مجله علمی پزشکی جندی شاپور
سال هفتم شماره 4 (پیاپی 59، زمستان 1387)

Thalassemia, a one group of hereditary anemia, is created by mutation of hemoglobin genomes. Management is possible with regular transfusion with pre-transfusion hemoglobin remaining within 9-10.5g/dl range. In specific cases splenectomy helps hemoglobin to remain within this range. The aim of this study was to assess the effect of splenectomy on the need for transfusion as well as on other important hematological indexes among these patients. In this study 25 major and intermediate splenectomized thalassemia patients (21 major and 4 intermediate) were studied. The need for and the interval between transfusion one year before and 4 years after splenectomy were assessed. Analysis of data was made by use of spss 11.5 and T Test.Transfusion of packed red blood cells was reduced from 246.12 ± 77.06 ml/kg/year before splenectomy to 132 ± 96.53 ml/kg/year after splenectomy (P>0.0001). Mean hemoglobin level was 5.6±0.16 g/dl before splenctomy which was raised to 10.4±0.87 g/dl after splenectomy. The mean of transfusion rate was reduced from 18.1 times/year before splenectomy to 12.86 times/year. Complication observed in two cases. This study establishes a definite place for splenectomy in both intermediate and major -thalassemia.

Neonatal hypothermia is a frequent medical problem in low socioeconomic Countries. It is a significant perinatal problem contributes to increase morbidity and mortality. The goal of this study was to determine the frequency of neonatal hypothermia and associated risk factors. A cross-sectional and randomized study of neonatal hypothermia was performed on 1871 newborns delivered during 12 months period, form October 2002 to September 2003, at Imam Khomeini hospital of Ahvaz. Auxiliary temperature measurement was made during the first 24 hours period after birth randomly.The study showed that 7.48 % of the newborns were hypothermic. Cold stress and moderate hypothermia occurred in 72.8 and 27.2 % of newborns respectively. Severe hypothermia was not detected in any of them. The most frequency of hypothermia occurred during 15-20 hours after birth. The frequency of hypothermia in low birth weight infants was 25.7 % (P<0.05). Breast feeding was performed in 65.7 % of infants in first hour of life and 37.9 % of hypothermic infants belong to this group (P<0.05). Route of delivery, seasons, gender and bathing did not affect the frequency of hypothermia. No significant differences in the frequency of hypothermia between Winter and Summer seasons were recorded. the finding of this study demonstrated that low-birth weight and feeding after first hour of life was significantly associated with neonatal hypothermia. It is essential that adequate training of care taking staff on these findings will be useful in prevention of this phenomenon

Since thalassemic patients receive continuously blood and its products, they are in high risk to acquiring various transfusion-transmitted viral infections, such as hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency (HIV). Nowadays, one of the major hygienic problems in thalassemic patients is to reduce and control these viral infections effectively. The aim of this study was to determine the prevalence of HBV DNA, HCV RNA, and HIV RNA among thalassemic patients. A descriptive cross-sectional study was conducted on 206 thalassemic patients referred to the Hemoglubinopathy and Thalassemia Center of Ahvaz Shapha Hospital during October 2005 to February 2006. Demography data and results of HBsAg, Anti-HCV and Anti-HIV serologic tests were collected from the patients, files at hospital. HBV DNA was detected with specific set of primer for core region. Furthermore HCV RNA and HIV RNA had been tested by using specific primers for 5´-UTR and gag regions, respectively. The results were analyzed using chi-square test.Out of 206 patients 97 (47.1%) and 109 (52.9%) were men and women respectively, with mean age of 16 ± 6.42 years. Forty six (22.3%, 95% CI: 17.1-28.5) individuals were positive for HCV RNA. Non of the patients were positive for HBV DNA and HIV RNA. There was significant positive relationship between prevalence of HCV RNA positivity with mean age (P<0.001), duration of blood transfusion (P<0.001), and number of transfusions (P<0.01). It can be concluded the incidence of HCV is rather high among thalassemia patients of Khuzestan province of Iran. More stringent and sensitive screening program of donated bloods in order to reduce the incidence of viral infections, specially HCV, is mandatory.

Multiple lines of evidence demonstrated that increased brain oxidative stress is an important cause of Alzheimer’s disease. Due to high oxygen consumption, high level of poly unsaturated fatty acids (PUFA) and low content of natural antioxidants, brain cells are very sensitive to oxidative stress. Also, oxidative stress can damage muscarinic receptors that lead to memory impairment. Several studies have indicted that rich antioxidant regimen can inhibit oxidative stress and its related disorders.The aim of this study was to assess the effect of hydroalcoholic grape seed extract (GSE) on memory of young and aged mice using passive avoidance apparatus. To achieve this objective, 80 male N-MRI mice were divided into eight groups (10 in each group). The first three groups in young (3-4 months) and aged (15 months) received 100, 200, 400 mg/kg IG extract, respectively and two remaining young and aged groups used as control groups which received 10 ml/kg ig. Of distilled water once daily for 30 days consecutively. One day after the last dose administration, passive avoidance test was performed, during consecutive 4 days. On the first day animals were made familiar to instrument. On second day step-down latency was measured. On the third day, after stepping-down, the animals were exposed to electroshock. On the fourth day, memory of step-down latency was measured for each group without any electroshock.The results showed that chronic oral administration of GSE, improves memory in all aged animal groups significantly. Our data suggest because of more oxidative agents are produced in aged brain tissue than young brain may cause neuronal apoptosis and thereby cognition impairment. So, GSE administration in aged subjects can remove oxidative products from their brain and improve memory.

Identification of the infecting virus genotype has become relevant in the investigation of many aspects of HCV infection, including epidemiology, pathogenesis, and response to antiviral therapy. The aim of this study was to determine the prevalence of HCV genotypes in Khuzestan province. Two hundred and eighty patients (188 men and 92 women; mean age 33 ± 9.2 years) with chronic hepatitis C infection were included. Type-specific Multiplex nested-PCR for HCV genotyping was used.The genotypes 1a, 1b, 3a and 1a+1b were present in 46.4% (130), 16.1% (45), 35.4% (99) and 2.1% (6) of the patients, respectively. The genotypes 2a and 2b were not found in the study population. Furthermore, was no significant correlation was found among HCV genotype frequency with gender or age of the patients. The results of this study indicate that the dominant HCV genotype among hepatitis C patients living Khuzestan province is 1a.

Laryngeal cancer is one of the most common malignancies in head and neck and it has different prevalence in various geographic areas in the world. Laryngeal cancer occurs almost in elderly men and rarely under forty five years of age. This study was undertaken with the aim to determine and compare risk factors in laryngeal malignancies in patients under and older than forty five years old. Patients and This retrospective analytical study was conducted in Otorhinolaryngology, Head and Neck Surgery Department, Ahvaz Jundishapur University of Medical Sciences from 1997 to 2003. The risk factors of laryngeal cancer (Familial history of head and neck malignancy, Positive past medical history of head and neck malignancy, Gastro-esophageal reflux, Smoking more than 20 Pack/Year, Opium dependency, Exposure to toxin agents and industrial environment more than 15 years, Alcohol, HPV, Radiation) and the most common site involvement (1.glottic, 2.supra-glottic, 3.sub-glottic) and finally most common complaint in these groups were investigated and were compared with each other.This study included 116 known cases of laryngeal malignancies with documented pathological report. Ninety one patients were older than forty five years (Mean ± SD: 59 ± 3.5) and twenty five patients under forty five years old (Mean ± SD: 33 ± 2.1). We found that opium dependency, positive family history, exposure to industrial environment over 15 years period and gastroesophageal reflux were associated more frequently in patients with less than forty five years old compared to other group with statistically significant findings.Although all two groups have no difference in histological type and site and location of laryngeal cancer, but it seems Familial history of head and neck malignancy, Gastro-esophageal reflux, Opium dependency and Exposure to toxin agents and industrial environment more than 15 years have significant effect in patients under forty five years old.

The aim of this study was to evaluate alteration in nasal sensibility following rhinoplasty with open approach and compared it with the close approach. In this prospective study, 50 patients who underwent either open rhinoplasty using a V shape incision (n= 25) or closed approach (delivery approach) (n=25) were included. All patients underwent. Subjective questioning and objective testing of nasal sensibility using validated neurological Sensibility tests were obtained preoperatively and 3 weeks and 1 year after surgery. The match-paired student's t-test was used for statistical analysis.At 3 weeks after surgery, there was a subjective and significant objective alteration of sensibility in the area of skin supplied by the external nasal nerve (nasal tip and adjacent upper columella). This altered sensibility, however, recovered by 1 year after surgery.There are no differences in nasal sensibility post rhinoplasty with open and close approach in long term of 1 year. The recovery was thought to be due either to recovery of the external nasal nerve itself, or to collateral sprouting from the nerves supplying the adjacent areas of nasal skin.

In spit of advances of our knowledge of bone biology, blood supply and surgical techniques, talus fracture, a rare condition, is one of the most problematic fractures of foot and ankle region is still associated with a high rate of complication. The aim of this study was to assess its prevalence in our region. Iam Khomeini Hospital Ahvaz, Iran over 10 years (during 995-2005). The demographic characn this retrospective study carried out on 20 000 in-patient files in the Orthopedic Department of Imteristics of patients suffering from talus fracture, as well as the type, cause and treatment options undertaken were also reviewed.Twenty eight of talar neck farctures were found in 27 patients. Twenty five cases (89%) in men and 3 cases (11%) in women. A bilateral case was found in a 17 years old female teenager. Mean age of the patients was 31 years and 17 cases (61%) occurred in the right side and 11 (39%) cases occurred in left side. Most common cause of talar neck fracture were vehicle accident (53.6%), fall from height (32.1%), motor bike slipping (10.7%) and gun shot injury (3.6%). The types of talus fracture, according to modified Hawkins classification were as following: Type 2 (35.7%), type 3 (32.2%), type 1 (21.4%), type 4 (10.7%). Four cases had open fractures (34.3%) and 19 (68%) cases had an extra fractures as well as talar neck fracture. The most common accompanying fracture was medial malolous fracture in 12 (43%) cases and calcaneous fracture in 2 (14.3%). Posterior tibialis nerve injury was found in two patients and peroneal nerve injury was found in one patient. Sixty eight % of patients were treated with open reduction with or without internal fixation and 28.6% of patients were treated with closed reduction and casting. One case was treated with applying skeletal traction to the calcaneous.Talar neck fracture is rare lesion with a male/female ratio of 8:1 in our region. The most common type of fracture is type 2 caused primarily by vehicle accidents and fall from height. The most common accompanying fracture was medial maleolous and calcaneous fractures. Peroneal nerve injury was not reported before in a review of article but found in one patient.

-thalassemia is characterized by reduced synthesis of the hemoglobin chain. Nowadays, more than 200 disease-causing mutations in globin gene have been identified. thalassemia is the commonest monogenic diseases worldwide and the most common hereditary disorder in Iran. Since the gene frequency of thalassemia is high and varies considerably in each region and due to multiethnic population in Khozestan province of Iran, it is expected that a vast spectrum of thalassemia mutations may be present in this region. Therefore it is necessary to determine the frequency and distribution of thalassemia mutations in different areas of the country. After collection of information and samples of 202 thalassemia major patients, genomic DNA from blood was extracted and after amplification of globin gene by specific primers, full length sequencing of globin gene was done by DNA sequencing. Twenty nine gene mutations were found in 404 studied alleles. Our results show that IVSII-1 (G>A) with a frequency of 21. 3% (86) represented the most common mutation. The descending frequency of other four mutations were: IVSI-110 (G>A) (17. 8%), CD36/37 (-T) (16%), IVSI-5 (G>C) (6. 9 %) and CD5 (-CT) (5. 2%د). Our findings indicate that the Khuzestan population has a wide variety of -thalassemia allelic distribution. These results can be used as a basis of prenatal diagnosis of thalassemia

Breast cancer is the second leading cause of cancer deaths and the most common cancer, among women in all over the word. According to the studies, performed in Iran, many of women with breast cancer refer to physician in advanced stages and the time between call to physician and finding of symptoms, is prolonged. We believe, if women in Iran (more specifically Ahvazian women) have knowledge about breast self-examination (BSE) this scenario may not occur. The aim of this study was to assessment the knowledge about BSE among women higher than 18 years in Ahvaz. For this aim, a 14-item questionnaire was distributed among 400 women referring to 10 health care centers in different regions of Ahvaz. The responses were collected and analyzed with SPSS software. The results showed that 32.3 % of participated women had no information about BSE, 41.8% of them had little information, and just 26% of them had acceptable level of information. A significant association was found between knowledge about BSE with age, level of education, and income. However, no association was found between knowledge about BSE with marital status, positive family history of breast cancer and past history of breast diseases. Higher level knowledge about BSE was found among those given education about BSE and those who had regular visits to health care centers.the majority of Ahvazian women had little or no information about BSE and that the screening program in this region is not very succeful. It is hoped that educational programs on BSE and encouragement of women to visit health cenres before the age of 40 may help in early detection and reduce the morbidity and mortality associated with breast cancer.

Plantar fasciitis is one of the most common causes of heel pain which can have a dramatic impact on physical activity. Many treatment options including avoidance of potentially aggravating activities, stretching and strengthening exercise and NSAIDs have been used to treat this disorder. In this study we evaluate the efficacy of a new supportive heel wedge to treat heel pain in patients with plantar fasciitis. Fifty patients with heel pain unresponsive to traditional treatment entered the study. Their characteristics included age, sex, activity level, heel spur, location and severity of heel pain and BMI were evaluated. A medial wedge support designed by author with medial height of 5 mm was used in all of patients. The pain relief was assessed by ankle-hindfoot-scale over a 6 months period of follow up.Fifty patients (18 males, 32 females) with mean age of 42.2 (18-70 y) were evaluated. Pain reduction was observed in 82 % of patients and 18 % had no response. An excellent to good result was seen in women and patients with lighter work. Normal arc of the foot was seen in 44 and flexible flat foot in 6 patients, non had rigid foot. Medial heel wedge can be considered as a good modality and first option in treatment of heel pain. This orthoses is safe, cheap and easily available without known side effect. Pain relief was noted more in women and low body weight patients.

The purpose of the present study was to investigate the level of post–traumatic syndrome disease (PTSD) symptoms among children less than 6 years old, 3 months after the bomb explosion event in Ahvaz city at 2005(1384). In this cross-sectional study, the subjects included all the children attending in the only kindergarten located with the 500 m radius from the bomb explosion area. Although the questionnaires were given to the parents of 100 children, only 62 questionnaires were completed. The data were analyzed through the spss software with non-parametric statistical Procedure.The results showed that 62.97% of children were diagnosed to have difference degrees of PTSD symptoms. These symptoms included re-experience (19.4%), hyper-arousal (14.5%) and avoidance (99.7%). Re-experience showed to have the higher frequency and the most severe symptom was avoidance.The present study showed that a noticeable percentage of pre-school children in the nearest kindergarten to the bombing area had some degrees of PTSD symptoms. Furthermore, this study suggests that appropriate psychological support is needed to be given to people, especially in children, who experience similar events.

Asbestos is one of the most important factors in pneumoconiosis. A number of articles point to the role of smoking on intensifying pulmonary changes due to asbestos. High Resonance Computerized Tomography (HRCT) has been advocated as a suitable method for evaluation of pulmonary changes in occupational-exposure to asbestos. The aim of this study was to evaluate the effect of smoking on intensity of pulmonary radiological changes among asbestos workers using HRCT. This study was performed in Nov 2002 among 56 Hajat Chrysotile Asbestos Factory and mine workers located in Nehbandan-Brigand- Khorasan province. The workers were randomly chosen and matched in two groups, smoker (25 individuals) and non-smoker (31 individuals). The level of possible exposure to asbestos in the different areas of the factory and mine was measured. All of the workers were interviewed and underwent HRCT. HRCT was interpretation by 3 radiologists, first separately, then in consultation. The results show, the mean value of asbestos in the respiratory field of asbestos-exposed workers was about 80 times over standard limit (39.75 f/ml; TLV= 0.5 f/ml). HRCT finding demonstrates parenchymal involvement in 39 individuals (69.63%) in form of septal thickening, parenchymal band, subpleural curvilinear lines or band, linear density and ground glass opacity; minimal airway pulmonary diseases in form of air trapping in 3 individuals (5.36%) and pleural involvement in form of pleural plaque or pleural thickening in 30 individuals (53.55%). In addition, 3 single nodules were seen among smoking group. There is significant difference between two groups in pulmonary parenchymal lesions (P<0.01). There is no significant difference between two groups in pleural involvement. Smoking results in significant increase and intensity of asbestos parenchymal lesions. This hazard is severe enough even among light smoker.

Foreign body aspiration (FBA) can be a life-threatening emergency requiring immediate intervention. Foreign body aspiration is one of the most common and sometimes even life threatening conditions in children and other age groups. The peak incidence of foreign body aspiration occurred during the second year of life in the child and during the sixth decade in the adult group. Nuts are the most common foreign body aspirated by children. Symptoms of aspiration can be chocking, cough and/or cyanosis, though most of the patients do not have any complains. A precise history in favour of FBA should put the physician in doubt. Even though the radiological intervention can be negative in some cases, it should be performed for all patients suspected of FBA. Definite diagnosis is made with endoscopy and it is necessary to removing the foreign body for preventing consequent complications which includes: pneumothorax, pneumomediastinum, athelectasis, bronchectasis, lung abscess and recurrent pneumonia. Rigid endoscopy is choice for FBA removing, but in special cases surgical management may be necessary. In this case report, a 12-year girl with respiratory signs and undiagnosed FBA due to chicken bone which lead to lung abscess and no response to medicine therapy is reported.

Crimean-Congo hemorrhagic fever (CCHF) is an acute viral illness which is transmitted to humans by infected ticks or direct contact with blood or tissues of vieremic domestic livestock and rarely by nosocomial transmission. Since CCHF is a zoonotic infection, it is more common among livestock handler and slaughterhouse workers. Children are rarely affected by CCHF except in familial outbreaks. We present 2 children from Ahvaz who developed fever, decreased level of consciousness and bleeding tendency after a suspicious tick bite. Both of them received a ten-day course of oral ribavirin and discharged from hospital with good general condition. Serologic surveys detected IgM and IgG antibodies against CCHF.However, CCHF is a rare childhood disease, because of its high mortality rate, it should be considered in any child with Fever, decreased level of consciousness and bleeding tendency and the treatment should be promptly be started with proper antiviral therapy.

prevalance of endoscopic transnasal, transesphenoid to transcranial method for pituitary tumor. From March 2005 to August 2006, 11 patients with pituitary adenoma were operated on by endoscopic transnasal transsphenoid method carried out by a team of neurosurgeons and otorhinolaryngologists. The characters under study were age, sex, cause of referral, hormonal findings, imaging, visual function and probable complications. The clinical diagnosis was confirmed in all patients by pathology report.11 patients (7 females and 4 males) with mean age of was 40.8 y. The mean time of follow-up was 3 to 12 months. Two female patients had Cushing Syndrome and 3 females had prolactinoma refractory to medical treatment. The other 6 patients had non-functional adenoma. Microadenoma in 2 patients and 9 patients with macroadenoma. In 9 patients, there were visual disturbances before operation. There was no major complication after operation. Only 2 patients had diabetes incipidus and 1 had CSF leakage which was controlled by medical treatment.Endoscopic transnasal transsphenoid surgery is the method of choice to reach to sellar region pathologies. Its benefits consist the easily view of the instruments in their passage, lessening the time of operation and lessening the patients discomfort. Existence of normal anatomy in one side of the nose is sufficient. Postoperative complications are minimal. This method is a safe and effective one and its use is recommended. In comparison with other methods, this method is more effective and has fewer complications and so its use is highly recommended.