فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال چهارم شماره 4 (پیاپی 16، زمستان 1387)

On one hand the prevalence of Irritable Bowel Syndrome (IBS) ranges from 4 to 12 percent in the community; on the other hand, Celiac disease is prevalent in 4% of the IBS patients. Regarding the fact that cereals containing gluten are routinely used in Iran, diagnosing celiac disease in IBS patients is important for conducting the treatments. The objective of this study was to assess the frequency of Celiac in IBS patients.This study was designed as a case control prospective study. Eighty six subjects were enrolled in this study according to Rome II Criteria. The control group included healthy subjects that were checked up on a routine base. The evaluation of Celiac was done through serology exams such as Anti Gliadin and Anti Transglutaminase (IgG and IgA).Thirty eight male and 48 female patients suffering from IBS with a mean age of 34±11.7 years were enrolled in this study. The case and control groups were not significantly different in terms of sex and age. Flatulence, excessive gas passing and mucus passage were the most frequent symptoms in IBS patients. Night symptoms and weight loss (alarm signs) were observed in 37% and 32%, respectively. Elevated Antigliadin Titer was evident in 22 subjects (25%) which suggests a significantly higher rate for the case group as compared to the control group (t=4.67,P=0.0001). Elevated IgG Anti Transglutaminase Titer was observed in 2 cases (2.3%) while IgA Anti Transglutaminase was not elevated in any of the IBS subjects, neither in the control group nor in the case group.Biopsy of small intestine can be suggested to rule out the elevated Antigliadin Titer Celiac Disease in IBS patients.

Since CNS is derived from ectoderm during the fetal period, there are some common congenital or hereditary conditions that affect both the skin and nervous systems. Such conditions are traditionally called neurocutaneous disorders or phakomatosis.In this study, we have reviewed the most common clinical features and paraclinical findings in neurofibromatosis (NF) and tuberous sclerosis.In this cross sectional study, 50 patients with tuberous sclerosis or NF were chosen among all the patients who referred to the neurological clinic of Shahrivar 17th Hospital during a ten-month period. They were physically examined to detect any suspicion of neuroectodermal syndromes employing paraclinic exams like CT scan, MRI and EEG. Information about patients’ familial history, age, sex, clinical and paraclinical findings was collected to fill out the questionnaires. Finally, the data were analyzed with SPSS and SAS soft wares. 80% of our patients had NF. The ratio of males to females was calculated as 1.1. The average age for the emergence of the disease was 7.8 years old for tuberous sclerosis, 11.3 years old for NF1 and 59 years old for our only case of NF2. The most common manifestation of these syndromes was Cutaneus Lesions (88.9% in tuberous sclerosis and 100% in NF). Seizure and mental retardation were also common features in tuberous sclerosis with frequencies of 88.9% and 75%, respectively. Paraclinical studies were helpful in diagnosing the 50% of tuberous sclerosis and the8.7% of neurofibromatosis cases.Clinical and paraclinical manifestations of neurocutaneous disorders in this study are similar to other studies in the world.

Hydatid cyst of lungs is mainly diagnosed by imaging procedures such as chest Roentgenogram and chest CT Scan. In endemic area, hydatid cyst may be discovered during the surgery appearing in a form which is not usually identified with typical Hydatidosis of lungs. The objective of this study was to give a description of the most important atypical radiological presentation of lung Hydatidosis. All the patients diagnosed as having pulmonary Hydatidosis through a surgical exploration were included in this study. Standard chest Roentgenograms and computed Tomographies were evaluated before the surgery for diagnosing any lung cyst or unknown lesion. Radiological findings were divided into two categories: 1-Typical Hydatid cysts which have already been described in literature as having imaging presentations such as intact cyst, water lily sign and crescent sign. 2- Atypical Hydatid cysts that do not resemble any feature of typical Hydatid cysts as mentioned above. 1614 subjects who had already been diagnosed with pulmonary Hydatidosis over a period of 28 years went under surgical operations. Seventy nine of them received standard Thoracic CT scan. Atypical cysts were detected in 35% of the subjects that were X-rayed by chest and in 32 of them (40.5%) who received CT Scan. The most frequent chief complaint was coughing as reported by 68 (87%) of the cases. None of the clinical and demographic findings were significantly more frequent in the subjects with atypical Hydatid cyst. The most frequent manifestation illustrated in the radiological pictures was thick cavity wall in 9 subjects (28%). Other findings were as follows: solid mass in 7 (21%), abscess in 6 (18%), consolidation in 3 (9%), fungus ball in 3 (9%), collapse (atelectasis) in 2 (6%) and round pneumonia in 2 (6%). Cavity was significantly more frequently seen in the right lung (90%) and mass like opacity was significantly more frequent in the lower lung field (100%). Hydatid cyst showing atypical features is relatively common; thus, physicians should be cautious about the possibility of Hydatid cyst while evaluating most of the radiological pictures of the lung, no matter what the localization, size and count of the lesion.

Myelopathy due to Human T Lymphocyte virus Type 1or Human associated myelopathy (Tropical Spastic paraparesis) is one of the clinical manifestations of this virus which is endemic in specific areas including the North-Eastern part of Iran. The aim of this case- control study was to evaluate the neurological symptoms and signs among patients who had already been identified as affected by the virus.The patients’ family background and medical history in terms of HTlV1 infection were evaluated. In addition, through administrating a laboratory investigation, sensory examination was used to detect any pain, vibration and/or priprioception in both upper and lower extremities. The evaluation of motor system was done according to force (0 to 5 on the basis of Medical Research Council Power Classification) and tonicity (based on the Modified Asworth Scale). Deep tendon reflexes as well as sphincter complaints were also investigated.Among 15 cases (3 males, 12 females), the average age was 50.6±16.5 years. The average duration of symptomatic was found to be 5.6±4.1 years. Two patients reported to have background history of Htlv1 infection. The most common complaints by the patients were: paresthesia (53.3%), muscular weakness (33.3%) and urination frequency (13.3%). None of the patients had atrophy. Symmetrical increase in tonicity was detected in both extremities; however, it was predominant in the lower ones (P=0.02).Urinary complaints may be the first clinical presentation of HAM/TSP. The most common sensory sign in our patients was paresthesia. We suggest that all the patients with problems in symmetric sensory and/or motor system who are especially at risk of being exposed to HTLV1 infection as well as those who complain about urinary problems should be checked for HAM/TSP.

Dementia is basically the disease of old people which is usually caused by a primary degenerative lesion or by a structural disease in the brain. In terms of etiology, dementia is associated with reversible and irreversible causes. Determination of the underlying causes of dementia may facilitate its treatment and prognosis. The purpose of this study is to evaluate clinical and paraclinical symptoms of dementia as well as to determine the most common causes. This is a cross sectional descriptive study on 100 patients with dementia who referred to Shahrivar 17th Hospital in Mashhad. First, the patients who were diagnosed as being infected by dementia were evaluated according to DSM-IV criteria. They were also enrolled in history taking and physical examinations as well as paraclinical managements like EEG, CT Scan and MRI. The obtained data were then recorded down in the questionnaires. 36% of the patients were females and 64% were males. Of this population, 43% had Alzheimer Disease (AD), 40% had Vascular Dementia (VaD), 9% Parkinson disease (PD) and 8% had other types of dementia while there was no case of Ferontotemporal dementia (FTD). HTN, DM and Hyperlipidemia were found to have a fully significant effect on VaD. 100% with the history of TIA and 88% with the history of CVA had VaD which was meaningful, too. 55% of the VaD patients were identified with Gait disorder and 65% with Incontinence which is ststistically significant. Based on the results of MRI and CT Scan, 100% of the AD patients, 47.5% of the VaD patients and 88.9% of the PD patients were identified with cortical atrophy. In addition, it was found that hypocampus atrophy was present in 53.5% of the patients with AD and in 15% of the patients with VaD. In 90% of the VaD patients, hypodense foci was observed which is statistically significant, too.As the findings of the study suggest, the results of CT Scan and MRI was notably related to the type of dementia. Thus, it seems that using these two techniques can determine the existence of dementia in the early stages which can help with improving the quality and quantity of life in these patients. According to the frequency rate of VaD in our patients, it seems that the lack of or poor control of the risk factors like HTN, DM and hyperlipidemia can lead to the high frequency rate of vascular dementia.

The incidence of End-Stage Renal Disease (ESRD) varies markedly according to the age, race and sex of the population as well as the geographical characteristics of the place where they live. Low socio-economic status is associated with the occurrence of several different chronic diseases, but evidence regarding renal disease is scant. This study was performed to determine the relationship between the level of patient’s family education and income with the etiology of ESRD.A cross sectional study was conducted on 62 patients (30 Boys and 32 Girls) with chronic renal failure who were under dialysis treatment. A control group consisting of 400 students was also enrolled in the study. Socioeconomic data were obtained from both groups by using a questionnaire. Meanwhile, the cause of renal failure and the kind of dialysis were also determined for the patients. Socioeconomic features were compared in both the patients and the control group by using student T-Test, Chi-square, Fisher Exact Test and logistic regression analysis. In the dialysis group, there were remarkably more children from families with either one parent or without any supervisor, as compared with the control group)P<0.001). The level of family education in the dialysis group and control group was 10.6 and 13.3 years of schooling, respectively (P<0.001). Dialysis patients were either tenants or were living in houses smaller than the control group’s (P<0.001). In addition, the household’s monthly income for the case group was lower than that of the control group and only 3% of the patients were living in the socioeconomic areas of high classes (P<0.001).The dialysis patients’ families had lower socioeconomic level in comparison with the healthy population. The high prevalence of ESRD in these families may be related to the lack of access to hygienic facilities, the parents’ lack of sufficient knowledge and inattentiveness which may lead to delayed diagnosis of the disease, and incomplete treatment of the primary disease which may, in turn, develop ESRD.

Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties (e.g. difficult intubations, aspiration pneumonia, and analgesic side effect) in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine’s Alfa adrenergic is dominant. This study aimed at investigating the potential hemodynamic effects of adding Epinephrine to lidocaine during spinal anesthesia on expecting mothers who are candidates of caesarean section.This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387. The subjects of the study were divided into two groups, (1) and (2) on the basis of the randomized digital table as follows: Group 1:80 mg lidocaine 5% +2 micro gram sufentanil Group2: 80 mg lidocaine 5% +2 micro gram sufentanyl + 0.2 mg (0.2cc) Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded.According to the findings in this study, there werent any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There werent any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there werent any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There werent any significant differences in SPO2 and side effects (nausea, vomiting, dysphagia, respiratory disorder, shivering) between the two groups.Adding Epinephrine to Lidocaine 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of hemodynamic and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of hemodynamic in this group is essential.

Eye trauma is a common cause of one-sided blindness in children and teenagers. Blunt trauma can cause rupture of orbital cavity and the herniation of its content may affect the nearby sinuses leading to hemorrhage in the anterior chamber (hyphema).Traumatic hyphema that specially happens in the eyes with blunt trauma can be followed by high infra ocular pressure, corneal staining, cataract, injury of the optic nerve and sever loss of visual acuity (VA). Early diagnosis and treatment of this complication can prevent the later and worst complications. The aim of this study is to determine the prevalence of traumatic hyphema and its complications in eye blunt trauma.According to a cross- sectional descriptive protocol, we studied 83 patients with eye blunt trauma who referred to the eye clinics of Bahman 22nd and Farabi hospitals. A formal questionnaire was designed to be completed for personal particularities of each patient as well as the information about the examinations of orbit, cornea, AC, lens and optic nerves. In addition, the Intraocular Pressure (IOP) and initial VA were recorded. Then we analyzed these records and evaluated the prevalence of hyphema and its complications in eye blunt trauma. This study shows that hyphema is a common complication of eye blunt trauma that occurs in approximately 50% of the patients with eye blunt trauma. 36.1% of the patients were in the age group of 20-40 years old with an average age of 36.7 years. There were 65.9% males and 34.1% females. The most common causes of trauma included projectiles (48.8%) and assaults (36.6%). The most common associated symptoms with hyphema included red eye (56.09%) and dark vision (48.7%).The most frequent occurring complications included sever decrease of initial VA (75.6%) and high IOP (48.8%). Hyphema is a common complication of eye blunt trauma that may lead to other complications like sever loss of VA and high IOP. So, thinking of and searching for hyphema in any patient with eye blunt trauma can help us to diagnose it at early stages and prevent other complications.