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  • ضرغام حسین احمدی، ساویز پژهان، حمیدرضا خورشیدی*، بابک شریف کاشانی، زهرا انصاری اول، حبیب الله امامی، امین نیایش
    زمینه و هدف
    علیرغم پیشرفت های اخیر در روش های درمانی مدیکال و جراحی، الگوریتم درمانی تعریف شده ای برای آمبولی پولمونر ماسیو وجود ندارد. هدف از مطالعه حاضر، گزارش تجربیات ما از جراحی آمبولکتومی پولمونر در بیماران مبتلا به آمبولی ماسیو و حاد شریان ریوی بود.
    مواد و روش ها
    در یک مطالعه مشاهده ای، 15 بیمار مبتلا به آمبولی ماسیو و حاد شریان ریوی مراجعه کننده به بخش کاردیوتوراسیک بیمارستان مسیح دانشوری که بین سال های 85 تا 91 مراجعه و تحت عمل جراحی آمبولکتومی از طریق استرنوتومی میانی و بای پس کاردیو پولموناری قرار گرفته بودند مورد مطالعه قرار گرفتند. اطلاعات به دست آمده با نرم افزار آماری SPSS ویرایش 17 مورد تجزیه و تحلیل آماری قرار گرفت و در موارد مورد نیاز، از آزمون های آماری تی تست و ناپارامتری استفاده شد.
    یافته ها
    میانگین سنی افراد مورد مطالعه، 13/52 سال بود. میانگین فاصله زمانی تشخیص بیماری تا انتقال به اتاق عمل 40/53±53/44 ساعت بود. میانگین زمان بستری در بخش مراقبت های ویژه پس از جراحی 95/9±26/12 روز بود. تنگی نفس در 12 بیمار، درد پلورتیک در 6 بیمار، سرفه در 5 بیمار، هموپتزی در 3 بیمار و ضعف و خستگی زودرس در 2 بیمار وجود داشت. تاکی کاردی در 6/66% و تاکی پنه در 60% وجود داشت. 14 بیمار تحت اکوکاردیوگرافی و 11 بیمار تحت سونوگرافی اندام قرار گرفته بودند. در 9 بیمار سی تی اسکن مولتی اسلایس انجام شده بود. سه بیمار (20%) قبل از جراحی تحت فیبرینولیتیک تراپی قرار گرفته بودند. مرگ در 40% بیماران اتفاق افتاد.
    نتیجه گیری
    با توجه به نتایج مطالعه حاضر، روش آمبولکتومی پولمونر یک روش مناسب با نتایج قابل قبول در درمان آمبولی پولمونر ماسیو حاد می باشد.
    کلید واژگان: آمبولی ماسیو و حاد شریان ریوی، آمبولکتومی، مرگ و میر
    Hossain Ahmadi Z., Pejhan S., Khorshidi H. R.*, Sharif Kashashani B., Ansari Aval Z., Emami H., Niayesh A., Farzanegan R
    Introduction &
    Objective
    Despite recent advances in both medical and surgical treatment strategies, no defined treatment algorithm exists for massive pulmonary embolism (PE). Our objective was to analyze our experience with surgical embolectomy in patients with acute massive pulmonary embolism.
    Materials and Methods
    In an observational study, 15 patients were studied who suffered from acute massive pulmonary embolism. They had visited the cardiothoracic ward of the Masih Daneshvari Hospital and undergone embolectomy, in which the cardiopulmonary bypass technique was used and the median sternotomy surgical procedure was performed, between the years 2006 and 2012. Acquired data were analyzed statistically with the SPSS 17, and T-test and Non parametric test were used whenever was necessary.
    Results
    The average age of the patients was 52.13 years. The average time between diagnosis of the disease and the surgical operation was 44.53±53.40 hours, and the average time spent at the ICU after the operation was 12.26±9.95 days. Twelve patients suffered from short breath, six from pleuritic pain, five from coughs, three from hemoptysis, and two from weakness and premature tiredness. Tachycardia was observed in 66.6 percent of the patients and tachypnia in 60 percent. Fourteen patients had undergone echocardiography and sonography had been performed on 11 patients. Four patients (20%) had undergone fibrinolytic therapy before the operation. Forty percent of the patients died.
    Conclusions
    Results of this study, show that pulmonary embolectomy is a suitable procedure with acceptable results in treating acute massive pulmonary embolism.
    Keywords: Acute Massive Pulmonary Embolism, Embolectomy, Mortality
  • رضا نوری، بهاره محمودیه، ارسلان دمیرچی، فرهاد رحمانی نیا، نادر رهنما، حمید امامی
    زمینه و هدف
    (عوامل رشد شبه انسولین) IGFs و برخی پروتئین های پیوندی آن می توانند سبب رخداد و بازرخداد سرطان پستان شوند. از طرفی، نقش فعالیت های ورزشی ترکیبی بر این عوامل مشخص نیست. از این رو، هدف مطالعه ی حاضر بررسی تغییرات عوامل محور IGF و برخی پروتئین های پیوندی آن در زنان یائسه ی مبتلا به سرطان پستان پس از 15 هفته فعالیت ورزشی ترکیبی است.
    روش بررسی
    بدین منظور 29 زن یائسه ی (با میانگین سن 31/6 ± 27/58 سال) مبتلا به سرطان پستان که جراحی، شیمی درمانی و پرتودرمانی دریافت کرده، در حال حاضر تحت هورمون درمانی بودند، به دو گروه تجربی و شاهد تقسیم شدند. گروه تجربی به مدت 15 هفته و هر هفته 4 جلسه (2 جلسه پیاده روی و 2 جلسه تمرین مقاومتی) به تمرین پرداختند. در این مدت گروه شاهد در هیچ برنامه ی فعالیت ورزشی یا بدنی شرکت نکردند. داده ها با استفاده از آزمون ANCOVA تجزیه و تحلیل شدند (05/0P≤).
    یافته ها
    فعالیت ورزشی ترکیبی بر مقادیر IGF-1 (001/0P=) و IGFBP-3 (0001/0P<)، نسبت مولار IGF-1 به IGFBP-3 (0001/0P<) زنان یائسه ی مبتلا به سرطان پستان به طور معنادار اثر داشت. پس از 15 هفته، مقادیر IGF-1 در گروه تجربی 9 درصد کاهش و مقادیر IGFBP-3 28 درصد افزایش یافت. این نوع فعالیت نتواست تغییرات معناداری در مقادیر IGFBP-1 این افراد ایجاد کند (652/0P=).
    نتیجه گیری
    به دلیل این که عوامل محور IGF و برخی پروتئین های پیوندی آن، نقش مهمی در ابتلا به سرطان پستان و بازرخداد آن ایفا می کنند، احتمالا تعدیل این عوامل توسط فعالیت ورزشی ترکیبی بتواند بازرخداد سرطان پستان را به تعویق بیندازد.
    کلید واژگان: فعالیت ورزشی ترکیبی، سرطان پستان، زنان یائسه، IGF، 1، IGFBP، 3
    Nuri R., Mahmudieh B., Damirchi A., Rahmani Nia F., Rahnama N., Emami H.
    Background And Objective
    IGFs (Insulin-like growth factors) and some binding proteins can cause occurrence and recurrence of breast cancer. Since the role of combined exercise training on these factors is not clear, therefore, the aim of this study was to look at the changes of IGF axis and some binding proteins in postmenopausal women with breast cancer after 15 weeks of combined exercise training.
    Materials And Methods
    Twenty- nine women with breast cancer (58.27 ± 6.31 years) who underwent surgery, chemotherapy and radiation- therapy with current hormone therapy were divided into two groups of experimental and control. Subjects of the experimental group performed 15 weeks of combined exercises including walking (2 sessions per week) and resistance training (2 sessions per week that differed from walking days). Data were analyzed by using ANCOVA (p≤ 0.05).
    Results
    Combined exercise training had significant effect on IGF-1 levels (P= 0.001), IGFB-3 levels (P= 0.000) and IGF-1: IGFB-3 (P= 0.000) in postmenopausal women with breast cancer. After 15 weeks, IGE -1 reduced in the experimental group up to 9 percent and IGFB-3 increased by 28 percent. On the other hand, exercise training had no significant effect on the IGFB-1 (P= 0.652) in postmenopausal women with breast cancer.
    Conclusion
    While the IGF axis factors and some binding proteins play an important role in breast cancer and its recurrence, it seems that changes in these factors through combined exercise training programs can delay its recurrence.
    Keywords: Combined exercise training, Breast cancer, Postmenopausal women, IGF, 1, IGFBP, 3
  • Rezaei H., Motovali, Bashi M., Khodadad K., Elahi A., Emami H., Naddaffnia H
    This study has examined the relationship between the XPD Lys 751 Gln polymorphism and colorectal cancer in 88 patients and their 88 age and sex-matched controls. Genomic DNA from peripheral whole blood was extracted using standard method to determine the genotype of subjects with RFLP-PCR analysis. Although this study shows cancer patients harbor more heterozygous genotype (XPD Lys 751 Gln) (OR=1.33, CI: 0.679-2.620 and less wild genotype (Lys751 Lys) compare to control group. However, it is not statistically significant (P = 0.406). Furthermore, colorectal cancer was less common in individuals with recessive homozygous genotype (OR=0.097, CI: 0.032-0.297; P= 00.000). Notably, in our study colorectal cancer was more frequent in male gender, elder people compared younger people and individuals with positive colorectal cancer in their first relatives (OR=4.5; CI= 2.010-10.044, P=0.000).
    Keywords: Colorectal cancer, Nucleotide excision repair, XPD gene, polymorphism
  • Babazade Sh, Emami H., Amouheidari Ar, Roayaei M. Hassanzade A., Akbari A
    Background
    To compare the cosmetic results of whole breast radiotherapy between cobalt 60 and photon 9MegaVolt in patients underwent breast conserving surgery.
    Methods
    The patients with breast saving surgery who were treated by whole breast radiotherapy with either cobalt 60 or photon 9MV between 2001-2006 in Sayed-al-Shohada hospital entered the study. The cosmetic results were evaluated by an expert radiation oncologist with definite criteria.
    Results
    Frothy patients in cobalt 60 group and 43 patients in photon group were compared, with median follow up of 40.5 months. The patients in photon group had less telangectasia and discoloration (p=0.018 and p=0.01, respectively). The consistency of breast in photon group was better (p=0.019), but for fibrosis the difference was not statistically significant (p=0.055).Overall cosmetic results in photon group was much better rather than cobalt 60 group (p=0.005). No recurrences were observed in both groups.
    Conclusion
    Cosmetic results in group with photon 9MV were superior to cobalt group, but the effect of these two beam energy on disease free survival (DFS) and /or overall survival (OS) should be in more consideration.
  • Heydari Ghr, Marashian M., Emami H.
    Background
    Treatment for tobacco dependency involves a combination of behavioral therapy, antidepressants, and nicotine replacement therapy. This study was conducted in order to compare the outcome of smoking cessation by using each of the four forms of nicotine replacement therapy (NRT) among participants using Trazodone tablet 50 mg.
    Materials And Methods
    In this non-randomized quasi-experimental study the efficacy of four mentioned forms of nicotine replacement therapy (NRT) including patches, gums and microtabs and two forms of NRT together was evaluated. Smoking cessation while using Trazodone was also studied. All the smokers who referred to the smoking cessation clinic of Iranian National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran from Oct. 2005 to Oct. 2007 entered the study. They attended 4 weekly sessions followed by 2 sessions in the next 12 months.
    Results
    A total of 286 subjects participated in this study. Trazodone was prescribed for them and 253 used at least one form of NRT. There were 181 (74.6%) males. The mean age was 42.43±13.4 yrs.Thirty three cases selected nicotine patches, 99(39.4%) used nicotine gums, 64(25%) chose microtabs and 57(23%) preferred using two types of NRT simultaneously. A total of 152 participants (60%) quit smoking at the fourth session. At the fourth session, it was proved that nicotine patches had the highest success rate and were most efficient for quitting smoking (94%). Also, after 6 and 12 months follow-up it was found that nicotine patches were most effective for abstinence.
    Conclusion
    Nicotine patches used in combination with Trazodone tablets could result in higher success rates for smoking cessation. (Tanaffos2010; 9(3): 50-57
  • ابوالفضل نیک فرجام، پروانه شکرانی، حمید امامی، شهرام منادی، الهام گنجعلی خان حاکمی
    زمینه و هدف

    لزوم وجود برنامه های دوره ای کنترل کیفیت در آنکولوژی تابشی توسط سازمان های مختلفی نظیر AAPM، ACR، ACMP و ESTRO توصیه شده است. یکی از بهترین روش های انجام کنترل کیفیت انجام دزیمتری in vivo در حین پرتودرمانی می باشد. این مطالعه به منظور طراحی پروتکلی ساده برای دزیمتری in vivo در پرتودرمانی تومورهای سر و گردن با استفاده از تصویربرداری پورتال انجام گردید.

    روش بررسی

    در این مطالعه Case Series دز خط میانی به صورت in vivo و همراه با تصویربرداری پورتال روی 19 بیمار مبتلا به تومورهای سروگردن تحت درمان با دستگاه کبالت-60 مراجعه کننده به بخش پرتودرمانی بیمارستان سیدالشهداء اصفهان طی ماه های مرداد و آذر 1386؛ اندازه گیری شد. توزیع دز ورودی و خروجی با استفاده از دو دیود و نسبت های خارج از محور و تصویربرداری پورتال به همراه کد کاربری نوشته شده به زبان MATLAB برای تبدیل شدت نوری فیلم به دانسیته نوری تعیین گردید. با استفاده از مقادیر دز ورودی و خروجی و با به کارگیری الگوریتم هوسکین، دز در طول خط میانی در فواصل یک سانتی متری به دست آمد.

    یافته ها

    دز خط میانی در 165 نقطه اندازه گیری شد. میانگین و انحراف معیار بین دز اندازه گیری شده و دز تجویز شده در حدود 3.61+-4.27 درصد به دست آمد. همچنین در 110 نقطه (66.66 درصد) میزان انحراف کمتر از 5درصد (1.37+-2.27)، در 41 نقطه (24.84 درصد) بین 5 درصد و 10 درصد (1.2+-6.51) و در 14 نقطه (8.48 درصد) بیش از 10 درصد (2.34+-13.37) تعیین گردید. بیشترین و کمترین میزان انحراف به ترتیب در مرکز میدان درمان (1.63+-2.6) و در فاصله 5 سانتی متری از مرکز میدان (4.86+-7.24) و برای میدان هایی با ابعاد 14 سانتی متر (3.53+-5.08) و 8 سانتی متر (2.13+-2.95) محاسبه شد.

    نتیجه گیری

    این مطالعه نشان داد که استفاده از آشکارساز پورتال به همراه دو دیود روشی ساده و دقیق برای کنترل کیفیت روزانه درمان در پرتودرمانی می باشد. داده های به دست آمده از این روش را برای بررسی دقت مراحل درمان شامل تعیین خروجی ماشین درمان، کنترل کیفیت سیستم طراحی درمان و صحت محاسبات و تنظیم بیمار می توان مورد ارزیابی قرار داد.

    کلید واژگان: تومور سر و گردن، کنترل کیفیت در پرتودرمانی، تصویربرداری پورتال، دزیمتری in vivo
    Nickfarjam A., Shokrani P., Emami H., Monadi S., Ganjalikhan Hakemi E
    Background And Objective

    Several organization such as AAPM (American Association of Physicist in Medicine), ACR (American College of Radiology), ACMP (American College of Medical Physics) and ESTRO (European Society for Therapeutic Radiology and Oncology) recommended the need for periodic quality control procedure in radiation oncology. One of the best methods for quality control is in vivo dosimetry, while radiotherapy is performed. The aim of this study was to design and optimiz a protocol for the quality control of radiation treatment of patients with head and neck malignancy.

    Materials And Methods

    In this case series study midle line dose was measured in vivo in conjunction with portal imaging in 19 patients that were treated using a Co-60 unit, in August and December 2007. Distribution of entrance and exit dose was determined using two diodes, off axis ratios and portal imaging together with a user code written in MATLAB. User code was applied to convert optical intensity of portal film to optical density. Midline dose was calculated in one centimeter intervals using entrance and exit dose with the Huyskens algorithm method.

    Results

    The midline dose was calculated in 165 points. The mean and standard deviation between measured and prescribed dose was about 4.27±3.61%. In 110 points (66.66%), the deviation was less than 5% (2.27±1.37), in 41 points (24.84%) the mean deviation was between 5 and 10% (6.51±1.2) and in 14 points (8.48%) mean deviation was more than 10% (13.37±2.34). The maximum and minimum deviations were found in center of the field (2.6±1.63) and 5cm away from center of the field (7.24±4.86) respectively. Maximum and minimum deviations correspond to the equivalent field of 14cm2 (5.08±3.53) and 8cm2 (2.95±2.13) respectively.

    Conclusion

    This study showed that using a portal detector in conjunction with two diodes is a simple and accurate method for daily quality control in radiotherapy. The data is acquired in this way can be used for evaluating the accuracy of treatment steps including determination of output of a treatment machine, quality control of a treatment planning system and precision of calculations and patient setup.

  • Sharifi H., Heydari Gh, Emami H., Masjedi Mr
    Background
    Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking.
    Materials And Methods
    A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people.
    Results
    Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week.
    Conclusion
    Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard.
  • Air Pollution Status and Cardiorespiratory Admissions in Tehran
    Khalilzadeh S., Khalilzadeh Z., Emami H., Masjedi Mr
    Background
    Air pollution is a major horror in many cities in Iran especially in Tehran. The cost of traffic congestion in the capital is put at two billion hours of time wasted each year. Tehran has also recorded SO2 levels four times the standard prescribed by the World Health Organization. Tehran is the capital of the Islamic Republic of Iran with almost 11 million inhabitants (one sixth of the country’s population), and is the most densely populated city of the country. The purpose of this research was to investigate the effects of air pollution on cardiorespiratory system. We assessed the relationship between the levels of air pollutants and emergency visits for asthma and cardiovascular diseases in Tehran, Iran. Two research questions investigated in this study were as follows: a) Which criteria elements of hazardous toxic air pollution were associated most strongly with the level of hospital admissions for cardiorespiratory conditions? b) What proportion of the variation in hospital admissions for cardiorespiratory conditions was explained by variations in levels of air pollution?
    Materials And Methods
    During a 12-month period (from April 2004 to March 2005), the concentrations of 5 air pollutants (CO, NO2, O3, SO2 and PM10) were measured in four stations located in north, west, south and central part of Tehran. The level of air pollution was calculated according to PSI (Pollution Standard Index).
    Results
    Based on the results obtained during the study period, concentration of CO was reported as “above standard” on most of the days, leading to an “unhealthy” situation. 51.9% of measurements were made at PSI≤100 and standard conditions. 34.7% of measurements were at “unhealthy” levels with PSI= 101- 200. 13.2% of measurements were in “very- unhealthy” conditions with PSI= 201- 300. and 0.2% of measurements were recorded in one station and in a “hazardous” condition with PSI>300. For ozone (O3), all measurements were at standard conditions, PSI≤100. The concentration of SO2 on most of the days was at “standard” condition. Only 6% of the measurements (2 samples) were at “unhealthy” or “hazardous” levels, PSI=101-200.Regarding particulate matter (PM10), all samples were evaluated as 88.7% of the measurements were at standard conditions with PSI≤100 while 11.3% of the measurements showed “unhealthy” condition with PSI=101-200.
    Conclusion
    It was observed that carbon monoxide and particulate matter were the main air pollutants in Tehran that had levels higher than standard values. The results showed that the number of admissions because of cardiopulmonary complaint was positively correlated with concentration of all studied pollutants except for ozone (O3). The main source for these air pollutants was motor vehicles. It is notable that atmospheric condition along with geographical situation of Tehran help augment the air pollution in this city. Thus, in addition to encouraging the use of CNG as the combustion material for cars, buses and minibuses, other extensive measures should be implemented in this regard.
  • Salek S., Salek S., Emami H., Masjedi Mr, Velayati Aa
    Background
    After Sistan and Balouchestan, Golestan province is ranked second in terms of TB prevalence in Iran. Therefore, a 5-year study was conducted to evaluate the alterations of TB epidemiologic indices in this province.
    Materials And Methods
    This was a trend study. All patients suffering from various forms of pulmonary tuberculosis (smear positive, smear negative, extrapulmonary and miliary) during 1999-2003 in Golestan province were studied. Alterations of TB epidemiologic indices were evaluated by using Chi-square test.
    Results
    Out of a total of 3,417 registered TB patients during 1999-2003 in the Center for Communicable Disease Control in Golestan, 2,773 (81%) were available and entered the study; 47% were male. 62.7% of patients had smear positive, 16.4% had smear negative, 20.7% had extrapulmonary and 0.1% had miliary tuberculosis. The overall incidence of all forms of TB during the study period was 36 in 100,000 and no significant difference was detected while assessing the alterations of this index during the study period. Incidence of TB had an increasing trend among children; its prevalence among 0-14 year old females was higher than males during the study period.
    Conclusion
    Although Golestan province is not adjacent to the provinces with high TB prevalence, it is ranked second in terms of incidence and prevalence of TB and various factors such as immigration can affect TB epidemiologic indices. An independent study is required to evaluate the distribution of TB among different ethnic groups. (Tanaffos
  • Emami H., Saber Ashkzari M., Naseri Gh, Aghaei B., Soha Rezaei Shiraz A., Masjedi Mr
    Background
    Generally, non-smokers have healthier lifestyles compared to smokers. Typical foods eaten more by non-smokers are fruits and vegetables, whereas smokers eat more meat and fat and drink more alcoholic beverages. We aimed to compare nutritional knowledge, attitude and practice (KAP) of smokers participating in smoking cessation clinics with their non-smoker family members.
    Materials And Methods
    Two hundred twenty-six smokers and 260 non-smokers aged 18 years and over were compared in a cross-sectional study. A Likert type KAP questionnaire including 36 items was used. Knowledge and attitude scores were compared between smokers and non-smokers using the Mann-Whitney test. Practice patterns were compared by the Chi-square test. Differences were significant at p =0.05.
    Results
    The mean age of male smokers and non-smokers were 38.5±11 and 33.5±14 years respectively and in women these rates were 42±10.4 and 31.3±15 yrs. respectively (p<0.0001). In males, the mean percentage of knowledge in non-smokers was higher than smokers (2.41 vs. 1.85) and the average score of attitude in smokers was less than that of non-smokers (37.5 vs. 37.9; the differences were not significant). Sixty (26.5%) smokers and 93 (35.8%) non-smokers reported having regular physical activity (p=0.005). In women, the mean percentage of knowledge in non-smokers was higher than smokers (3.37 and 2.93 respectively; the difference was not significant). Attitude score of female non-smokers was higher than smokers (40.3 vs. 37.1; p=0.001). Among female non-smokers, 68 (46.9%) reported daily meat consumption; this rate for female smokers was 41 (56.2%; p=0.001). Female non-smokers consumed daily breakfast more than female smokers (107, 73.8% vs. 35, 47.9%; p=0.001).
    Conclusion
    Our data showed a significant difference in nutritional KAP between smokers and non-smokers.
  • سلماز سالک، سالک سالک، حبیب امامی
    مقدمه و اهداف
    نظر به اینکه کودکان از نظر ابتلای به سل جزء اقشار آسیب پذیر جامعه هستند و میزان بروز سل در کودکان به نوعی نشانگر وضعیت سل در جامعه است، لذا مطالعه حاضر با هدف بررسی روند تغییرات شاخص های اپیدمیولوژیک سل در کودکان انجام شد.
    مواد و روش ها
    مطالعه حاضر از نوع Trend Study بوده و تمامی بیماران مبتلا به یکی از اشکال مختلف سل ریوی اسمیر مثبت، منفی و خارج ریوی از کل ایران که در محدوده سنی زیر 14 سال قرار داشتند طی سالهای 84-1371 وارد مطالعه شدند و با استفاده از تست X2 روند تغییرات شاخص های اپیدمیولوژیک سل بررسی شد.
    نتایج
    تعداد 6168 بیمار مبتلا به سل مورد بررسی قرار گرفتند. از این تعداد 2528 نفر(1/40%) پسر و بقیه دختر بودند. بیماران بر اساس شکل بیماری به سه گروه سل ریوی اسمیر مثبت 1812 نفر(4/29%)، سل ریوی اسمیرمنفی 1920نفر(1/31%) و خارج ریوی 2449 نفر(7/39%) تقسیم شدند. میزان بروز سل ریوی اسمیر مثبت از 8/0 در صد هزار در سال 1371 به 2/0 در صد هزار در سال 1384 کاهش پیدا کرده است. میزان بروز سل ریوی اسمیر منفی، خارج ریوی و کل موارد نیز طی سالهای 84 – 1376 کاهش داشت. از نظر سنی نیز کل بیماران در سه گروه سنی 4-0 و9-5 و14-10 سال به تفکیک جنسیت مورد بررسی قرار گرفتند. در تمامی سال های مورد مطالعه در گروه سنی 4-0 و9-5، سال تفاوت چشمگیری از نظر ابتلای به سل در بین دخترها و پسرها مشاهده نشد ولی در گروه سنی 14-10 سال، میزان بروز در دخترها بیش از دو برابر پسرها بود.
    نتیجه گیری
    طی دوره 14 ساله مورد مطالعه، میزان بروز سل ریوی اسمیر مثبت به میزان چهار برابر کاهش نشان داد. این میزان کاهش می تواند نشانگر افزایش آگاهی، در ارتقاء بهداشت و موثر بودن برنامه ملی کنترل سل کشوری باشد. در کودکان زیر ده سال میزان ابتلا به سل نزد دو جنس دختر و پسر تفاوت محسوسی ندارد. با شروع دوران بلوغ جنسی، دختران بیشتر از پسرهای هم سن خود به بیماری سل مبتلا می شوند. با توجه به نتایج بدست آمده به منظور یافتن پاسخ برای اختلاف توزیع جنسی سل کودکان در سنین بلوغ بر ضرورت انجام بررسی های بیشتر دراین مورد تاکید می شود.
    کلید واژگان: سل، کودکان، جنسیت، اپیدمیولوژی
    Salek So, Salek S., Emami H
    Background and Objectives
    Children are highly vulnerable to TB and childhood tuberculosis is a sign of TB transmission in community. This study aimed to determine the epidemiologic trend of this disease in Iranian children.
    Method
    A Trend Study was conducted to evaluate all Iranian patients aged below 14 who had been diagnosed with pulmonary or extrapulmonary TB from 1992 to 2005. Statistical relationships were tested using chi square tests (c²) and the software package SPSS (version 11.5).
    Results
    Out of the 6168 cases studied, 2528 (40.1%) were boys. Patients were assigned to three groups based on disease type: there were 1812 (29.4%) sputum- positive, 1920 (31.1%) sputum-negative, and 2449(39.7%) extrapulmonary cases.The incidence of sputum-positive TB declined from 0.8 per 100000 in 1992 to 0.2 per 100000 in 2005. A similar declining trend was observed for the overall TB incidence and in the incidence of sputum-negative and extrapulmonary cases. There was significant difference in TB incidence between girls and boys in the 10-14 year age group (P<0.001), but no sex difference was observed in 0-4y and 5-9y age groups.
    Discussion
    The incidence of sputum-positive TB decreased by 75 percent over the study period. This could be partly due to improvements in health status, better disease knowledge and the effects of Iran's National TB Control Program.
    Conclusions
    In children aged below 10 years, there was no significant difference in the incidence of tuberculosis between girls and boys. At puberty, the incidence of all types of TB was higher in girls. Based on these findings, further studies are needed to elucidate the gender distribution of childhood tuberculosis in Iran.
    Keywords: Iran, Tuberculosis, Children
  • Emami H., Aqdasi M., Asousheh A
    Background and
    Purpose
    As in many countries, Medical Education (ME) is offered in three levels including Undergraduate ME, Graduate ME, and Continuing ME. Informtion tehnology development has provided a suitable chance for ME. E-learning in ME is growing more and more. The present study seeks to determine the key success factors (KSF) in E-learning in medical fields.
    Methods
    KSF has been scrutinized in the literature following of which, and due to similarity, a classification with seven groupings was established including institutional factor, technology, interested parties, information knowledge, methods and approaches educational resources, and environmental factors. Through a questionnaire, the data were gatered from the information technology (IT) directors in all medical universities throughout the country. The data collected were subjected to factorial analysis. Data from heads of educational groups were obtained through focus group discussion. Cronbach reliability coefficient was calculated for questionnaire used. Factorial analysis was used to identify meaningful KSF. T-Test, and one-way variance analysis as well as Pearson’s correlation were used. The analysis was conducted with SPSS software
    Results
    The results showed no significant differences between age, sex, career, and level of education, and KSF. The preparedness factors were analyzed through group discussions with the heads of the academic departments under the study. By factorial analyses, five factors were found including the departmental interest and potential (27.3%), task performance potential (25.1%), E-teaching development in basic and clinical sciences, and continuing education (20.1%), suitable cultural environment (16.8%), and infrastructures (10.8%). Fisher Exeact Test was used to compare the obtained ratios in 5% curve whose results showed that among the three factors including legal and technocal environment, specialized hardwareand software, and high speed internet, performance interest and potentials showed a significant difference (p=0.002). A p=0.011 was found for the authorities’ interest and financial and non-financial rewards. No other significant differences were found anywhere else.
    Conclusion
    Our results showed that sex, age, career, work has no relation with KSF which means that if other factors such as technology, organizational and financial preparedness, curriculum content, human resources, teaching methods, standards, literacy, communications systems, trainers and learners, environment and culturewere ready motivated person can experience success in e learning in medicine
  • سالک سالک، محمدرضا مسجدی، سلماز سالک، حبیب امامی
    مقدمه و اهداف
    استان گلستان هر ساله، بعد از سیستان و بلوچستان به عنوان دومین استان پرشیوع کشور از نظر بیماری سل گزارش می شود. این مطالعه با هدف بررسی میزان بروز سل در قومیت های مختلف ساکن استان گلستان انجام شد.
    روش کار
    در مطالعه ای توصیفی، تمامی بیماران مبتلا به یکی از اشکال مختلف سل ریوی اسمیر مثبت ومنفی، خارج ریوی و ارزنی طی سال های 1382-1378 در استان گلستان مورد مطالعه قرار گرفتند و میزان بروز همه اشکال سل در قومیت های مقیم استان مورد مقایسه گردید.
    نتایج
    تعداد2773 بیمار سلی ثبت شده بین سالهای 1382–1378 در مرکز مبارزه با بیماری های واگیر استان گلستان قابل دسترسی بودند که وارد مطالعه شدند. 47% آن ها مرد و بقیه زن بودند. بر اساس نوع بیماری، 7/62% بیماران، سل ریوی اسمیرمثبت، 4/16% اسمیر منفی، 7/20% خارج ریوی و 1/0% ارزنی بودند. به طور کلی میزان بروز تمامی اشکال سل طی مدت مطالعه 36 مورد در صدهزار نفر بوده که روند تغییرات این شاخص طی مدت مطالعه اختلاف آماری معنی داری را نشان نداد. نظر به توزیع سل در قومیت های این استان، سیستانی ها و بلوچ ها با مجموع تنها 20% کل جمعیت استان، بیش از 50% کل موارد سل این منطقه را به خود اختصاص دادند. میزان بروز سل در سیستانی ها، 10 برابر ترک و کردها، 6 برابر فارس ها، 4 برابر ترکمن ها و 5/2 برابر افغانی های این منطقه بود.
    نتیجه گیری
    میزان بروز سل نزد قومیت های مختلف استان گلستان تفاوت چشمگیری داشت و سیستانی ها بیش از همه اقوام ساکن در این منطقه مبتلا به بیماری سل شدند.
    کلید واژگان: ایران، سل، گروه قومی، اپیدمیولوژی
    Salek S., Masjedi Mr, Salek S., Emami H.
    Background and Objectives
    Over the last few years, the province of Golestan has ranked second among all Iranian provinces in terms of TB prevalence after Sistan and Balochestan. The present study was done with the aim of evaluating the incidence of TB among different ethnic groups residing in Golestan.
    Methods
    In a descriptive study, all TB patients including sputum smear-positive and negative, extra-pulmonary, and milliary cases were evaluated from 1999 to 2003. The incidence of all types of TB was compared among different ethnicities in the province.
    Results
    Forty-seven percent of the 2773 cases registered for Golestan Province in the Communicable Disease Control Center from1999 to 2003 were male. As regards the type of disease, 62.7% of the cases were sputum smear-positive, 16.4% were smear-negative, 20.7% had extra-pulmonary disease, and 0.1% were milliary TB cases. The incidence rate of all types of TB was 36 per 100000 population and the rate did not show any significant changes over the study period. As for the ethnic distribution of the cases, more than 50% of all TB cases were observed among Sistanis and Baluches, who together account for only 20% of all Golestan residents. The incidence in Sistanis was ten times that in Turks and Kurds, six times that in Persians, 4 times the rate in Torkamans, and 2.5 times that in Afghans living in the same region.
    Conclusions
    The incidence rate of tuberculosis was significantly different among various ethnicities of Golestan province, being highest in Sistanis.
  • Fiberoptic Bronchoscopy: Correlation of Cytology and Biopsy Results
    Mohammad Taheri Z., Mohammadi F., Karimi Sh, Jabbar Darjani Hr, Seyfollahi L., Emami H., Bahadori M., Masjedi Mr
    Background
    Fiberoptic bronchoscopy is a diagnostic method for respiratory diseases. At present, its diagnostic yield has been increased by different cytologic and histologic procedures by convention.
    Objective
    This study was conducted to evaluate the concordance and agreement between cytologic and histologic findings in conventional diagnostic bronchoscopic methods (washing and biopsy) for lung malignancies.
    Materials And Methods
    This was a cross-sectional study performed on 2076 cases of bronchial biopsy and bronchial washing between 1996 and 2003.
    Results
    Of 2163 patients who underwent fiberoptic bronchoscopy after omitting 87(4%) cases due to unsatisfactory specimens, 2076 cases were studied including 832 (36.9%) females and 1244 (63.1%) males in the age range of 2 to 100 years, (mean age 57.7±16.3 yrs). Male to female ratio was 1.5. Malignancy was diagnosed in 657(31.6%) biopsy and 283(13.6%) cytology specimens. Two hundred and sixty-five cases had malignant lesions according to both bronchial biopsy and bronchial washing; therefore, Kappa coefficient in both methods was 46.7% (P value = 0.000). Concordance rate was 77.4%. Ninety-seven point three percent of malignant cases were diagnosed by biopsy and 41.9% by cytology. Cytology contributed to an additional diagnostic rate of 2.6%.
    Conclusion
    Kappa agreement is classified as fair and although there is a very good concordance between the two sampling techniques, the diagnostic yield of cytology for malignancy must be improved by combination of multiple assays. (Tanaffos 2007; 6(2): 46-50)
  • Khodadad K., Abdollah Shamshirsaz Ah, Azadi A., Mostofi An, Tahbaz Mo, Emami H., Karimi Sh
    Background
    Prostaglandins (PGs) can enhance tumor growth and metastasis by stimulating angiogenesis and invasiveness, in addition to apoptosis and immune surveillance. Microtubule-interfering agents induce cyclooxygenase-2 (COX-2) and PG biosynthesis and this might reduce the efficacy of paclitaxel. Preclinical studies suggest that treatment with a selective COX-2 inhibitor may augment the antitumoral effects of chemotherapy. Thus, we designed a phase II trial to evaluate the efficacy of the combination of paclitaxel, carboplatin and celecoxib in advanced non-small cell lung cancer.
    Materials And Methods
    Thirty-seven patients were enrolled in this trial. The inclusion criteria were: chemotherapy-naïve advanced NSCLC (non-resectable locally advanced stage IIIA, stage IIIB and IV), age>18 yrs. and performance status (PS) of 0-2 (ECOG). All patients were given paclitaxel (200 mg/m2) and carboplatin (AUC 6) on day 1, every 21 days and celecoxib (400 mg) daily.
    Results
    Most of the patients were male and the mean age was 58 yrs. Old. Performance status 0, 1, and 2 were 8.2%, 40.5% and 51.3%, respectively. Four patients were in stage IIIA (10.8%), 12 patients in stage IIIB (32.4%) and 21 (56.8%) in stage IV. The overall response rate was 54%. Time to progression and median overall survival were 5.7 and 9 months, respectively. Only one patient had grade 3 anemia. There was no grade 4 cytotoxicity. Three patients had cytotoxic drug allergy.
    Conclusion
    Based on this study, adding 400 mg celecoxib to the standard regimen (paclitaxel plus carboplatin) does not enhance time to progression and overall survival compared to historical data. Thus, we recommend combining higher dosage of celecoxib with other targeted agents in phase I/II trials. (Tanaffos 2007; 6(1): 37-46)
  • سعید فلاح تفتی، سیدمهران مرعشیان، علی چراغوندی، حبیب امامی
    سابقه و هدف
    یکی از ابزارهای مهم سنجش کیفیت زندگی در بیماری های مزمن، استفاده از پرسشنامه هایی است که در آن مفاهیم آثار ناشی از بیماری و تاثیر درمان های مختلف را در انجام امور روزمره و فعالیت های اجتماعی مورد سنجش قرار دهد. این پژوهش با هدف اندازه گیری اعتبار و پایایی پرسشنامه تنفسی سنت جورج به زبان فارسی صورت گرفت.
    مواد و روش ها
    ابتدا پرسشنامه به فارسی ترجمه شد، برخی مفاهیم آن توسط گروه محققین تغییر یافت و مجددا توسط فردی که در منطقه انگلیسی زبان زندگی میکرد و اطلاعی از موضوع نداشت به زبان فارسی برگردانیده شد (Back Translation). در مرحله چهارم توسط 15 نفر از بیماران بصورت گروه های کوچک بر روی مفاهیم کار شد و سپس در مجموع 55 بیمار به پرسشنامه پاسخ دادند که در نهایت از نظر پایایی درونی با محاسبه آلفای کرونباخ مورد سنجش قرار گرفت.
    یافته ها
    پس از ترجمه پرسشنامه، توسط گروه محققین در 17% موارد جملات با عبارت مناسب و منطبق با فرهنگ زبان فارسی تغییر یافت. سؤالاتی که پاسخ آنها مورد تردید قرارداشت یا پیشنهاد مناسبی توسط گروه بیماران مبتلا به بیماری های انسدادی مزمن برای آن وجود داشت توسط گروه محققین تغییر نهایی یافت و در نهایت توسط 55 بیمار دیگر پاسخ داده شد. برای ارزیابی آماری و تغییرات همگرائی بین سوالات و حیطه های مختلف در اختیار متخصص آمار قرار گرفت. در بخش اول (شکایات) ضریب کرونباخ 74/0 بود که با حذف سؤال آخر (در مورد خس خس سینه) به 78/0 افزایش یافت. در بخش دوم که مجموع فعالیت ها و تاثیر بیماری بر فعالیت های اجتماعی مورد سنجش قرار گرفته بود، ضریب کرونباخ برابر 93/0 بدست آمد. توسط گروه محققین آخرین سؤال مربوط به این بخش که آثار فعالیت را بر میزان مشکلات تنفسی مورد پرسش قرار داده بود بدلیل گزینه های ناهمگن توسط بیماران و عدم پاسخ توسط 5 نفر (15%) حذف گردید که ضریب کرونباخ به 95/0افزایش یافت و در مجموع سؤالات پرسشنامه، آلفای کرونباخ محاسبه شده عدد 93/0 بدست آمد.
    نتیجه گیری
    ترجمه این پرسشنامه بزبان فارسی، علاوه بر اینکه منطبق با مفاهیم پرسشنامه اصلی انگلیسی زبان است، با مفاهیم زبان و فرهنگ فارسی قابل تطبیق بوده و می تواند برای بررسی کیفیت بیماران ریوی مزمن مورد استفاده قرار گیرد.
    کلید واژگان: پرسشنامه تنفسی سنت جورج، ویرایش فارسی، پایائی، اعتبار سنجی
    Fallah Tafti S., Marashian Sm, Cheraghvandi A., Emami H
    Background
    Health related quality of life (HRQL) questionnaires allow clinicians to measure daily the impact of disease on a patients daily life and is valuable in clinical trial designed to assess benefits and costs of management. We describe the adaptation into Persian version of the St.George Respiratory Questionnaires (SGRQ); a recognized valid self administered questionnaire for chronic obstructive pulomnary diseases.
    Materials And Methods
    In order to adapt the face validity, the forward and back- translation method was used. Then this questionnaire was edited by researchers and a single pulmonologist as an internist. The content of tests evaluated for feasibility and comprehension by 15 educated COPD patients. In following, the professional committee of researcher assessed the content validity. At last, 55 COPD patients with wide range of disease severity fulfilled the Persian version of the SGRQ. Internal consistency were measured by Cronbach’s alpha coefficient test.
    Results
    The test coefficiency for reliability was 0.74 in part I of questionnaire; "symptoms". Factor analysis indicated that if latest question of part 1 was eliminated [“If you wheeze, is it become worse in the morning?”] Cronbach’s alpha would be elevated to 0.78. Cronbach’s alpha was 0.95 in Part II (Activity & impact) and for overall scale, the result was found to be 0.93.
    Conclusion
    Data from this study revealed that Persian version of SGRQ, as a research tool, is of good validity and sufficient reliablity. The present study suggest the feasibility of adapting a specific instrument of health related quality of life in patients with respiratory disease to be used in different settings from where the instrument has been originally developed.
  • Bakhshayesh Karam M., Zahirifard S., Tahbaz Mo, Nabatchian A., Sadr M., Kazempour Dizaji M., Emami H., Mir, Afsharieh Sa, Masjedi Mr
    Background
    Transthoracic CT-guided percutaneous fine-needle aspiration biopsy (FNAB) has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions.
    Materials And Methods
    505 patients (311 men and 194 women) aged 7-90 years old (mean age 56.2 years) with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy.Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5.
    Results
    FNAB samples were adequate for diagnosis in 410 (81.2%) of 505 patients. Two hundred and forty-nine lesions (60.7%0) were malignant, and 161 (39.3%) were benign or atypical. Thirty-four (6.7%) patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 (1.8%) patients and follow-up was carried out. No further complications were reported.
    Conclusion
    CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer. (Tanaffos 2006; 5(3): 37-44)
  • Saadat N., Emami H., Salehi P., Azizi F.
    Many studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran.
    Materials And Methods
    Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (ĸ statistic) were obtained using WHO and ADA criteria.
    Results
    Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose); p<0.05 and <0.001 for diabetes and IGT, respectively and 7355 (84%) had concordance with both criteria. Among 7105 normal subjects classified according to WHO criteria, 153 (2.2%) had IFG or diabetes by ADA, whereas from 8068 normal subjects according to ADA criteria, 1116 (13.8%) had IGT or diabetes based on WHO criteria. The level of agreement (ĸ statistic) between the two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 100%, respectively, considering WHO as the gold standard.
    Conclusion
    Our data shows a low level of agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetes, glucose disorders are detected more frequently using WHO criteria.
  • Mirsadraee M., Saeedi P., Emami H.
    Introduction
    It is believed that H1 histamine receptor blocker does not have any beneficial effect on treatment of asthma, but combination of H1 and H2 receptor antagonists has a good effect on chronic resistant urticaria. Since the pathogenesis of asthma and urticaria are similar, we expected that this combination might have some benefits in treatment of asthma.
    Materials And Methods
    In this study, we selected 66 patients with known diagnosis of asthma in acute exacerbation of their disease. The patients did not have any history of smoking, GERD, postnasal discharge and rhinorrhea, but experienced symptoms such as cough, dyspnea, and wheezing. All patients underwent spirometry (Spirosift 3000 Fukuda Denshi), and those who had obstructive pattern and improved FEV1 more than 20% after using bronchodilator were randomly entered either the case or control groups after signing the consent. Spirometry parameters were VC, FVC, FEV1, FEV1/FVC, PEF, FEF 25-75%, MEF25%, and MEF 50%.Phase 1: Case group treated with 0.5 mg/kg prednisolone and salbutamol orally plus terfenadine (bid) and Ranitidine (tid), for one week.Phase 2: Case group treated with salbutamol and beclomethasone spray with antihistamines as mentioned, for two weeks.Phase 3: Same as phase two for one month. Spirometry was done at the end of each phase.In control group since exclusion of corticosteroid and bronchodilator from treatment was dangerous, management was similar to the case group. The only exception was the omission of antihistamines.Statistical analysis: Chi-square was used for interpretation of qualitative variables. F statistics and Kruskal Wallis tests as well as paired t- test were used for comparison of changes in spirometry findings.
    Results
    66 patients finished first and second phases and 24 patients went through the third phase. M/F ratio was 2/3, median age was 33 years in both groups (range10-70 yrs.). Comparison of symptoms between case and control groups showed that in study group during second phase, cough improved more than control group. Otherwise, there were no significant differences in symptoms and signs of the two groups. During all three phases, spirometry measurement showed no significant difference between study and control group, except for MEF25% that improved in study group more than control group in the second phase.
    Conclusion
    Corticosteroids and b-2 agonists are very potent and effective drugs in treatment of asthma. Addition of H1 and H2 histamine receptor antagonists to standard therapy of asthma has minimal effect but in case of troublesome cough that is not relieved with that treatment, addition of antihistamines may be beneficial.
  • جعفر مبلغی، دکترحسیم امامی
    مقدمه
    علل خونریزی های تحتانی گوارشی در جوامع مختلف و در سنین مختلف متفاوت است. این مطالعه به منظور تعیین فراوانی نسبی علل خونریزی تحتانی دستگاه گوارش در بیماران بستری شده در بیمارستان بعثت سنندج طراحی گردید.
    مواد و روش ها
    این تحقیق از نوع توصیفی است. جمعیت مورد مطالعه کلیه بیماران مبتلا به خونریزی گوارشی تحتانی بودند که در سال 1378 در بخشهای داخلی و جراحی بیمارستان بعثت بستری شده بودند. تعداد بیماران 112 نفر بودند که در محدوده سنی 81-1 سال قرار داشتند. اطلاعات لازم از پرونده های بیماران استخراج شد.
    نتایج
    نتایج بدست آمده از این مطالعه نشان داد که 76 نفر (9/67 درصد) مذکر و 36 نفر(1/32 درصد) مؤنث، 63 نفر(3/56 درصد) ساکن شهر و 49 نفر(8/43 درصد) ساکن روستا بودند. از بین بیماران فقط 1 نفر (9/0 درصد) بدون تشخیص از بیمارستان ترخیص شده بود. بیشترین تعداد بیماران در گروه سنی کمتر از 55 سال با 86 نفر(8/76 درصد) بودند 9 نفر (1/8 درصد) در گروه سنی کمتر از 25 سال که در بین گروه های سنی مختلف کمترین فراوانی را داشت، قرار داشتند. در جمعیت مورد مطالعه 23 نفر(5/20 درصد) دارای بیماری دیگری همراه با خونریزی تحتانی گوارش بودند. بیشترین شکایت بیماران حین مراجعه دفع خون روشن از طریق رکتوم بود. این شکایت در 29 نفر (9/25 درصد) افراد مراجعه کننده وجود داشت (به تنهایی). اما دفع خون از طریق رکتوم در 103 نفر (7/92 درصد) افراد مورد مطالعه یکی از شکایات بیماران بود (حداقل یکی از شکایات بیماران در حین مراجعه دفع خون روشن بوده است). 7 نفر (3/6 درصد) بدون خونریزی واضح مراجعه کرده بودند و شکایت اصلی 5 نفر از آنها ضعف و بیحالی و کاهش وزن و تغییرات اجابت مزاج بود و 2 نفر بقیه نیز (8/1 درصد) با شکایت دفع مدفوع سیاهرنگ (ملنا) و دردشکم مراجعه کرده بودند.
    در کل بیماران 58 نفر (8/51 درصد) هموروئید داشته اند که شامل درجات مختلف هموروئید بود ولی در 68 نفر (7/60 درصد) یکی از تشخیص ها هموروئید بود. 10 نفر (9/8 درصد) فقط شکاف مقعد داشتند ولی در 15 نفر (6/13 درصد) یکی از تشخیص ها شکاف مقعد بود. پولیپ ها به تنهایی در 11 نفر (10 درصد) علت خونریزی گوارشی تحتانی گزارش شده بودند ولی در 12 نفر (7/10 درصد) پولیپ یکی از تشخیصهای این نوع خونریزی گزارش شده بود. کانسر کولون و رکتوم به تنهایی در 13 نفر(6/11 درصد) گزارش شده بود و در یک نفر (9/0 درصد) علاوه بر کانسر، هموروئید نیز گزارش شده بود. کولیت (التهابی و عفونی) در 6 نفر (4/5 درصد) علت خونریزی تحتانی گزارش شده بود. در 2 نفر (8/1 درصد) نیز پرولاپس رکتوم علت خونریزی گوارشی ذکر شده بود.
    نتیجه گیری
    نتایج این مطالعه نشان میدهد که فراوانی نسبی علل خونریزی های تحتانی گوارشی از جمله کانسرهای کولون و رکتوم در این مطالعه با سایر مطالعات مطابقت دارد.
    کلید واژگان: خونریزی تحتانی دستگاه گوارش، کانسر، کولون، رکتوم، هموروئید
    Mobaleghij., Emamih.
    Introduction
    Lower gastrointestinal (GI) tract bleeding has different ethiologies in different populations and in different ages. This study was aimed to demonstrate relative frequency of causes of lower GI bleeding in patients admitted in Besat hospital of Sanandaj.
    Materials and Methods
    This was a descriptive study. The subjects included all patients with lower GI bleeding that were admitted in Besat hospital in 1999. They were 112 patients with age range from 1 to 81 years. Data was collected from the patient`s files.
    Results
    Seventy six patients (67.9%)were male and 36 patients (32.1%) were female. Sixty three patients (56.3%) were town resident and 49 patients (43.8%) were village resident. Ethiology of lower GI bleeding was not diagnosed only in 1 patient (0.9%). Most of the patients had less than 55 years-old-age (76.8%). Nine patients had less than 25 years-old age that was the least freqnency (8.1%) among the age groups.Twenty three patients(20.5%) had another disease associated with lower GI bleeding. The most prevalent chief complaint of the patient was discharge of clear blood from rectum that was present in 29 patients (25.9%)alone. Rectal bleeding was at least one of the patients` complaints in 103 cases (92.7%). Seven patients(6.3%) had no clear rectal bleeding and in five of them the chief complaints were weakness,weight loss and defecation changes. Two of them (1.8%) had melena and abdominal Pain. Fifty eight patients(51.8%) had hemorrhoid in different grades.Hemorrhoid was one of the associated diseases in 68 patients (60.7%). Ten patients(8.9%) had only anal fissure while it was an associated disease in 15 patients (13.6%).Polyps was the cause of lower GI bleeding in 11 patients (10%) while it was an associated disease in 12 patients (10.7%).Colorectal cancer was the cause of lower GI bleeding in 13 patients(11.6%). One patient(0.9%) had both colorectal cancer and hemorrhoid. Inflammatory and infectious colitis were the causes of lower GI bleeding in 6 patients(5.4%).In 2 patients(1.8%) rectal prolapse was the cause of lower GI bleeding.
    Conclusion
    Relative freqnency of causes of lower GI bleeding including colorectal cancer in our study are the same as other researchs.
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