نشریه پژوهش در پزشکی
سال سی‌ام شماره 4 (پیاپی 120، زمستان 1385)

The purpose of the study was to assess changes in total cholesterol, LDL-C, HDL-C, non HDL-C and triglyceride levels over a 3-year period in subjects enrolled in the Tehran Lipid and Glucose Study.

A total of 1839 males and 2553 females, aged 3 years and over, were included in this study. Baseline demographic characteristics and lipid levels were determined GTT was performed at baseline and after 3 years in subjects ≥20 years age.

In both sexes, BMI and WHR,(waist-hip ratio), increased significantly from baseline. Mean BMI at baseline was 24.7±5.8, which in phase 2, rose to 26.0±5.6 kg/m2 (p=0.001). In phase one, 32 and 18.6% of all subjects and in phase two, 34 and 23.4% respectively were overweight and obese (p=0.05). Prevalence of impaired glucose tolerance, (IGT), and Diabetes mellitus increased in phase 2 of the study. 13% of all subjects in phase 1 had IGT and 11.4% had diabetes these statistics increased to 14.2 and 12.3% respectively in phase 2. In phase 2, systolic and diastolic blood pressure, mean cholesterol, LDL-C, HDL-C, non HDL-C and triglycerides decreased significantly from baseline levels. In phases one and two, 5.1% and 7.6% of subjects respectively were unaware of their diabetes.

There is a high prevalence of cardiovascular risk factors, such as overweight, obesity, low HDL-C, IGT and diabetes in the urban population of Tehran. It was seen that although mean total cholesterol, LDL-C, non-HDL-C, TG, SBP and DBP decreased significantly after 3 years, IGT, DM, overweight, obesity and Low HDL-C increased from baseline values.

Trigeminal neuralgia is a common disorder with well established diagnostic characteristics. Remission of symptoms with carbamazepine seems diagnostic, however, cases who failed to respond might advise surgery. In the present study, we investigate postoperative complications and outcomes in a group of Iranian patients referring with trigeminal neuralgia during a 10-year period.

It was a retrospective study. We reviewed medical files of patients referring with trigeminal neuralgia and underwent microvascular decompression during a 10-year period (1995-2004).

Totally, 35 patients with the mean age of 55 years and male to female ratio of 1.33 underwent microvascular decompression. A combination of maxillary and mandibular branches of trigeminal nerve was the most commonly involved root, reported in almost half of the patients. Superior cerebellar artery was, by far, the most frequent compressor of the nerve. Immediate response to surgery was reported in 83%. Postoperative complications were observed in 8 patients, 4 due to medications while the other 4 were believed to be neurologic in origin. Unfortunately, 2 patients died. Patients were followed for 1-46 months (mean 14 months), during which 4 returned with symptoms recurrence and received medical therapy.

Microvascular decompression is the standard surgical approach for trigeminal neuralgia since it is associated with symptoms relief, excellent postoperative outcomes, minor complications and low recurrence rate.

Thyroid antibodies have a key role in follow up of the patients with thyroid carcinoma, thus present study investigates thyroid antibodies in patients with differentiated thyroid carcinoma.

For this cross sectional study, 157 patients with differentiated thyroid carcinoma (case group) and 434 healthy subjects (control group) were included. Serum level of antithyroglubin and antiperoxidase were measured (RADIM, Italia). Antithyroglubin and antiperoxidase levels of >150u/ml and 100u/ml, respectively, were considered positive. Based on the recent intervention (surgery or radioactive iodine intake) patients were assigned in two groups of before and after 6 months and the aforementioned antibodies were checked.

The mean (±standard deviation) of antithyroglubin was 290±111 and 405±111 u/ml in case and control group, respectively. The mean antiperoxidase level was 257±46 and 302±73u/ml, respectively. positive antithyroglubin level was reported in 21(13.4%) cases versus 65(15%) controls (NS), however, positive antiperoxidase level was found in 6(3.8%) cases and 42(9.7%) controls (p=0.02).

Patients with thyroid carcinoma showed similar antithyroid antibodies as healthy population, however, their level within the first 6-month following the intervention was significantly higher than 6 months after the intervention.

Narcotics are widely prescribed to eliminate postoperative pain. The present study was designed to survey the pattern of narcotic analgesia usage in surgical wards of Taleghani hospital.

This Drug Utilization Evaluation (DUE) was designed based on Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). The usage of injecting narcotics including pethidine, morphine, methadone, pentazocine, and fentanyl was surveyed during a 6-month period. Finally, ridge regression analysis was performed to draw the final model of probable associated factors.

Totally, 1029 patients received at least one dose of narcotic. Total usage of injecting narcotics was 335/24DDD or 4.67DDD/100 bed days. Narcotics were prescribed more frequently in the general surgery ward (129/32DDD), however, patients underwent renal transplantation received narcotics less frequently (11/175DDD). Multivariate regression analysis showed that postoperative narcotic requirement (DDD/day) has an inverse association with patient's age. Meanwhile, females consumed narcotics more frequently.

Younger age and female gender are associated with higher narcotic consumption. This could in part explain physiologic and psychologic aspects of these patients

Thyroid hormones have extensive effects on differentiation, development, and growth of different organs. Effect of the administration of PTU in pregnant and lactating rats on isolated aorta response of their adult off-springs has been investigated.

Three groups of female rats were selected. In the first group, (fetal group), observation of vaginal plug after mating was considered as the first day of pregnancy, and then PTU was added to their drinking water until the end of gestational period. In the second group, PTU was added to the drinking water of female rats from the time of labor for 25 days postpartum, (neonatal group). The third group was the control group which consumed only drinking water. In all three groups total‏ thyroxine (tT4), free thyroxine (fT4), total triiodothyronine (tT3), free triiodothyronine (fT3) and TSH were measured in the sera obtained from the mothers, immediately after discontinuing the drug.

Levels of the above mentioned hormones, (except TSH), in fetal and neonatal groups were significantly lower than control group (p<0.05) TSH in fetal and neonatal groups was significantly higher than controls, (p<0.001). After two months the adult off springs were anesthetized, dissected and isolated aorta response was examined against KCl and phenylephrine. Results of this study indicated that responsiveness of aorta in fetal group was significantly decreased compared to the control group (p<0.05), but neonatal group had no significant difference with the control group.

Hypothyroidism in fetal period has significant effects on differentiation and development of vascular bed, (aorta), in a way that can be still observed during adulthood.

Epilepsy is the most prevalent chronic nervous disease among general population prevalence of depression among these patients is twice that of individuals suffering from other disabling diseases. However, depression is often undiagnosed in these patients or treated partially, leading to serious consequences. The present study was designed to asses the prevalence of depressive symptoms and risk factors related to depression in epileptic patients,

The present study is a descriptive research. 97 epileptic patients referred to the hospitals affiliated with the Shaheed Beheshti University were evaluated by Beck Inventory and a demographic questionnaire.

Beck inventory revealed that 51.6% of epileptic patients, (with generalized tonic clonic epilepsy), suffered from mild and moderate depression. There was a significant relation between depression and the following variables: occupation, educational level, economic status and residential place (p<0.05).

Our findings suggested a high rate of depressive symptoms among epileptic patients most of them had not received optimal treatment. Considering the fact that depression is amenable to treatment, screening and timely diagnose is useful and important.

The aim of this study was to assess non-communicable disease risk factors in children of parents with an ECG evidence of myocardial infarction (MI), and compare them with children from families with no such parental history.

Of 15005 participants in the Tehran Lipid and Glucose Study, all individuals over the age of 30 years underwent routine ECG exams. Among these, 303 off springs aged 3-30 years, who had one or two parents with possible or probable myocardial infarction (MI) according to the Minnesota coding were selected. An age and sex-matched sample of 601 off springs who had no parental evidence of ECG-defined MI were randomly selected as the control group. Risk factors studied were: BMI, blood pressure, FBS, total cholesterol, HDL-C, LDL-C, triglycerides and the metabolic syndrome.

A "paternal" and "parental" history of MI was associated with a higher prevalence of overweight and obesity, respectively, (34.9% vs. 24.8 %) and a lower prevalence of high blood pressure, (12.2% vs. 18.1%), in their off springs. Likewise, in male children of fathers or both parents with ECG evidence of MI, a lower prevalence of hypertension was noticed, Compared with the control group, in female children of mothers with a history of MI,a higher prevalence of elevated serum LDL-C was found (28.0% vs. 10.7%) (p<0.05). Paternal MI was associated with increased prevalence of higher body mass indices (BMI) in their off springs (OR=1.6 95% CI: 1.1-2.4p<0.05).

There is a significant familial correlation between paternal history of MI and overweight and obesity in their offspring.

Diabetic foot infections are a potentially severe complication of diabetes. Diabetic foot infections can sometimes lead to long-term debilitation and, in the most severe cases, amputation. They are the most common infections in patients with diabetes, whose weakened immune systems put them at an increased risk of acquiring antibiotic resistant infections.

For this descriptive study, 120 diabetic patients (30 women and 90 men age ranged between 45-65 years and disease duration of 0.5 to 37 years) were investigated. Immediately after the hospitalization, specimens from infected foot lesions were taken using Thio and BHI as transport medium. Aerobic cultures were carried out in all cases according to conventional methods while anaerobic cultures were performed when appropriate. Finally, susceptibility tests were performed on isolated microorganism.

Totally, 75% of cases were polymicrobial infections. We isolated gram positive cocci 95%, gram positive bacilli 35%, gram negative 55% and mycobacterium 10%. Meanwhile, we found that 12.5% of our bacteria were anaerobic and 87.5% were facultative aerobic bacteria. In antimicrobial susceptibility testing, Rifampin was the most effective antibiotic against S.aureus and peptostreptococcus. Surprisingly, E.coli was resistant to all tested antibiotics.

Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be prescribed on the results of microbiological investigation.

Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Approximately 4% of pregnancies are affected by diabetes mellitus, 90% of which represent gestational diabetes mellitus (GDM). Detection of GDM permits the identification of women who are at risk for development of type 2 diabetes mellitus later in life. Appropriate treatment may reduce the risk of fetal and neonatal complications. One of the risk factors identified recently is "irregular menstruation". Several studies have reported the relationship between irregular menstruation and insulin resistance. The aim of this case-control study was determination of relationship between irregular menstruation and gestational diabetes.

Pregnant women who were referred to prenatal clinics affiliated to Endocrinology and Metabolism centers of Shariati and Taleghani hospitals, and Iran Endocrinology and Metabolism institute, were studied. Mothers were interviewed by trained members of the study team and relevant information recorded on a structured questionairre. Sampling was performed by convenience method. Case group including 60 women with gestational diabetes and control group comprising of 60 women without gestational diabetes were matched for age, parity, BMI, family history of diabetes, history of still-birth, or delivery of a previous malformed newborn. Demographic characteristics, history of irregular menstruation and its etiology were compared between the two groups. We excluded subjects with history of fetal macrosomia (weight>4500 g), pre-pregnancy diabetes, diabetes in previous pregnancy, smoking before or during pregnancy, recurrent abortion and preterm delivery.

Demographic characteristics and etiology of irregularity were similar between cases and controls. Irregular cycles were more prevalent in the case group, (36.7% vs. 15.0 %, P=0.007, Odds Ratio=3.28, CI=95%, 1.40-7.90 ).

A history of irregular menstrual cycles was a significant independent predictor of gestational diabetes mellitus. If selective screening is implemented for gestational diabetes mellitus, such history should be considered in the decision of whom to test.

The metabolic syndrome is a constellation of risk factors that increase the incidence of cardiovascular disease and type 2 diabetes mellitus in adults. Some studies in recent years have found evidence of initiation of this disease in childhood and of the association of childhood obesity with adult cardiovascular disease and diabetes. The present study was carried out to determine the prevalence of risk factors for metabolic syndrome in children, in order to prevent, or at-least decrease the occurrence of fatal cardiovascular and diabetic complications.

In a cross-sectional study within the framework of the Tehran Lipid and Glucose Study (TLGS), 1067 children, 3-9 years of age, including 506 boys and 561 girls were investigated. Weight and height was measured and BMI calculated. Fasting blood samples for the measurements of glucose and lipid concentrations were drawn. A qualified physician measured blood pressure three times in a seated position using a standard mercury sphygmomanometer and the mean of three measurements was considered as the participant’s blood pressure. After gathering the results of basic measurements, all results, except blood pressure were matched with Iranian tables of percentiles of BMI and lipids for age and sex. For blood pressure we used the world wide accepted NCHS tables. ‘At risk of overweight’ was defined as ≥85th to <95th percentile of BMI for age and sex. Subjects with three or more characteristics of the following components of metabolic syndrome were categorized as having the syndrome (1) BMI≥95th percentile for age and sex (2) TG≥95th percentile for age and sex (3) HDL cholesterol <5th percentile for age and sex (4) Impaired fasting glucose (FBS between 100-125 mg/dl) (5) systolic/ diastolic blood pressure>95th percentile for age, sex, and height.

Prevalence of metabolic syndrome was 0.9 percent, (95%CI:0.3-1.5) overall, 8.9 percent in overweight youngsters, 0.3 percent in at risk of overweight and only 0.1 percent in the normal weight group. Prevalence increased with increases of body-weight with a significant difference between overweight children and other BMI groups. Overall, 12 percent of children were at risk of overweight, 8.4 percent were overweight, with no significant difference between two sex groups. Most prevalent components of metabolic syndrome in overweight children were hypertension and high TGL, (14.4%) low HDL and impaired fasting glucose were next in order of frequency. In comparison with subjects with normal weights, the difference in hypertension was significant in overweight children, (P<0.01).TGL was significantly different from normal weight group (P<0.01) and also with at risk of overweight (P<0.05).

This study showed a low prevalence of metabolic syndrome among Iranian children but the prevalence of this syndrome in overweight youngsters was significantly higher than other BMI groups. The prevalence of at risk of overweight of 12 percent on one hand, and the high rate of transition of overweight children into obese adults in subsequent years of life on the other hand, is alarming. Special attention to weight control through nutritional counseling and increased physical activity during childhood and adolescence is recommended.

Jaundice is one of the most common problems in the neonatal period usual management of neonatal jaundice includes phototherapy, drug therapy, and exchange transfusion. In some countries, people use herbs for the treatment of jaundice. In Iran, cotoneaster spp. named shir khesht is used as a remedy for jaundice.

We prepared a 16% solution of shir khesht from the original plant. After controlling for contamination with pathogenic bacteria, the mixture, (5 gram of shir khesht in 30 ml. of distilled water), was given in three divided doses to 32 icteric newborns, for one day. 30 ml. of placebo mixture in three divided dose was given to 32 controls. Both groups received phototherapy as well. Serum bilirubin was checked prior to, and after prescription in each group every 12 hr for 36 hours.

Decline in the level of bilirubin in cases, i.e. those receiving shir khesht, was greater in comparison with controls reduction was significant at 12 hours, (mean=11.89±1.34 vs, 13.96±2.8), p=0.001, 24 hours, (mean=8.34±3.19 vs 11.66±2.33), p<0.001, and at 36hours (mean=3.90±2.48 vs 10.26±2.67) , p<0.001. The duration of hospital stay in cases was much less than controls, (mean admission in days=3.98 ±2 vs. 4.59±1.93, respectively), p<0.001.

In this study shir khesht was found to be effective in the treatment of neonatal hyperbilirubinemia resulting in a rapid decline in serum bilirubin, thus reducing duration of hospital stay. We suggest that further studies should be done so that it could be dispensed as a standard formula and used for neonatal jaundice.

Despite an improvement in dialysis care during the past decade, the number of hemodialysis patient with kidney failure has doubled and they are suffering from mental disorders, anxiety and depression. This paper aimed to determine the effects of applying continuous care model, (CCM), on stress, anxiety and depression in hemodialysis patients.

Thirty eight hemodyalysis, (HD) patients were selected through simple randomized sampling and all were assigned to one group. Each case was his or her own control, classified as control ‘before’ intervention and as a ‘case’ after intervention. Data collection tools included DASS21 and demographic questionnaires. In the first phase, (before intervention), the research team organized orientation sessions for all partcipants and completed the questionnaires. Immediately after this intervention was started in the form of CCM for all cases. SPSS Software V(13) was uilized for data analysis descriptive statistics, Paired t-test and Chi-square statistical test were used as required.

Data analysis shows that there is a significant relationship between application of Continuous care model and levels of stress, anxiety and depression in HD patients (p=0/0001).

According to these findings, applying CCM causes significant difference in the levels of stress, anxiety and depression HD patients consequently, applying this caring model can promote HD patient's quality of life.

Depressive disorders are quite prevalent among the old population of developed countries, therefore, validated scaling systems are necessary for screening purpose. The present study was designed to develop and validate GDS-15 in Iran.

The Persian version was prepared using translation, reverse translation and comparing technique. Then, 204 adults aged >59 years were randomly selected to fill the questionnaire. Standard Clinical Interview using Composite International Diagnostic Interview (CIDI) was applied as the gold standard for depressive disorders diagnosis.

Results revealed satisfactory reliability coefficient. Depression-associated factor (including 11 questions) could be considered as a brief form with alpha and correlation coefficient of 0.92 and 0.58 with the original form (p<0.001). Having applied ROC analysis, cut off points of 8 and 6 were determined for 15- and 11-question forms, respectively, with sensitivities of 0.9 and 0.9 and specificities of 0.84 and 0.83, respectively.

Our results revealed that 11- and 15-question forms of GDS are quite reliable and valid for epidemiological and screening studies, especially among urban population.

Soft tissue thickness over the tip of the nose varies considerably between patients, subcutaneous fat being thickest in the supratip area. Fat nose is a challenging issue to manage, and surgeons have not found the ultimate solution to handle this problem during the evolution of rhinoplastic surgery. Due to multiplicity of techniques and controversies published in literature, it becomes confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The focus of this paper is to introduce a new procedure for reducing the overlying soft tissue of nasal tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in two layers. We believe that soft tissue trimming in biplane dissection, described in the paper, can minimize the thickness of the tip skin in a safe and homogenous manner. In this paper we have demonstrated a new dissection method of nasal soft tissue and trimming it in different areas of the nose for different purposes. In the authors’ opinion this approach is one of the most effective way of handling unpliable thick nasal skin.

Among legally identified cases of paraphilias, pedophilia is most common. Psychiatric disorders frequently coexist with pedophilia. Unfortunately, pedophilia is extremely difficult to treat. The authors report a patient with pedophilia, bipolar mood disorder and mental retardation who was treated with combination of carbamazepine and spironolactone.

Primary hyperparathyroidism is a quite frequent disorder however, giant parathyroid adenoma is a rare entity. We described a 39-year old woman presenting with lower extremities bone pain within the recent 3 years. She had been receiving levothyroxin during the past 10 years due to hypothyroidism, meanwhile, she had a bulge right thyroid lobe. Laboratory examinations revealed she was euthyroid, however, scanning showed parathyroid adenoma. During surgery, an adenoma measured 2×3×6cm, weighted 22gr was resected. Giant parathyroid adenoma present with non-characteristic symptoms, thus, routine laboratory measurements including serum calcium and phosphorous should be proposed for suspected individuals. .