Zahedan Journal of Research in Medical Sciences
Volume:15 Issue: 9, Sep 2013

A few factors appear to boost a child''s risk of having recurrent febrile seizures, including young age during the first seizure, seizure type, and having immediate family members with a history of febrile seizures. The present study aimed to provide reliable information about recurrent febrile seizure in Iranian children. On the computerized literature valid on valid keyword with search in valid database PubMed, Scientific Information Databases (SID (, Global medical article limberly (Medlib), Iranian Biomedical Journals (Iran Medex), Iranian Journal Database (Magiran), and Google Scholar recruited in different geographic areas. To explore heterogeneity in studies I2 index was used. Meta-analysis used to data analysis with random effects model. Hospital data of 4,599 children with febrile seizure. Overall, 21 studies met our inclusion criteria. Febrile seizure in 2 age groups (<2 and 2-6 years) were 55.8% (95% CI: 50.4-61.2) and 44.2% (95% CI: 38.8-61.2) respectively. Pooled recurrent rate of febrile seizure in Iran was 20.9% (95% CI: 12.3-29.5). In 28.8 (95% CI: 19.3-38.4), children there was positive family history. The mean prevalence of simple and complex seizures was 69.3% (95% CI: 59.5-79.0) and 28.3% (95% CI: 19.6-31.0) respectively. The rates in different geographical regions of central, east, and west of Iran, 25, 20.8 and 27.1% were estimated, respectively. According to the data the prevalence febrile seizure is higher in males and children under two years. Recurrence rate in Iran, similar to other studies performed in other regions of the world.

Parkinson disease is one of the most prevalent degenerative nervous system diseases. Some recent studies show the possible effects of uric acid on this disorder. The aim of this study was to evaluate serum level of uric acid in patients with Parkinson disease. Serum uric acid were determined in 50 patients with Parkinson''s disease and compared with 50 healthy persons, which were matched with age and sex. Data were analyzed with software SPSS-16 and statistical descriptive methods (mean-percentage, SD) and t-test. In this study, 26 men (52%) and 24 women (48%) were evaluated. The mean serum uric acid in patients was 4.79±1.21 and in the control group was 5.85 ±1.41. This difference was statistically significant (p≤0.001). Also, the mean serum uric acid in both men (4.87±1.20) and women (4.7±1.23) in patients group was statistically lower than both men (5.42±1.25) and women (5.91±1.62) in control group (p≤0.001). The findings of this study show that low serum uric acid increase the risk of Parkinson''s disease.

Nonalcoholic fatty liver disease is a highly prevalent condition that is strongly associated with obesity, type II diabetes, and dyslipidemia. The purpose of this study is to investigate mean common carotid artery intima-media thickness as a marker of atherosclerosis in moderate to severe nonalcoholic fatty liver patients in comparison with control group. In this study, the mean common carotid artery intima-media thickness (CCIMT) and other cardiovascular risk factors were measured in 39 nonalcoholic fatty liver patients and 39 control subjects. All were selected from general population in Zahedan. Then, the data were analyzed using χ2 and independent t-tests. The results showed that nonalcoholic fatty liver patients had significantly higher common carotid intima-media thickness, waist circumference, waist/hip ratio, body mass index, triglyceride, total cholesterol (p=0.001), ALT (p=0.04), ALP (p=0.048), compared with the control group. Nonalcoholic fatty acid liver patients are at significantly higher risk for atherosclerosis and cardiovascular diseases. Therefore, all of these patients should be evaluated for common carotid intima-media thickness and other cardiovascular risk factors.

Febrile seizure is the most common form of seizure and iron deficiency is the most prevalent nutritional deficiency in children. Pathogenesis of this type of seizure is not well known, but several factors including genetic predisposition, lack of elements such as zinc, magnesium and iron are implicated in its occurrence. The objective of this study is to determine the iron status and iron deficiency anemia in patients with febrile seizure referred to “Ali-Ebn-e-Abitaleb hospital” of Zahedan in 2010. This case-control study was conducted on 50 children with febrile seizure and 50 children with febrile illness but not seizure as a control group with age range of 6-72 months. Both groups were identical in terms of age and gender. After obtaining demographic information based on clinical examination, history and information contained in the documents, complete blood cells count, red blood cell indices and serum ferritin were performed for all patients. The average age of patients in the case and control groups was 25.28±17.26 and 26.12±20.04 months, respectively. Mean values of hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin, plasma ferritin and serum iron levels in patients with febrile seizure were lower than the control group, but this difference was not statistically significant. The number of patients suffered from iron deficiency anemia in the case and control groups, were 22(44%) and 18(36%), respectively. Considering the lack of significant differences between the case and control groups in terms of iron status and anemia prevalence, it is suggested that careful evaluation of anemia and RBC indices in such patients should be done only based on clinical and nutritional history of each patient.

Cardiac resynchronization therapy (CRT) has introduced as new treatment strategy in heart failure (HF) patients and some of its effects have been investigated. The aim of this study was to study the effectiveness of CRT in the improvement of left ventricular systolic function indicated by left ventricular ejection fraction (LVEF) in HF patients. In our prospective study 22 HF patients with NYHA class III and above, QRS duration>120 ms and EF (ejection fraction) ≤35% who were candidates for CRT enrolled. Patients were evaluated for NYHA class, QRS width, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and LVEF before and two months after the CRT procedure. Paired-t test analysis used to compare the before and post-CRT data statistically. Initial evaluation showed that all of the patients were in NYHA class III before CRT. Two months after CRT, all of the patients improved their NYHA class in a way that 18 patients (82%) were in NYHA class I and the other 4 (18%) were in NYHA class II. The mean (SD) QRS width decreased significantly after biventricular (BiV) pacing (p<0.001). Also a significant decrease in LVESV, LVEDV and increase in LVEF was shown in HF patients after CRT (p<0.001). The present study showed the efficacy of CRT in improvement of LVEF in HF patients with wide QRS after two months from CRT.

Different additives have been used with local anesthetics to provide prolonged duration of sensory block in spinal anesthesia. The aim of present study was to evaluate the onset and duration of sensory block of intrathecal dexamethasone and epinephrine as adjuvants to lidocaine in patients who were candidate for cesarean section. This double-blind clinical trial research was conducted on 90 pregnant women candidate for cesarean section under spinal anesthesia. Patients were randomly allocated to receive intrathecally either 75 mg hyperbaric lidocaine plus 100 μg epinephrine or 75 mg hyperbaric lidocaine plus 4 mg dexamethasone or 75 mg hyperbaric lidocaine. The onset and duration of sensory block as well as postoperative analgesia were assessed. The time to reach the peak sensory block in lidocaine group was shorter than that of other two groups (p<0.001). Duration of sensory block in the control group, dexamethasone group, and epinephrine group were 64.16±7.99 min, 74.79±12.78 min, and 99.30±10.93 min, respectively (p<0.001). The present research shows that intrathecal dexamethasone and intrathecal epinephrine as adjuvant to lidocaine increases sensory block duration in the women candidate for cesarean section.

Bronchial asthma (BA) is a chronic inflammatory disease and it is a major health problem. Trace elements such as copper and zinc are essential components of anti-oxidant enzymes and optimal function of the immune response. Changes in the levels of these elements may lead to increase the risk of asthma. The study group consisted of 175 asthmatic children and 165 control group of healthy general population who attend the outpatient allergic clinic (Bou Ali Hospital) in Sari, Mazandaran, Iran between August 2010 and March 2011. Complete blood count, eosinophil count and serum total IgE level and Serum trace element levels (Zinc, lead and copper) were measured in both groups. There was a significant difference in serum levels of copper, lead, IgE (increased), and decreased IgA, between two groups (p=0.001). There was no significant difference in blood zinc levels and eosinophilia between two groups (p=0.732 and 0.068, respectively). Increased serum levels of copper and lead may be associated with asthma.

Preterm infants have respiratory failure and complications because surfactant in alveolus is low. CPAP (Continuous positive airway pressure) is a method for respiratory support in pre-term neonates and is provided by different equipment and methods. This study aims to compare two different routes of CPAP delivery in preterm newborn infants and to determine the need for surfactant replacement therapy in two groups. This is a randomized controlled clinical trial. Eighty four preterm infants delivered in Al-Zahra Hospital with gestational age 28-32 weeks were enrolled in this study from January 2012 to September 2012. They were randomly allocated in two groups. After initial stabilization in delivery room, forty two infants transferred to neonatal intensive care unit (NICU) with face mask CPAP and 42 infant with nasopharyngeal CPAP and continued nasal CPAP in the NICU in both groups. All infants were followed for developing respiratory distress and need for surfactant replacement therapy and oxygen dependency till discharge. The neonates that treated with two methods of CPAP delivery were similar with respect to gestation age, birth weight and other demographic characteristics. Twenty three neonates (65.5%) in face mask group and 15 neonates (39.5%) in nasopharyngeal CPAP group need surfactant replacement therapy (p=0.08). Mask CPAP or nasopharyngeal CPAP can used in preterm infants after delivery for neonatal transfer to NICU. This study showed no method of CPAP delivery is preferable to other in decreasing the need for surfactant therapy.

Anxiety and stress during labor increase plasma level of cortisol hormone and slow down the progress of delivery. The purpose of this study is to investigate the effects of massage therapy on the progress of labor and plasma level of cortisol in nulliparous women in labor. In this experimental study, 30 subjects were selected voluntarily among nulliparous women aged 20 to 30 years in active labor phase. They, then, divided into two equal experimental and control groups randomly. The experimental group in the active phase (dilated 3-4 cm) to transitional phase (dilated 8-10 cm) received massage therapy. The massage was done for 10 minutes with 10 minutes rest in between sets. Meanwhile, control group received no intervention. Next, labor duration and plasma level of cortisol hormone were evaluated by drawing blood of parturient women. Results were analyzed using independent t-test and paired t-test. The mean age of control and experimental groups were, 23.9±30 and 23.6±4.0 years, respectively. In terms of educational level, 10% in both groups were under diploma, 23.3% and 24.3% of subjects in control and experimental groups, in turn, had diploma, and 16.7% and 15.7% in control and experimental groups possessed bachelor degree, respectively. The results from statistical analysis showed that labor duration and level of cortisol hormone had significant reduction in experimental group than control group (p≤0.05). According to the results from comparison between two groups, massage therapy decreases labor duration and the level of cortisol hormone. The probable reason is that massage may reduce stress and cortisol level, and increase uterine activity by decreasing anxiety.

Coronary artery disease causes changes in biomechanical parameters and function of myocardial. Recently, torsion angle is one of the most important mechanical parameters. Therefore in this study, torsion angle in healthy subjects and LAD significant coronary artery disease patients, using echo tracking method in short axis view, was evaluated. In cross sectional study, 14 healthy subjects and 10 patients with significant stenosis of LAD were evaluated. Two dimensional echocardiography images were scanned in apical and basal parasternal short axis view were recorded. Successive ultrasonic images were processed by echo tracking under block matching algorithm and peak torsion angle were estimated. Difference between healthy group and patient group were extracted by using peak torsion angle by the confidence level of 95%. In this study, basal rotation angle, apical rotation angle and torsion angle in short axis view in significant coronary artery disease patients significantly decreased 33%, 44% and 38% relative to healthy subjects, respectively. Also time to reach peak torsion angle in LAD coronary artery stenosis patients increased 19% relative to healthy group. It seems, torsion angle in short axis view, can diagnose LAD coronary artery stenosis patients reative to healthy subject.

Electroconvulsive therapy is one of the therapeutic ways to treat several severe and threatening psychiatric disorders that may cause hemodynamic complications. This study was conducted to examine the effects of intravenous alfentanil on heart rate, mean arterial pressure, seizure duration, respiratory arrest, and recovery after electroconvulsive therapy (ECT). A total of 100 patients with psychiatric disorder were examined in a prospective randomized double-blind study. Alfentanil, thiopental, and succinylcholine were administered to 50 subjects, and the remaining subjects received normal saline, thiopental, and succinylcholine, in that neither the patient nor the injector was aware of alfentanil or normal saline in A and B coded syringes. Two groups were not significantly different by age and sex. Average values of mean arterial pressure changes, immediately after ETC, were 5.41±1.9 and 32.29±2.7 in alfentanil and placebo groups, respectively. Mean values of heart rate changes, immediately after ECT, were 10.78±0.8 and 22.6±1.2 in alfentanil and placebo groups, respectively. Alfentanil significantly reduced heart rate and mean arterial pressure, after electroconvulsive. Alfentanil had no significant effect on seizure duration, respiratory arrest, and recovery. Alfentanil probably could be useful to reduce ECT-induced tachycardia and hypertension in high-risk patients without affecting seizure duration and treatment effects of ECT.

Thumb is with a special role in hand function. Therefore, in addition to the significance of using thin, pliable, color-matched, and hairless cover in resurfacing the lesion in this area, recovery of sensation should also be taken into consideration. Thirteen patients with thumb degloving injuries were candidates for sensate reverse island radial forearm surgery. After transferring the flap, forearm lateral sensory nerve was sewn to the thumb digital nerve. At least for two years, these patients received regular diagnosis, and monofilament, static two point discrimination (S-2PD), and moving two point discrimination (M-2PD) tests were taken from them. Monofilament test did not show normal sensation recovery, at protective sensation threshold, in the parents. The difference between monofilament test and normal thumb was statistically significant (p<0.0001). In spite of this, the protective sensation was restored in all flaps after two years. According to the results from S-2PD and M-2PD tests, the restored sensation was at protective threshold or reduced, and the difference was statistically significant (p<0.0001). Given difficulties of performing free flaps, and also deficiencies of pedicle flaps, the forearm radial island flap is known as one of the primary choices in most of the thumb soft tissue and hand defects reconstruction, due to its advantages, especially restoring the sensation of the injured site.

The present study aimed to determine association between abnormal maternal body mass index and adverse maternal/prenatal outcomes In this descriptive-correlation study 8270 pregnant women referred to rural and urban health centers of Ardabil district (from Mar 2009 to Dec 2010) were studied. Data were collected from prenatal healthcare records using a self designed questionnaire. Women with twin pregnancy, less than 18 and above 35 of age, and women with systemic or chronic disease were excluded from the study. The variables examined in this study include, demographic information (e.g. age, social and economy status, and literacy), present pregnancy information (e.g. parity, hemoglobin level, gestational diabetes, preeclampsia) and prenatal information (e.g. preterm delivery, low birth weight, and congenital malformation). Data were analyzed through Kruscal wallis, chi-square, and logistic regression tests using SPSS-16. 8.2, 25 and 15.4% pregnant of women were underweight, overweight, and obese, respectively. Obese women were at increased risk for macrosomia (OR=1.820, CI: 1.345-2.447, p=0.001), unwanted pregnancy (OR= 1.436, CI: 1.198-1.720, p=0.001), pregnancy induced hypertension (OR= 1.633, CI: 1.072-2.486, p=0.022), preeclampsia (OR= 4.666, CI: 2.353-9.2550, p=0.001), and still birth (OR= 2.602, CI: 1.306-5.184, p=0.007). However, the risk of low birth weight delivery in underweight women were 1.6 times higher than the normal cases (OR= 1.674, CI: 0962-2.912, p=0.068). Considering high prevalence of abnormal maternal body mass index and its associated adverse maternal and prenatal outcomes; consultation before pregnancy is recommended in order to achieve normal body mass index and reduce the relevant complications.

There are conflicting reports about the effect of wiping cervix with cotton on Pap-smear results. Therefore, we aimed to do a research about this subject. 234 eligible women attended to have Pap-smear at an educational hospital in Rasht, Iran, from July to September 2011, were allocated by block randomization into two groups. In the intervention group, we cleaned cervix with a sterile cotton rotating 360 degrees and obtained samples using spatula for exocervix and cytobrush for endocervix. This method was performed without cleaning the cervix on the control group. Data collection, vulvovaginal examination, laboratory assay were done by investigators masked to the group allocation. Participants were also blind. The data were analyzed using logistic regression in SPSS-13. Rate of sufficient endocervical cell of the slides in the intervention group was significantly higher than in the control group (70.3% vs. 57.8%, p=0.03). In the intervention group 42.4% of the slides were satisfactory and 57.6% had limited quality for interpretation. These figures in the control group were 37.1% and 62.9%, respectively. This difference was not statistically significant. Also, there was no significant difference between the groups on rate of slides with inadequacy of squamous cells and obscuring 75% or more of the slides with inflammatory exudate or blood (p>0.05). There were no significant differences between the groups on some quality indicators of the smears. However, frequency of smears with sufficient endocervical cells was higher in the group with cervical wipping. Therefore, it is recommended to clean cervix before obtaining the smears.

Several studies have indicated that when compared to non-consanguinous marriage, consanguinous marriage may lead to a higher incidence of congenital abnormalities. The study was performed to evaluate few screening tests to estimate the risk of chromosomal abnormalities in the first trimester compared between familial and non-familial marriages. In this cross sectional study, 300 pregnant women with singleton pregnancy presenting to Tabriz Al-Zahra hospital from 2007 to 2009 were enrolled as study population. The participants were evaluated about chromosomal malformations using a combination of NT (Nuchal Translucency), PAPP-A (Pregnancy-Associated Plasma Protein A), and free beta- human chorionic gonadotropin (β-hCG). In positive screening test results, the participants underwent fetal karyotyping using amniocentesis or chorionic villi sampling (CVS). Pregnancies with higher risk were observed more among non-consanguineous marriages. The maternal age was not found to be a determinant in this regard. NT and free β-hCG values (but not PAPP-A) were significantly different between the two study groups. The triple screening test had a sensitivity of 100%. There were two cases of Down syndrome both belonging to the maternal age less than 35 years and non-consanguineous marriages. Considering that a statistically significant association was not observed between abnormal test results and pregnancy complications (p=0.73), it seems that it is essential to use screening tests in all pregnant women. Especially that the only two pregnancies with Down syndrome in our study were under 35 years of age.

Existence of heavy metals, may have adverse effects on consumers. This study was carried out to determine some heavy metals concentrations (cadmium, chromium and lead) in Mashhad drinking water network. In this cross study, samples were collected from different points of urban drinking water network according to the standard methods, and tested by atomic absorption spectrophotometeric method. Cadmium and chromium concentrations did not exceed national and international standards, only lead concentrations were slightly higher than standard rate in some areas and its mean difference spring and summer was significant (p=0.03). It is necessary to do needful measures by responsible company because of the metals importance.

In This study some vegetables'' (mint, leek, radish and scallion) cadmium and lead metals level was investigated in two areas (west, east) of Mashhad from May to October 2011. The amount of heavy metals was determined by graphite atomic absorption after acidic digestion of the samples and the data were analyzed. The results indicated that maximum and minimum level of lead concentration was found in two areas: scallion of east (42.13mg/kg) and radish of west (17.76 mg/kg) respectively which were Leek (0.89 mg/kg) and scallion (0.22) of east for cadmium. The survey of heavy metals is needed to assess health hazards, food safety, and security.

Radon is a radioactive gas and the second leading cause of death due to lung cancer after smoking. Ramsar is known for having the highest levels of natural background radiation on earth. In this research study, 50 stations of high radioactivity areas of Ramsar were selected in warm season of the year. Then gamma dose and radon exhalation rate were measured. Results showed that gamma dose and radon exhalation rate were in the range of 51-7100 nSv/hr and 9-15370 mBq/m2s, respectively. Compare to the worldwide average 16 mBq/m2s, estimated average annual effective of Radon exhalation rate in the study area is too high.

Diagnosis and measurement of air pollution in workplace is one of the most important aspects of controlling chemical agent and purpose of this study is to measure inhalation exposure welding fumes. In this study, with the help of a personal pump and ester cellulose filters, welding fumes in total working hours was measured. The samples prepared and analyzed by atomic absorption. The findings suggest that the inhalation of iron oxide is higher than threshold limit value but the amount of nickel is less than the limits. Results confirms the need for some corrective actions.

About 1% of pregnancies are ectopic، usually implants in the fallopian tube. Most ectopic pregnancy (EP) continues to grow and lead to rupture the tube. The most common site of EP is the ampulla and 12% occurs in isthmic portion. Early Rupture is the usual outcome of isthmic pregnancy and usually there is early tubal rupture in the first few weeks. In this report a 29 years old infertile woman had a large size unruptured isthmic EP in left fallopian tube following ovulation induction that was managed with laparoscopy. Therefore، an isthmic EP may attain a large size prior to rupture.

Accurate knowledge of the normal and variant arterial pattern of the upper extremities is important for reparative surgeons. During dissection of a male cadaver, a common trunk taking origin from the third part of the axillary artery was observed. This common trunk at first gave rise to the usual branches of this part of the artery and then descended into the arm. In the arm, it gave rise to the main branches of the brachial artery and then continued as the inferior ulnar collateral artery. In this specimen, a rare pattern of auxiliary artery branching was observed. Numerous alternatives that exist during the formation of upper limb vessels seem to be responsible for anomalous arterial branching patterns.

Two main risk factors of uterine rupture during pregnancy or labor are prior uterine myomectomy and cesarean section. The risk of uterine scar rupture increases with increase of the size and numbers of incision. Severe complications may occur following uterine scar rupture. We report a case with prior large and multiple myomectomies, repeat cesarean sections, deliveries of 4 normal large, alive fetuses without any complication or uterine scars rupture.