Archives of Iranian Medicine
Volume:3 Issue: 3, Jul 2000

Background-There are no available native reference values for pulmonary function tests in Iran. A study was carried out in Isfahan to develop prediction equations of ventilatory function for normal children and adolescents based on age and height.Methods-The data for healthy individuals aged between 4 to 18 (357 girls and 442 boys) were extracted from a larger study of spirometric measurements collected from 2,602 individuals studied at medical services in Isfahan, Iran. Several models were tested for the prediction of FEV1, FVC and the FEV1/FVC ratio. Using multiple regression analysis, many equations were tested and the best models were selected for each gender.Results-In children, the best models were those using linear regression with age and height (r2=0.86-0.94)Conclusion-In children, pulmonary function can be efficiently predicted, based on age and height, by using appropriate equations.

Background-During the past decades, improvement in health standards has resulted in lower mortality due to malnutrition and infectious diseases in Iran. This has led to greater prominence of cardiovascular disease as a cause of mortality. In some developing countries, the treatment of acute myocardial infarction (AMI) does not follow the latest recommendations. Thrombolytic therapy and early revascularization are not available to all centers in Iran. The mortality of cardiogenic shock (CS) complicating AMI is around 77%. However, limited information is available on independent predictors for development of post-AMI CS. Objective-To identify the important factors determining development of post-AMI CS.Methods- Of 652 patients with the diagnosis of AMI, admitted to our Coronary Care Units between March 1997 and March 1998, 70 (11.2%) developed post-AMI CS (group A) while in hospital. One-hundred and forty subjects were selected at random from those who did not develop post-AMI CS (group B). The medical records of these patients were reviewed for several variables including gender, age, peak total plasma creatine kinase activity, AMI location, history of previous MI, smoking, diabetes mellitus, hypertension and hyperlipidemia.Results-A univariate analysis revealed that group A was older (65.04 vs. 58.8 years; p < 0.001), had a higher prevalence of previous myocardial infarctions (44.8% vs. 18.1%; p < 0.001), had a higher prevalence rate of global or anterior wall AMI (90% vs. 38.8%; p < 0.001), and a higher median peak total plasma creatine kinase activity (1359 vs. 627 U/L; p < 0.001) than group B. A logistic regression analysis identified the first 3 variables, i.e., age, history of previous MI, and AMI location, as independent predictors for the development of post-AMI CS.Conclusion-Age, history of previous MI, and the site of MI can predict the development of post-AMI CS with an acceptable level of accuracy (78%). A discriminant equation is proposed by which the patients at risk of developing post–AMI CS can be identified, so that appropriate treatment can be started immediately.

Objective- Wilson’s disease (WD) is an autosomal recessive disease with different manifestations. This study was aimed to assess the clinical and paraclinical features of this disease in different groups of patients in order to reach a diagnostic algorithm.Methods- Over a period of 10 years (1990-1999), 84 patients with WD (mean age 27 years, 54 males) were studied in 6 referral university hospitals. The presenting features were chronic liver disease in 37, acute hepatitis in 9, hepatocerebral involvement in 10 and neurological disease in 11 patients. Further seventeen patients were detected by a family screening program. Diagnosis was based on clinical evaluation including ophthalmologic and neurologic examinations, positive laboratory investigations such as abnormal liver function tests, serum ceruloplasmin level below 20 mg/dl, and urinary copper excretion levels above 100 µg/day. The patients underwent treatment with a daily dose of 1-2 g D-penicillamine.Results- The most frequent abdominal manifestations were splenomegaly (63%), jaundice (46%) and hepatomegaly (46%). Decreased serum ceruloplasmin was seen in 93.7% and urinary copper excertion was increased in 68% of cases. Kayser-Fleischer rings were detected in 69% of the patients. In contrast to patients with neurological disease, of whom 91% displayed the Kayser-Fleischer rings, only 67.5% of patients with liver disease showed such rings. Serum ceruloplasmin levels were similar in the two groups and around 90% of the patients had levels below 20 mg/dl. Mortality rate related to WD was 10% over a period of 10 years.Conclusion- According to our data, WD should be considered in all young patients presenting with acute or chronic liver disease and negative viral markers. Decreased serum ceruloplasmin level was a good screening test in all but the acute hepatitis group.

Objectives- To study the livers from S. mansoni infected mice during 16 weeks of infection with regard to granulomas and the kinetics of mast cells and eosinophils in the granuloma.Methods-The tissues were stained with a newly developed method designed to detect mast cells and eosinophils simultaneously. Results- Granulomas appeared from the sixth post-infection week and both the number and size of the granulomas increased gradually in the acute phase of the infection and then reduced as the infection matured. Eosinophils comprised 97% of the cell types in the granuloma and probably play an important role in schistosoma egg destruction. At all times during the infection mast cells comprised approximately 3% of the cells in the granuloma.Conclusion-The appearance of mast cells in the granuloma may be dependent on factors other than those associated directly with the granuloma.

Background-Direct association of trace and macro-elements in relation to human disease has been observed in many research studies. In many cases, an alteration in the metabolism of these minerals has been demonstrated.Methods-In this investigation, the serum and hair levels of the trace elements zinc (Zn), copper (Cu), chromium (Cr), manganese (Mn) and the macro-element magnesium (Mg) were determined in 40 subjects (20 insulin-dependent diabetics and 20 controls). Samples were analyzed using atomic absorption spectrophotometric methods.Results-Serum levels for Zn were lower in the patient groups in comparison to the controls (p<0.01), however, Zn levels in hair follicles were not found to be statistically different. Serum Cu levels were significantly higher in diabetic subjects (p<0.008) where as hair levels were unaltered. Comparison of levels of Cr in hair samples revealed a significant difference between patients and controls (p=0.001). Serum Mn evaluation revealed no significant difference between mean levels of controls and patients (p<0.96), but hair follicle analysis revealed a significant difference between the two groups. For Mg, statistical analysis indicated a significant difference in the two groups of serum levels (p<0.0007), with hair samples showing no significant difference (p<0.01). These results are consistent with results obtained by some other researchers.

Background- Injury to the spinal cord can lead to dysfunction of the urinary system, which in turn leads to an increased risk for the development of conditions such as urinary tract infection (UTI) and stones, vesicoureteral reflux, bladder diverticula, increased urinary residue, urinary obstruction and renal failure.Methods-This study was conducted on 50 spinal cord transected war victims of Gilan province, north of Iran. Complete laboratory tests, including urine culture and antibiogram were performed for all patients.Results- Out of the 50 patients in our study, 23 (46%) were found to have UTI (54%). The average age of the UTI and the non-UTI patients was 35.9 and 36 years respectively and the average period since the spinal cord transection was 14 years in the UTI and 13.5 years in non-UTI patients. E. coli was the most common organism resistant to routine drugs. Maximum resistance existed towards ceftizoxime (84.6%), kanamycin (84.7%), and Co-trimoxazole (92%) and least resistance towards cephalothin (15.2%) and amoxicillin (15.2%).Conclusion-Our study shows that a considerable number (88%) of the patients had some form of drug resistance which is probably due to the indiscriminate use of antibiotics in war victims. It is recommended to treat spinal cord transected war victims suffering from UTI, with the more available and cheaper antimicrobials such as cephalothin and amoxicillin in the first line and resort to more costly antimicrobials for special cases.

Congenital bony fusion of the jaws (syngnathia) without any other anatomic oral anomalies is a very rare condition. Numerous cases with combination of cleft palate, aglossia, and soft or bony adhesion between the maxilla and mandible have been reported. Syngnathia could also occur with popliteal pterygium syndrome and van der Woude syndrome. This report presents a case of syngnathia with bilateral maxillo-mandibular inter-alveolar adhesion, unusually with no other intra-oral anomalies.

Robertsonian translocation is one of the major chromosomal re-arrangements and comprises 18% of total genetic abnormalities. It occurs between different chromosomes and chromosomal segments and less than 0.2% of individuals carry a symptomatic chromosomal rearrangement. However, the t(22;22)is a rare phenomenon which mainly manifests as familial monosomy or trisomy. We report on a 30-year old woman who was referred to a pathological laboratory in Kerman, Iran. She had no mental retardation, but suffered from repeated abortions. On the basis of GTG-banding and karyotyping, it was found that a Robertsonian translocation in the chromosome 22;22 was the primary cause of this syndrome.