نشریه پژوهش در پزشکی
سال سی و سوم شماره 4 (پیاپی 132، زمستان 1388)

Abstract Loss of active abduction and forward flexion of shoulder in brachial plexus injury (BPI) is a severe disability in daily life and employment. Several methods of tendon transfer, such as Saha, Hartman and Bateman procedure, have been described with a limited function. In this study, 4 cases treated with functioning free Gracilis muscle transplantation for BPI were reported. In this clinical trial, four patients with upper roots of brachial plexus injury treated with functioning free Gracilis muscle transplantation were studied. Patients lower than 40 years and without vascular injury or limitation of shoulder were enrolled in the study. After muscle transplantation, patients had splint for 3 weeks. They received physiotherapy for 4 weeks, and then were followed up to evaluate failure of surgery and active abduction and forward flexion of shoulder for one year. 4 patients with mean age of 31 years were studied. All of them were male. Time to first contraction was 3.4±0.8 months. The mean shoulder abduction and forward flexion due to free Gracilis muscle transplantation was 90◦±14◦ and about 90◦, respectively. It seems that functioning free Gracilis muscle transplantation has satisfactory results on increasing shoulder abduction and forward flexion

Abstract Backgraound: Renal artery stenosis is a cause of secondary hypertension. Regarding known complication of this disease and possible positive effects of renal artery angioplasty on diastolic function, this study performed among patients with renal artery stenosis. This clinical trial, with before and after design, was performed on 35 eligible patients. Patients with renal artery stenosis (70% stenosis alone, or 50% stenosis with uncontrolled hypertension) which underwent stent– supported precutanous transluminal renal angioplasty (PTRA) were evaluated by Doppler echo and tissue Doppler before and six months after angioplasty. Isovolumic Relaxation Time (IVRT), Deceleration time (DT), E/A, E/Ea and diastolic function were studied. Data were analyzed by Wilcoxon test. 35 patients, including 11 male (31.4 percent) and 24 female (68.6 percent), with mean age (± standard deviation) of 59.6±10.2 years were studied. Renal artery angioplasty doesn’t affect on IVRT and E/A, but it decreased DT and E/Ea to 30.9±54.9 milliseconds (p< 0.002) and 0.44±0.9 (p< 0.04), respectively. It seems that renal artery angioplasty doesn’t alter type of diastolic function, but it decreases E/Ea, as a parameter representing diastolic function.

Abstract Regarding to prevalence and complications of no- or mis- diagnosis of premature rupture of membrane (PROM), and also high rate of false positive and negative results of traditional diagnostic methods, this study was designed to evaluate diagnostic values of urea and creatinin values of cervicovaginal discharges in determining of PROM in pregnant women referred to Khatam-ol-Anbia hospital, Gonbad, Iran in 2008. In a clinical trial- diagnostic study, 84 pregnant women with gestational age of 20-41 weeks and chief complaint of watery vaginal discharge were studied. They divided in two groups of PROM (n=42) and intact membrane (n=42) matched by gestational age. Secretions of posterior phornix of vagina were collected by 5 milliliter normal saline. Urea value was measured by enzymatic photometry or urease, and creatinin value was determined by Jaffee synthetic chemical colorimetry. Data were analyzed by descriptive and analytic statistics. Urea value of cervicovaginal secretions in PROM and control groups was 14.7±4.27 and 2.9±1.5 mg/dL, respectively. Regarding to cut-off of 7 mg/dl, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of urea of cervicovaginal discharge was 100 percent in diagnosis of PROM. Creatinin value of cervicovaginal secretions in PROM and control groups was 1.4±0.4 and 0.2±0.1 mg/dL, respectively. Regarding to cut-off of 0.55 mg/dl, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of creatinin of cervicovaginal discharge was 100 percent in diagnosis of PROM. It seems that measuring urea and creatinin of cervicovagal discharge can be used as a simple, new, rapid and reliable method to diagnose premature rupture of membrane in pregnant women

Abstract Recent studies have assessed the validity of glucometer devices in estimating the glucose level of gingival blood during routine periodontal examination (Bleeding On Probing). The purpose of this study was to evaluate whether blood oozing from gingival tissues during routine periodontal examination can be used for determining glucose levels by comparing it with laboratory measurements and standard glucometer method using two different glucometers. 50 patients (27 nondiabetic, 23 diabetic mean age 39/6 ± 11 years), with at least on site of adequate bleeding upon probing, participated in this study. At first the F.P.G test was done in the laboratory, Then the patients were referred to dental department. A site with profuse BOP was chosen for glucose determination. After isolating the appropriate site, probing was performed with Williams probe and then the sensitive tip of the strip was exposed to blood; Consequently, the amount of blood glucose (G.C.B.G) was estimated by the devices. Diagnosis of diabetes by conventional capillary fingerstick blood (C.B.G) and Gingival crevicular Blood glucose (G.C.B.G) techniques were compared with the standard technique of Fasting Plasma Glucose (FPG) and the positive predictive values and the negative predictive values were measured. The positive predictive value of Accu-chek and Elite glucometers were %100 and the negative predictive values were 93 and 90.6 percent respectively. The values also showed a very high intrapatient correlation. The results suggested that gingival crevicular blood glucose measurements by both devices can provide an acceptable blood sample for diagnosis of diabetes. In addition, this technique is safe and easy to perform in dental office for diabetes mellitus screening, but the negative predictive value of G.C.B.G is not clinically acceptable.

Abstract Mannose-binding lectin (MBL) is a constituent of the human innate immune system which may play an important role in combating a variety of infectious diseases and thus may be important for determining hepatitis B virus (HBV) persistence. In this study, we determined MBL genotypes in chronic hepatitis B subjects, spontaneously recovered subjects and healthy controls. In a case-control study, we examined 100 unrelated patients with chronic hepatitis B and 100 spontaneously recovered patients were referred to Taleghani Hospital and 100 healthy controls which all had been matched by sex and age. Genomic DNA was extracted from blood samples and the following genetic polymorphisms were studied by PCR-RFLP two point mutations in the promoter region at position -550(H/L variants),-221 (X/Y variants), one point mutation in the 5' untranslated (UT) region at position +4(P/Q variants) and three point mutations located at codon 52, 54 and 57 in exon 1 of the MBL gene, at nucleotide position 223,230 and 239, repectively. Our finding has shown that the frequency of +223 T allele of Codon 52 in chronic HBV patients was 0/22 and 0/37 in spontaneous recovered subjects, respectively. Our results show that there is no significant association between each polymorphisms of the MBL gene with persistent HBV infection in Studying population excepting codon +52 (p value=0.0). Heterozygous for codon 52 mutant allele (C/T) may be associated with recovery from chronic hepatitis B.

Abstract Backgraound: Regarding to increasingly prevalence of total hip arthroplasty and no information about its results in Akhtar hospital, this study was conducted in patients referred to Akhtar hospital between 1985 and 2005. This study was performed on existing data. Patients records, including age, sex, indication of surgery, applying cement, 10-year survival according to radiologic and clinical evaluation, and Haris Hip Score (HHS), were studied. Patients with at least one-year follow up were evaluated. 10-year survival was calculated and effects of associated factors were analyzed using chi-square or exact Fisher tests. 235 hips from 210 patients with mean age of 55.5±16.8 years were operated. 49 percent were male and 51 percent were female. According to applying or not applying cement, and also type of evaluation (clinical and radiographic), 10-year survival was measured between 60 and 85 percent (p<0.2). HHS was calculated as 78.8±15.7. Surgeon, type of surgery and body mass index (BMI) didn’t affect on therapeutic outcome. Survival rate of total hip arthroplasty was lower in Akhtar hospital compared with other centers and further studies were recommended to find causes of these differences.

Abstract Using dietary pattern analysis method reflects individuals’ dietary behaviors and therefore could provide more detailed information about nutritional etiology of chronic disease like obesity. The aim of this study is to determine major dietary patterns and general and central obesity in adult women living in north of Tehran in 2007. In this cross-sectional study 460 women aged 20-50 y, living in north of Tehran, were sampled with stratified random sampling method. Dietary intake in last year was collected by a semi-quantitative food frequency questionnaire. Weight, height and waist circumstance (WC) were measured with standard methods and body mass index (BMI) was calculated. General obesity was defined as BMI ≥30 kg/m2 and central obesity as WC ≥ 88 cm. Factor analysis method was used for identifying major dietary patterns. The association between major dietary patterns and general and central obesity were assessed by logistic regression analysis. Two major dietary patterns were extracted: Healthy dietary pattern and unhealthy dietary pattern. After adjusting for confounders, individuals in the upper quartile of the unhealthy dietary pattern score were more likely to be generally (OR=3.70, P<0.01) and centrally obese (OR=4.01, P<0.01), whereas those in the upper quartile of healthy dietary pattern were less likely to be generally and centrally obese. Major dietary patterns of the women in this study had the significant associations with general and central obesity. Further prospective investigations are required to confirm such associations.

Backgraound: Regarding to the increasing number of postmenopausal women in the world as well as increased life expectancy about 75 years old and respecting to the various complications due to menopause specially early menopause and on the other hand important role of women in family, this study was conducted to determine the incidence of age of menopausal women living in Tehran in 2005. In this cross-sectional study, 1500 women between 45 and 55 years, living in any of 22 different districts of Tehran, using a multi-stages sampling method in 100 blocks, were randomly selected. Inclusion criteria consist of living in Tehran for at least 10 years, lack of any operation on one or both ovaries or hysterectomy, lacking the history of cancer, cardiovascular diseases, diabetes, hypertension, mental disorders, hospitalization, and hormonal drugs. Data were collected by a questionnaire completed through interview. Content and test-retest methods were used for validity and reliability of the tools, respectively. Demographic data and age of menopause were estimated in samples and community. Factors associated with menopause age were evaluated by SPSS software. T-test, ANOVA and chi-square test were used for data analysis. The results showed the mean age of 49.4±3.4, age at menarche of 13.5±1.6, marital age of 18.9±4.7, primiparous age of 20.6±4.7, the history of lactation of 65.5%, history of taking oral contraceptives of 44.5%, being married of 87.8% and familial history of early menopause of 13.1%. The age of postmenopausal women was 47.13±3.9 years (95%CI: 46.8-50.2 years). The effective factors on menopausal age included smoking, low level of education in the subjects and their spouses, high number of children, long-term consumption of oral contraceptives, ownership of residence, familial history of early menopause. The age of menopause in Iranian women is lower than women from developed counties. Regarding to the limited and controversial knowledge about the related factors with menopausal age, further researches are recommended.

Abstract Backgraound: one of the most severe types of pain is acute postoperative pain. The more severe the pain, the more severe its hemodynamic consequences would be. The aim of this study was to assess the analgesic methods of postoperative pain control in orthopedic surgery patients, in Ayatollah Taleghani Hospital, Tehran, Iran. in a descriptive study, 100 cases undergoing orthopedic surgery were selected and evaluated regarding the severity of postoperative pain and its analgesic methods. A visual Analog Scale was used to assess the pain. Pain severity and its analgesic methods were evaluated. Among 100 patients, 68% did not need analgesic treatment modalities. General anesthesia and spinal anesthesia were the first two common analgesic modalities, respectively. Residual anesthesia was the most common pain control method. the results of this study demonstrated that acute postoperative pain is one of the great concerns, both for the physicians and the patients. This study suggests that more aggressive postoperative pain control is necessary. So, re-evaluation of the pain control methods in the postoperative period is mandatory.

Abstract With respect to the importance of scorpions sting and identification of manifestations and symptoms in traditional and Iranian medicine, the present study was conducted to review of scorpion sting treatment, prevention and control it on basis traditional medicine and, and discuss about deficit of methods of control and prevention. In this review article, we have searched through internet by key words. We have tried to cover almost all scorpion-related sites and journals as well as internal and external references. The references show that background of scorpion sting is as long as the history of Iran. Traditional and Iranian medicine have many views on scorpion sting, treatment and prevention of cases. Planning of prevention, control and treatment program based on traditional and Iranian medicine were suggested by researchers.