مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال شصت و یکم شماره 4 (پیاپی 34، دی 1382)

This research studies the quality of medical prescriptions for children under 5 years of age and their effective factors carried out by Behvarzes at Eslamshar town. The study took place in 19 health houses considering the medical family files of patient children seeking for medical care by 33 Behvarz for quality of medical prescription. Two questionnaire were used for the study. The first questionnaire contained information about children medical prescription and variables evaluated in relation to medical prescription dose, duration of consumption and the cure duration period, which carried out for both girl and boy group separately. The second questionnaire contained information about the condition of working Behvarzes demographic in health houses considered variable for Behvarzes are: Age, Sex, experience, education, place of residence marital status. The important points of the study are as follow: - In cases that according to Behvarzy training patient follow up is necessary, 56.9%of the needed cases did not full fill the appropriate and necessary follow up program. - One of the important constraints of the research is the high percent of unrecorded cases by Behvarzes including:1 - 1.2% unknown medical prescriptions.2- 44.2% unknown dose of prescribed medicine3- 52.4% unknown care duration period4- 36.5% unknown period of time for taking the medicine. According to the information: 1- 64.9 dose of prescribed medicine2- 73.2 period of time for taking the medicine3- 84.1 care duration period There were appropriate.

The main purpose of this study was to evaluate the prevalence of overweight and obesity among guidance-and high school students and its relation to modifiable environmental factors. The subjects have been 1000 girls and 1000 boys aged between 11-18 years, selected by multi-stage random sampling, their parents (2000 subjects) and their school staffs (500 subjects) in urban and rural areas of two provinces in Iran. Data have been analyzed by SPSSV10/ Win software. The prevalence of 85th < BMI<95th percentile and BMI>95th percentile in girls was significantly higher than boys (10.67±1.1%, 2.9±0.1% VS. 7.37±0.9%, 1.87±0.1% respectively, p<0.05). The mean BMI value was significantly different between urban and rural area (25.38±5.2 VS. 23.25±7.1, P< 0.05). BMI > 85th percentile was more prevalent in those with lower educated mothers (9.2+2.1 vs. 11.5+2.4 years of mothers education respectively). The mean of the total energy intake was not different between overweight or obese and normal- weight subjects (1825±90Kcal VS. 1815±85Kcal, P>0.05) but the percent of energy derived from carbohydrates was significantly higher in former than the latter (69.4% VS. 63.2%, P<0.05). Regular out-school sport activities were significantly lower and the time spent on television watching was significantly higher in overweight or obese than non-obese subjects (300±20 VS. 240±30 minutes/day, P<0.05). Significant linear association was shown between the consumption frequency of rice, bread, pasta, fast foods and fat/salty snack and BMI (p=0.05-0.06, p<0.05). A significant correlation was shown between BMI percentiles with serum triglyceride, high density lipoprotein-cholesterol and systolic blood pressure (Pearson r=0.38,-0.32 and 0.47 respectively).

One of the disturbing complications of propofol is pain on injection and the incidence ranges from 28% to 90%. Metoclopromide is commonly used as an anti emetic drug. Some investigators reported that this drug could reduce the pain on injection of propofol. The aim of this study was to assess and comparison of the efficacy of propofol pretreatment with metoclopromide in incidence and severity of its pain on injection. In a randomized, prospective, double-blinded, placebo-controlled trail, 150 patients 18 to 40 yr old were randomly allocated in one three groups. C group (2ml of normal saline), L group (40mg lidocaine in 2ml), M group (l0mg metoclopromide in 2ml). Immediately after injection of study or placebo drugs, 10 mg of propofol with injection rate of 0.5 ml/s (In 4 Seconds) were injected in to the same vein that was inserted to the most prominent dorsal hand vein. Pain severity was measured using Visual Analogue Pain Scale that were educated to the patients before the trail (0 for no pain and 100 for the most aggressive pain in life) and values other than zero was encountered pain appearance. Patients with signs of sedation were excluded. There was no statistically significant difference between patients in three groups in number of men and women (P = 0.66), age (P = 0.29) and weight (P = 0.49). Furthermore severity (P = differences (C = 41.18, L - 25.4 and M = 13.1, P < 0.001) and patients in metoclopromide group experiences lower pain than other two groups (P < 0.001). Pain incidence in Control group was 77.1% and it was significantly reduced in lidocaine and metoclopromide group (P = 0.002), but there were no significant difference between them (P = 0.051). The 0.69) and incidence (P ~ 0.29) of pain has no significant difference between men and women. Pain severity between three groups has significant results showed that metoclopromide could significantly reduce the seventy of pain on injection of propofol more than lidocaine (opposite to diazepam), but they had no difference in pain incidence. It might lie on the different mechanisms that they produce pain. Pain on injection of diazepam is primarily attributed to propylene glycol, as a vehicle, but the pain mechanism in propofol is remaining unknown. Finally as regards to other useful effects of metoclopromide including postoperative nausea and vomiting and propofol induction dose reduction, especially when there is a medical condition where lidocaine is contraindicated, it may be a reasonable alternative before injection of propofol.

The induction characteristic of halothane in nitrous oxide and oxygen were compared with halothane in oxygen alone and intravenous induction with thiopentum and succinylcholine. A vital capacity technique was used for the gaseous induction groups using a mapleson F system and a 1-litre reservoir bag. four end points of anesthesia were recorded: time to cessation of hand grip, time to loss of eyelash reflex, time to jaw relaxation, and time to settled breathing after tracheal tube insertion. we also recorded sequential blood pressure and pulse rate, the incidence of adverse airway events and the acceptability of the induction technique. Induction with thiopentum and succinylcholine had a faster time to cessation of hand grip (p, 0.05) and jaw relaxation (p, 0.01). These differences disappeared with the final induction stage and halothane in nitrous oxide and oxygen had the faster time to regular settled breathing though this did not reach statistical significance. Cardiac stability was good and comparable in all groups. These were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups.

Intra-operative measurement of intact Parathyroid hormone (iPTH) using a rapid assay technique is useful as an aid in determining adequacy of resection and leads to reduce re-operative cases. In a prospective case series study, PTH level determined before and after (intra-operative and one day after) Parathyroidectomy in 34 patients with primary hyperthyroidism that refer to Shariati hospital during 18 months between year 2000 and 2001. The average PTH levels before and after parathyroidectomy were 563 pgr/lit and 121 pgr/lit. All patients had significant decrease in PTH levels after Parathroidectomy (mean = 78%). One day after operation, this level decreased to 42 pgr/lit (mean = 87% decrease compared with before operation) In this study, like the same other studies from other countries there was significant decrease in PTH levels in rapid intra-operative assay that can demonstrate the reliability of PTH monitoring for intra-operative management and overall operative success rates.

Unstable angina (UA) is situated in a spectrum with myocardial infarction (MI) at one end of it and stable angina at the other end. To determine the clinical and paraclinical characteristics of unstable angina this study was designed. Two hundred patients with definite UA who were hospitalized at cardiac care units (CCU) in Yazd were enrolled in this cross- sectional study. Clinical and para-clinical characteristics including class of severity of angina, clinical circumstances, drugs, risk factors, changes in ECG, and patient's condition at the time of leaving hospital were evaluated.Results& The average of age of patients was 61.85 years and 57% of them were female and 43% were male. The most prevalent risk factor among men was smoking (48.8%) and among women was hypertension (62.8%). According to Braunwald suggestion, patients were divided into 3 classes based on the severity of their diseases. Frequency distribution of patients in classes I,H and III were 24.5%, 4% and 71.5%, respectively. Normal ECG, was observed in 24.5% of subjects at the time of hospitalization and in 67% of patients when leaving hospitals. Frequency distribution based on the risk stratification was 22.5%, 58.5% and 19% in the low, medium and high risk groups, respectively. During hospitalization, acute myocardial infarction (AMI) was seen in 3.5% of individuals that majority of them belonged to class III of angina.

Radioiodine therapy is the safest, simplest, least expensive and most effective method for treatment of Grave's disease. Due to difficulties in previous methods for dose determination, fixed dose method of 1-131 is now considered the best practical method for 1-131 therapy in Grave's disease, but there is no consensus on the dose. We compared two routinely recommended fixed doses of 5 and 10 mCi for this purpose. In this clinical trial, 59 patients with Grave's disease referred for radioiodine therapy were randomized into two groups, one group was treated with 5 mCi of 1-131 and the other with 10 mCi. All patients were followed for two years, with 6-month intervals. Totally, among 59 patients treated with 1-131, 20 (33.9%) patients became euthyroid and 19(32.2%) became hypothyroid, while failed therapy (no response or relapse) was noticed in 20 patients (33.9%). In the group treated by 5 mCi (33 patients), 10(30.3%) were euthyroid, 6(18.2%) were hypothyroid (overall cure of ^8.5%), while 17(51.5%) remained hyperthyroid by the end of the follow-up period. From the 26 patients treated with 10 mCi, the euthyroid and hypothyroid states were observed in 10(38.5%) and 13(50%)patients, respectively (overall cure rate of 88.5%), and hyperthyroid state in 3(11.5%). No relationship was noted between the outcome and age, sex, size of the thyroid gland and thyroid uptake, but the relationship between the disease outcome and the amount of administered radioiodine was significant (P<0.003). Although the incidence rate of early hypothyroidism (by the end of 2 years) in the group treated with 5 mCi is less than those treated with 10 mCi, the incidence of failed therapy is higher in the former group. In addition, it is known that long-term hypothyroidism prevalence is not significantly different by using different doses of I-131. On the other hand, if the initial dose is so little to cure, cost and time for perfect treatment, number of office visits and morbidity due to untreated hyperthyroidism are markedly increased. Regarding lower rate of failed therapy with 10 mCi, and as there is no significant difference in late hypothyroidism between low doses and high doses of I-131, we concluded that 10 mci is the optimal fixed dose for treatment of Grave's disease.

In this study the clinical course, risk factors for relapse and the predictors of long-term outcome of 502 patients (median age 5 years)with primary nephrotic syndrome were followed for an average of 60 months (3.5 to 240 months) from 1981 to 2000. Among the 502 patients 5 (1%) achieved spontaneous remission and 313 children were initial responder. One hundred eighty four patients received at least 1 kidney biopsy (78 prior and 106 after initiation of treatment). Of 104 children with frequently relapsing steroid sensitive and steroid dependent nephrotic syndrome, levamisole induced prolong remission in 33 (31.7%) of patients. Cyclophosphamid and cyclosporine A induced prolong remission in 49 (50%) of 98 and 28 (41.3%) of 68 patients respectively. At the time of the final clinical evaluation, 73 patients (14.5%) were on remission 301 (59.9%) had relapsing 43 (8.6%) had persistent nephrotic syndrome 33 (6.6%) of patients evolving to end-stage renal disease (ESRD) and 6 (1.2%) of them with chronic renal failure died (infection and cardio respiratory were the cause of death in 5 and 1 patient respectively). Young age (1-5 y) at onset of disease and atopy were identified as an independent risk factors for relapse (P0.05). Patients with steroid dependent nephrotic syndrome (SDNS) or MCNS had better response to cyclophosphamide or cyclosporin than children with steroid resistance nephrotic syndrome (SRNS) or FSGS (P0.05). Persistent proteinuria, hypertension, microscopic or macroscopic hematuia, glucosuria were associated with progression to chronic renal failure (PO.05). Steroid dependency and histopathology of MCNS in patients with nephrotic syndrome were significantly associated with good long-term prognosis. In contrast persistent proteinuria, histopatholoy of FSGS, hypertension, macroscopic or microscopic hematuria, and glucosoria were significantly correlated with unfavorable long-term outcome. Additionally our study showed a positive correlation between young age and atopy with higher rate of relapse.

In this study, the results of "Urethral Advancement & Glanuloplasty" in repairing anterior hypospadias were considered. Hypospadias is a common urethral anomaly in boys. More than 65 percent of hypospadias cases are anterior (glanular, coronal and distal penil shaft). More than two hundreds original techniques have been applied to correct hypospadias. Each of these techniques has some complications. The most common complications of hypospadias repairing are fistula and meatal stenosis. A total of 74 boys with anterior hypospadias underwent the procedure of "Urethral Advancement and Glanuloplasty" (UAGP) in our medical centers from March 1994 to April 1999. The procedure included: degloving, correction of chordee, urethral mobilization and glans plasty. Cosmetic results were excellent in most patients. There was no fistula, and also meatal stenosis was not observed after applying V-Flap of the glans.Results & In a 1 - 6 year follow - up (mean 3.15 years, SD ± 1.79) the results functionally and cosmetically, were satisfactory in all cases with no long-tem complication or chordee.

The changes that occur in all of the motor unit recruitment following the central and peripheral lesions of motor nerves can be effective on individual's disability. Following the low back pain (L.B.P) with any known cause, the effective role of muscles in providing postural or dynamic stability will be reduced. Today in rehabilitation of these patients, except of medical treatment for reduction of pain, a great attention is given to assess the motor control and its efficiency in order to prevent reappearance of the disease symptoms. The aim of this research is to determine the amount of changes in motor planning at motor control level in order to provide an appropriate setting for movement of lumbar spine following postural responses and peripheral stimulation. Ten healthy women (24.3+2.32 year) and five women with L.B.P (27.34+4.67 years) without any structural disorder of lumbar spine have participated in this study. The test stages included flexion and extension in sagital plan with/ without external hearing stimulation in the 30 degree of flexion and 10 degree of extension, with 5 repetition. By measuring the amount of individual's reactions and computation of range of motion (R.O.M), the velocity, torque and delay time for showing any reaction prior to reaching stimulation point and its post time as well as comparing them with each other in both groups and also comparing these two groups. There are a significant differences between R.O.M changes, velocity and torque in similar times before and after hearing stimulation in both types of movement (P<0.05). In such a way the said values before hearing the external stimulation was much greater than after hearing the external stimulations and appearance of postural responses (P<0.05). Also in comparing with the conditions that external stimulation and postural response imposing was loosed, the time of appearance the postural response has shown a meaningful reduction (P<0.05). The group consisted of patients with L.B.P in compare with normal group, during the period that the movement were without any external stimulation, has shown no significant difference, while in stages with external stimulation and occurrence of postural responses, the R.O.M, time, velocity and torque have shown a significant difference (P<0.05). In healthy cases the percentage of functional performance reduction following external stimulation was more than the patients (P<0.05). This shows that the patients with history of L.B.P will have problems in setting up motor planning or in feedworward process.