 0157:H7) and their improved management. On the other hand, the incidence of TTP is increasing in Southwestern Iran as in other countries.

One of the most common symptoms of the women referring with breast problems is detection of a palpable mass. These masses are benign or malignant. Benign masses are often common in the reproductive age. In this study we try to evaluate prevalence of breast mass with regarding of age and the type of breast mass. In this retrospective study which was carried out over 9 years from 1370 to 1378 (1991 to 1999), was based on histopathological reports of biopsy samples in Imam hospital of Ahwaz. From a total of 787 biopsy reports on breast tissue, 29 % were fibrocystic, and 24.5% were fibroadenoma. Thirty percent of biopsies were from patients in the 3rd decade while 23% of the samples were taken from patients in the 4th decade of life. In the age group lower than 30 years, 95% of the masses were benign, while 100 % of these masses were malignant in the age group above 80 years old women. The most common histopathological type was invasive ductal carcinoma (71.7 %). Benign breast mass is seen in a period of life in a lot of women. The majority of breast masses in females was seen in reproductive ages and the incidence of malignant masses increases with age. The results of this study showed that although the commonest masses in females in the 3rd and 4th decade of life were fibroadenoma and fibrocystic but the percentage of malignancies were significantly higher than reported globally. We therefore, advise early screening and more careful physical exam of young woman at lower age than is practiced in western countries.

Breastfeeding has many psychological, immunological, economical and health related benefits for mothers and their neonates. This feeding, especially at the first hours of birth is very notable, so that early breastfeeding can prevent neonatal infectious diseases and some chronic diseases in adulthood period. Moreover, breast feeding and physical contact between mother and neonate over a short period of time after delivery can influence the mother's psychological status and emotional feeling with her neonate. The aim of the present study was to assess factors that influence the time between delivery and the first breastfeeding. The statistical methods used for comparison of data were Cox regression, Log-rank test and Kaplan-Meier curve. In this cohort study, 110 paired mothers and their neonates were recruited in a hospital in Tehran. The data collected included time of first feeding following delivery in relation to the method of delivery, parity and the level of education of mother. The results showed that mode of delivery was the most important factor for starting the first breastfeeding, so that for any time duration after birth, the rate of breastfeeding for neonates in normal vaginal delivery method was 3.9 and 6.8 folds in usual and spinal cesarean delivery methods respectively. Other important factors, in sequence, were parity and educational level in mothers. The finding of this study demonstrated that increasing the awareness among pregnant women and their willingness for vaginal delivery can decrease in unnecessary cesarean section rate and can improve the relation between mother and neonate and the start of early breastfeeding.

Short stature has different prevalence in different countries, which varies from 2% to 10 % and has multiple etiologic factors. Short stature can have a natural course or pathologic causes. Rapid diagnosis, accurate treatment (in curable causes) is important, and if treated, its complications can be inhibited. The aim of the present study was to identify of prevalence of short stature among first year primary school students in Ahwaz, and its relation with factors such as: economic status, family problems, short birth height and weight, and genetic causes. In this study 698 students in their first year primary school in Ahwaz were selected in cluster pattern, and their heights and weights were measured and an questionnaire was filled which included information on the number of family members, economic status, fathers job, history of short stature in parents and family members and height and weight at the birth time. In this study 344 (44.3 %) of cases were females and 354 cases were males (50.7%). Prevalence of short stature was 3.7 % equally in both sexes. Also there was a direct relation between short statures and low weight at birth, as well as with family problems (separated parents) and parents short height. However, there was no significant relationship between short stature and economic status, number of family member, and presence of mother-in-law. Our study revealed that there is a statically significant relationship between short stature and low weight at birth, positive history of short parents or other family members and separation of parents. But more studies on role of other etiologic factors are needed

To evaluate the effectiveness of combined intraocular injection of gentamicin and clindamycin in the prevention of acute post–traumatic bacterial endophthalmitis following penetrating ocular injuries. A prospective randomized double–blind study was conducted on 60 eyes of 60 patients with penetrating ocular injuries. Following primary repair, the eyes were randomized into two groups: antibiotic-treated group who received a single intracameral or intravitreal injection of 0.1 ml containing 40 μg gentamicin and 45 μg of clindamycin. Placebo injection group received an intracameral or intravitreal injection of 0.1 ml of BSS. The incidence of acute post–traumatic bacterial endophthalmitis was seen in 2 eyes of the control group and none in the treatment group (p>0.05). Although the incidence of bacterial endophthalmitis was not significantly different, but the overall findings of this study suggest that, at the dosage used, combined intraocular injection of gentamicin and clindamycin may be an effective modality in the prevention of acute–traumatic bacterial endophthalmitis without any significant side effects.

Abstract In order to determine several epidemiologic aspects of inflammatory bowel disease (IBD), in the Khouzestan area, we conducted a retrospective, descriptive and cross-sectional, hospital-based and outpatient study. All subjects were studied for distribution of the various forms of IBD, age, sex, place of residence, familial aggregation, educational status, tobacco consumption and use of oral contraceptives. This study was crried out from 1st January 1999 to 30th December 2002. All patients who were diagnosed with IBD after admission to our department, well as those who were examined in our outpatient clinic and subsequently followed up were included in the present study. A detailed medical histroy was obtined and recoreded in a questrionaire. A total of 176 cases of IBD including, ulcerative colitis (166 cases), Crohn’s disease (8) and 2 with indetermined colitis were registered. The male-female ratio in UC was 1.07 and 1.6 in CD. Mean age at presentation was 38.6 ± 17.44 years (UC: 43.37 ± 17.55; CD: 33.98 ± 11.12). The frequency of disease in different races was Fars 62.5%, Lor 17 %, Arab 11.9 %, and Turk 2.8 %. Family history was found in 9%, and smoking in 13 %. Anatomical site was as follows: in UC: rectum(34) 20/4%, rectum and sigmoid(39) 23.4 %, left colitis (64)36.5 %, pancolitis(29)17.4 %; in CD: 25 % terminal ileum, 75 % restricted to the colon.Primary sclerosing cholangitis was encountered in(8) 4.8 % IBD patients, mostly in pancolitis(87.5 %). As in the other regions, the prevalence of UC exceeded CD in Khouzestan. The incidence of UC was slightly higher in female than in male. Complicated situations are infrequent in this group of patients. The rarity of extraintestinal manifestations and of colonic cancer is to be noted in spite of the relatively short period of study. We found that familial aggregation of the disease and smoking were similar to that reported from other studies.

Controversy continues to exist regarding the necessity for routine histopathological examination of excised tonsil specimens. While otolaryngologists fear missing an unsuspected diagnosis such as presence of tonsil malignancy in one hand, and given the rare incidence of this event in children on the other hand, the cost–effectiveness ratio for routine microscopic analysis remains questionable. The purpose of this study was to evaluate the necessity of histopathologic examination for routine tonsillectomy. In this cross–sectional study we performed a retrospective evaluation of 97 pediatric patients who underwent tonsillectomy over one year period, from April 2004 to March 2005 at Imam Khomeini hospital of Ahwaz Jundishapur University of Medical Sciences. All patients aged less than 14 years and were randomly selected. The data collected from hospital files included age, sex, indication for surgery and the result of histopathologic examination of the resected specimen. There were 50 boys (51.6 %) and 47girls (49.4 %) with age distribution of 3 to 14 years (mean 8.96 years). The histopathological reports revealed no malignancies. The finding from this study suggest that following careful clinical evaluation by an experienced otolaryngologist pathologic evaluation of all specimens may not be necessary. Histopathological examination should be done in only selected cases with grossly asymmetric tonsils or in patients with a history of malignancy.

Angle facture is one of the most common sites of mandibular fractures and presence of third molar in this area increases the risk of such fracture. The aim of this study was to assess the effect of eruption situation and position of third molar on the risk of angle fracture. This descriptive study comprised of 82 patients. The patients were treated in Ahwaz hospitals during four years (2001– 2005) and were suffering from angle fracture at the third molar. For every patient a questionnaire form wasc completed. The panoramic radiography of each patient scrutinized to determine other information such as position and impaction situation of third molars (according to Pell and Gregory classification). Favorability or unfavorability of fractures and the presence of fractures in other sites of the mandible were also considered. The results showed that the incidence of angle fractures to be higher in men and were caused mostly by motor accidents. Unfavorable angle fractures occurred more than favorable ones. Fractures of other areas often located in contralateral parasymphysis. The vertical class IA and secondary class IB were the most common eruptional situation and position of third molars. According to the results, erupted or semi-erupted third molars increased the risk of angle fracture. In addition since the upper border of mandible is under muscular tension zone so we hypothesis that presence of an intact band of bone in upper border of angle will decrease the risk of fracture, with the eruption of third molar, this integrity is lost and the probability of angle fracture increases.

Candida is a normal flora of the mouth in 30 to 50 % of general population. Corticosteroids like triamcinolone and betamethasone are being used as mouth washes, and administered orally, local or injected for treatment of mouth lesions. The aim of the present study was to find the amount of growth of Candida species following the use of betamethasone and triamcinolone mouth washes. In this experimental study, sixty healthy persons (18-40 years old), divided randomly into two equal age- and sex-matched groups and filled a questionnaire for medical history of underlying factors for candidiasis. All the subjects gargled for 1 minute with either a half spoon of triamcinolone or betamethasone solution twice a day for 2 weeks. The salivary samples of the selected people were collected in sterile tubes and cultured in chrome agar media for 48 hours and assessed for growth of different species of Candida. The growth of different types of Candida in each person was checked and compared with control saliva before starting treatment. This results showed that amount of Candida species in saliva of healthy people before and after the gargling of either betamethasone or triamcinolone were not significantly altered (p= 0.584 and 0.305 respectively). The most frequent type of Candida in the saliva of healthy people was Candida albicans. The finding of this study demonstrated that short-term gargling of topical corticosteroids has no effect on the growth of Candida species. Furthermore, the presence of Candida albicans in both normal and corticosteroids-treated saliva may be due to higher pathogenicity of this species.

Tempromandibular disorder (TMD), is a kind of disease that results from occlusal interferences and psychological factors. Because there were controversy about the role of occlusal interferences and psychological disordres in TMD, we decided to investigate the most important causes of TMD. The aim of this study was to compare the effect of occlusal interferences and psychological factors in TMD patients and individuals without TMD symptoms. Two grous of 37 (sex- and age-matched) subjects, with and without TMD symptoms were selected in this study. Patients in this study required full dental occlusal. The subjects were given HAD scale test for assessment amount of anxiety and depression. They were examined clinically for assessment occlusal interferences in centric, working, non working and protrusive situation. Results of this study showed that there was no meaningful differences between occlusal differences in both case and control groups (p>0.05) but there was significant difference in the psychological disorders between the case and control groups (p < 0.05). Results of this study showed that occlusal interferences plays as a cofactor in producing TMD, because cclusal interferences are relatively prevalent among the general population, who also are free of TMD sign and symptom and psychological factors play a more important role in the development of TMD.

Diabetes mellitus is the common endocrine disorder and one of its complications is nephropathy. The aim of this study was to investigate the effects of Trigonella foneum-graecum leaf aqueous–ethanolic extract on the kidney structure in the diabetic rats using stereological methods. Thirty two male Wistar Rats (140 ± 25 g), were randomly divided into 4 groups (n=8), including control, control + extract, diabetic and diabetic + extract groups. Experimental diabetes was induced using streptozotocin (STZ) (60 mg/kg b.w). Diabetic + extract and control + extract groups were treated with Trigonella foenum-graecum extract (175 mg/rat/day) for 30 days. Then the rats were anesthetized and left kidney was taken out and fixed. 4μm sections and H&E staining were also carried out. The mean volume of kidney, cortex, medulla and total mean volume of glomeruli were obtained using stereological methods. Then the results were statistically analyzed using ANOVA/Tukey test and were considered significantly different at p<0.05 level. The totals mean volume of kidney and cortex was the same in control, control + extract and diabetic + extract groups. A significant reduction was found in volume of kidney and cortex in control + extract group when compared with control ones (p<0.01). The mean volume of glomeruli was significantly increased in diabetic groups in comparing with control rats (p<0.05). Body weight was significantly reduced in diabetic groups when compared with control ones (p< 0.001). The results showed that Trigonella foenum-graecum leaf extract can affect some histopathological changes in nephropathy in experimental diabetes in the rats. However, prudently, more studies for understanding the underlying protective mechanisms of this plant is needed.

Ergonomic risk factors can lead to job-associated damages, cause mental stress, stretch damage and reduce quality of work. The major site of disorder of musculoskeletal is neck pain. The aim of this research was to determine relationship between ergonomic factors with neck pain among dentist. This research is a cross-sectional study. The population was all of dentists who worked in Ahwaz and had research condition.. In order to gathering data, self-made questionnaire was used which comprised of Pain (MacCaffery) American check list of factors ergonomic and demographic information. The data were collected by coding and the statistical analysis was carried out with SPSS program. Hundred out of 142 dentists in remedy part answered the questionnaire. The total results shows 61 % of person were males, 72 % were married. 20 % were specialized dentists and the remaining were general practice dentists. The length of occupation ranged from 6 to 10 years. 70 % of samples suffered from neck pain in whom 15% reported severe pain, 56 % moderate pain and 19 % mild pain. There was a meaningful relationship between neck pain with standard procedure Clock (p= 0.02), used of minor (p<0.01) and rest of visit patient but no meaningful relationship with work position (p= 0.56), daily hours of work (p = 0.23) and number of daily visit patient (p = 0.42). The results of this study demonstrated that there is relationship between neck pain and ergonomic factors. The results of this study can be utilized in periodic inspections of personals as well as in continuing training programs of dental professionals.

It has been recently shown that thymoquinone (TQ), the major constituent of Nigella sativa seeds, has inhibitory effects on contractile responses of guinea-pig trachea and ileum, probably through a non-selective antagonistic activity on serotonergic and histaminergic receptors. The aim this study was to evalute the effects of TQ on contractile responses of rat vas deferens using tension-recording technique. Male rats (6 groups of 4 each) were stunned by a blow to the head and exsanguinated. The vas deferens were dissected out and placed in Krebs solution in an organ bath set up (under an initial load of 0.5 g tension. The effects of TQ (10, 20, 40, 80, 100 M) on contractile responses of vas deferens to norepinephrine (NE) (10 M), dopamine (DA) (10 M) potassium chloride (KCl) (80 mM), and repetitive electrical field stimulation (REFS) (frequency = 20 Hz, duration = 0.1 ms, intensity=130 V) were recorded by an isometric transducer. The amplitude of REFS-evoked contractile responses, were also recorded in Ca2+-free medium and in the presence of cumulative concentrations of CaCl2 (0.1, 0.2, 0.4, 1, 2 mM). The results showed that TQ at concentrations less than 100 M decreased the amplitude of contractile responses of vas deferens induced by NE, DA, KCl, and REFS. The minimum effective concentration of TQ was 40 M for NE- and DA-, and 20 M for KCl- and REFS-induced contractions (p<0.01 and p<0.001, respectively). Addition of cumulative concentrations of CaCl2 in the presence of TQ (80 M) failed to increase the amplitude of contractions induced by REFS, which were suppressed in Ca2+-free medium (p<0.001). These results indicate that thymoquinone has inhibitory effects on the contractile responses of rat isolated vas deferens and exerts its effects at least in part through the blockade of calcium channels in vas deferens smooth muscle cells.

Extramedullary hematopoiesis (EMH) is a rare disorder, characterized by the appearance of the hematopoietic elements outside of the bone marrow, which occurs in patients with chronic myeloproliferative disorders or congenital hemolytic anemias. We report a case with a diagnosis of thalassemia intermediate, EMH in spinal cord and paravertebral mass. A 20-yr-old female who initially presented with back pain and leg weakness was found to have paravertebral mass in the spinal cord. We attempt to report and treat this rare case, in which EMH was diagnosed. In conclusion, based on characteristic radiographic findings and bone marrow scanning with technetium 99M sulfur colloid, it is important to recognize spinal cord extramedullary hematopoiesis as a differential diagnosis of epidural masses. In geographical areas where thalassemia is prevalent, to avoid unnecessary surgical interventions, spinal cord extramedullary hematopoiesis should be considered in differential diagnosis of patients who have chronic anemia.