مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 9 (پیاپی 225، آذر 1398)

Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.

A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).

The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).

Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Recently, the surgical methods are used in patients with anterior cruciate ligament rupture and have been associated with successful results. There are different results in the term of using of the surgical methods for anterior cruciate ligament that often is associated with some complications such as infection, static laxity, remaining the pain, need to recurrence surgery, and limitation in the range of motion. Therefore, in this study, we aimed to compare outcomes of anterior cruciate ligament reconstruction with the fixed loop and the adjustable loop.

This cross-sectional study was done on 60 patients undergoing anterior cruciate ligament reconstruction referred to Kashani Hospital of Isfahan, Iran, from March 2017 to February 2019. Also, this study was approved in the Isfahan University of Medical Sciences, Isfahan, Iran. 30 patients were assigned to a fixed loop and 30 patients under the adjustable loop method. Postoperative outcomes were compared with the fixed loop group and the adjustable loop group.

The frequency of static laxity below 8 mm in the fixed loop group was 83.3% and the frequency of static laxity below 8 mm in the adjustable loop was 76.7%. There was no significant difference between the fixed loop group and the adjustable loop group based on static laxity. Also, no infection was seen in the fixed loop group and the adjustable loop group. There was no significant difference between the fixed loop group and the adjustable loop group in terms of range of motion and knee score before and after surgery. After surgery, 96.7% of the fixed loop group and 86.7% of the adjustable loop group returned to normal activity. There was no significant difference between the fixed loop group and the adjustable loop group in terms of return to normal activity and satisfaction.

Using the fixed loop is effective, useful, and with low-complication for the patients with anterior cruciate ligament and also using the adjustable loop grafts is effective, useful, and with low-complication for the patients with the anterior cruciate ligament rupture.

Cerebral aneurysm disease causes intracranial hemorrhage by rupturing, which can eventually, lead to organ failure or death. For this reason, it is important to anticipate the reasons for rupturing of a cerebral aneurysm from biomechanical point of view. Investigating this disease may even help the physicians to find treatments and predict the patient’s situation. This research was conducted to understand risks of development and rupture of a patient-specific cerebral aneurysm.

In a computational simulation, fluid-structure interaction method has been used for a patient-specific case. Also, considering the speed of the systole as the initial condition of the problem, the blood fluid domain has been solved in three types of fluid mathematical models (Newtonian, non-Newtonian Carreau, and non-Newtonian power-law). Then, the pressure results on the wall have been transmitted to ANSYS software, version 15.0 (ANSYS Inc., Canonsburg, PA, USA) and the structure has been solved based on three material models (linear elastic, hyperplastic Neo-Hookean and hyperplastic Mooney-Rivlin, with 5 parameters). The study was done in University of Tehran, Iran, from October 2016 to September 2018.

Shear stress, pressure, flow velocity, wall displacement and von-Mises stress have been extracted from the simulations. The average wall displacement of the aneurysm was 1.8 mm. Also, no significant difference was found in the amount of arterial wall displacement, with constant wall material model and different blood models. However, a significant difference has been observed in the case of considering constant blood model and different wall material models in the value of displacement.

With regard to the amount of displacement of the aneurysm wall in this particular patient, with the geometry and location of the specific aneurysm, the brain nerves 3 and 6 were under stress and exposed to damage. The minimum shear stress was in the aneurysm neck, which stimulates the endothelial cells in the area of aneurysm. In addition, the blood model didn’t had a significant effect on the displacement calculations, while the wall material model played a more decisive role.

Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.

In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.

Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).

Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and excessive collagen deposition in the skin and internal organs. Based on the skin damage we divide the patients into two groups: limited and diffuse SSc. In restricted type, the thickness of the skin is limited in the face and distal parts of the elbows and knees, with less involvement of internal organs, whereas in diffuse type, facial skin, organs, and trunk generally increase in thickness and internal visceral involvement is noticeable as renal failure, pulmonary artery pressure, and interstitial lung fibrosis. According to the prevalence studies, the prevalence of systemic sclerosis is estimated to be 15 cases per 100,000, of which the prevalence in women is 3 times more than men. Based on clinical evidence the prevalence of SSc is high in Khuzestan province. The aim of this article was to evaluate the demographic features of SSc in Khuzestan province, Iran.

This cross-sectional study conducted on two hundred SSc patients referred to Rheumatology Clinic of the Golestan University Hospital in Iran, from 2001 to 2015. Patients were selected based on the American College of Rheumatology classification criteria for SSc and were divided into diffuse and restricted types based on the site of skin involvement. Individual characteristics and clinical symptoms were extracted from the information in the patient records which were carefully compiled by physicians. Data on age, sex, race, duration of illness, and family history of SSc were collected orally.

91.5% of the enrolled patients were female. The mean age was 44 years and the most common race in our study was Lor. The prevalence of the diffuse form of SSc was 68% and the limited form was 32%. The Raynaud's phenomenon was detected in 100% of patients. Sclerodactyly and interstitial lung disease were found in 88.5% and 54.5% of patients respectively. Laboratory features such as ANA (93%), Anti-Scl-70 (77.5%) and anti-centromere antibody (ACA) (70%) of SSc patients were reported.

According to the results of this article, the most systemic sclerosis patients in Khuzestan province were middle-aged Lor race females and the most common type was diffuse systemic sclerosis.

Congenital heart diseases are the second group of congenital anomalies in infants. These disorders are a major cause of death in the first year of a child's life. Early detection helps to treat these diseases better. In this study cardiology consultations of hospitalized infants in the neonatal intensive care unit were evaluated.

In this cross-sectional study, two hundred and fifty pediatric cardiology consultations conducted in Shahid Beheshti Hospital in the year 2012 were reviewed. Information such as the cause of consulting, delivery type, age of parents, relative couples, family history of congenital heart disease, maternal medications, maternal background diseases, the final diagnosis, and prognosis follow-up of the patients were recorded in a designed questionnaire. Finally, the data were entered into the SPSS software, version 16 (IBM SPSS, Armonk, NY, USA) and analyzed using descriptive statistics and chi-square test. P-value of less than 0.05 was considered significant.

The mean age of the consulted neonates was 4.845±5.14 days with a gestational age of 33.933±3.65 weeks. Male sex and cesarean section were the most frequent. Fifty-six percent of consulted infants were male. The present study revealed that prematurity (76%), murmurs (30.8%), respiratory distress syndrome (14.4%) and cyanosis (13.2%) were the most common causes of the cardiac consultation seeking among infants. Seventy-six percent of infants were consulted due to prematurity. Eighty-four percent of infants had a normal conditions. Septal defects (ventricular or atrial septal defect) and patent ductus arteriosus were the most common disease diagnosed with the prevalence of 27.5 and 17.5%, respectively. There was a significant relationship between preterm labor and congenital heart disease (P<0.001). Additionally, prematurity associated with respiratory distress syndrome and using assisted reproductive techniques.

The higher prevalence of congenital heart disease in the present study, compared with other studies, reflects the fact that cardiology consultation based on clinical suspicion leads to the more identification of congenital heart disease that means the right referral of newborns for consultation was accompanied with a higher incidence of heart failure.

Nowadays, cardiovascular diseases (CVDs) are among the most common causes of mortalities worldwide. Parathyroid hormone (PTH) has an important role in the pathogenesis of CVDs. The aim of the current study was to compare serum PTH levels between patients with acute myocardial infarction (MI), unstable angina, and normal coronary function.

This descriptive and analytic study was performed on patients with acute MI, unstable angina, and normal coronary function visiting Imam Ali Hospital of Kermanshah city in Iran, during years 2016 to 2017. Data collection was done from December 2017 to March 2018. Of the patients who met inclusion criteria, 120 were selected by accessible sampling and were allocated into three groups. Serum level of PTH was determined in the three groups.

Among the studied subjects, females and males comprised 43 (35.8%) and 77 (64.2%) respectively. Among those with normal coronary function, 22 (55%) and 18 (45%) were females and males respectively. In acute MI group, women and men comprised 8 (20%), and 32 (80%) respectively. Finally, males and females constituted 13 (32.5%) and 27 (67.5%) in unstable angina group. Based on this study, the overall mean serum PTH level was obtained 18.32 pg/ml. The highest PTH level was observed in individuals with normal coronary function, while the lowest level was recorded in patients with unstable angina. There was a significant difference in mean serum parathyroid hormone levels between the study groups in those with no history of smoking.

Our results indicated that parathyroid hormone serum level can be associated with cardiovascular diseases including unstable angina. There were significant differences in the means of parathyroid hormone level between the studied groups depending on the presence or absence of hyperlipidemia. In vitro evaluation of parathyroid hormone level in suspected subjects should be performed in the case of myocardial infarction, unstable angina and normal coronary, prevented from these diseases by testing.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The prevalence of PCOS among Iranian women is 14.6% based on the Rotterdam definition. PCOS can increase the risk of chronic metabolic complications. Metabolic syndrome (MetS) is one of the most important of them. Insulin resistance is fundamental in PCOS and MetS pathophysiology. MetS is a collection of chronic metabolic derangements, which promotes the risk of serious diseases such as cardiovascular disturbances and diabetes. The quality of diet is inversely correlated with obesity, which is one of the consequences of PCOS and it is a risk factor for metabolic syndrome. As the first study, the present study aimed to compare the dietary intake of macronutrients in PCOS women with and without MetS.

In this nested case-control study, the convenience sampling method was used to select participants. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The investigated macronutrients included fats (total fat, saturated fatty acids, mono and polyunsaturated fats, trans fatty acids), carbohydrate, protein, and fibers (total and soluble). The dietary intake assessment was carried out by a 168-item semi-quantitative food frequency questionnaire (FFQ). This study was performed on Arash Women's Hospital under support of Tarbiat Modares University, Tehran, Iran, from August 2014 to September 2015.

Dietary intake of total fat was significantly higher in PCOS women with MetS than the control group (P<0.001, 146.62±45.17 vs. 59.91±32.79 g/d). Dietary intake of saturated fatty acids (P=0.004, 11.44±11.08 vs. 19.73±6.76 g/d), monounsaturated fats (P<0.001, 14.15±12.66 vs. 26.16±7.76 g/d), polyunsaturated fats (P=0.002, 9.02±9.18 vs. 17.22±6.45 g/d), carbohydrate (P<0.001, 182.34±121.08 vs. 365.64±77.11 g/d), protein (P=0.001, 42.74±42.85 vs. 78.06±24.04 g/d), total fiber (P<0.001, 17.77±15.09 vs. 35.97±22.64 g/d) was significantly lower in PCOS women with MetS than the control group. All results are expressed in terms of grams consumed per day.

Our results demonstrated that dietary intake of macronutrients was significantly different in polycystic ovary syndrome patients with and without metabolic syndrome.

Intrauterine infections (TORCH) lead to the involvement of various organs of the body of the fetus, including the eye. The aim of this study was to determine the frequency and clinical response of eye lesions to specific drugs, in infants with confirmed TORCH induced ocular lesions.

This historical cohort study from 2011 to 2017, had done in Pediatrics and Ophthalmology Department of Rasoul Akram Hospital, Tehran, Iran. Cases included; 78 infants with confirmed intrauterine infection (TORCH) with ophthalmologic disorders (glaucoma, cataract, and retinitis), 3 cases died (without any treatment). The cases with incomplete diagnosis, no treatment or without follow-up excluded from study. Out of 74 children with confirmed TORCH induced ophthalmologic disorders, finally 37 children (25 cytomegalovirus, 12 toxoplasma) were treated with specific drugs, and clinical response to treatment was followed-up to 1 year by ophthalmologic examination.

From 12 cases with ophthalmologic disorders due to congenital toxoplasmosis, 5 cases had full treatment, 4 cases had complete response. One case had not any improvement. From 25 cases with congenital cytomegalovirus (CMV), 18 patients continued treatment, 9 cases with complete clinical response, 9 cases had not response to antiviral treatment, indeed most non responder cases had central nervous system involvement from birth. The best response observed in CMV infected cases accompanied with sensory hearing loss (without CNS involvement).

Good clinical response of ophthalmic diseases in 80% of congenital toxoplasma; and 50% of congenital cytomegalovirus infected cases. Probably with initial diagnosis and rapid treatment of cases with TORCH induced ophthalmic disorders (especially cases without CNS involvement) it would lead to stopping ocular lesions.

Self-mutilation is one of the most extreme types of self-harm, which is done deliberately to hurt the body, regardless of suicidal intent. In self-mutilation, the most important targets are the eyes, genital tract, and hands. So far, genital self-mutilation (GSM) has been less frequently reported around the world. According to our study, this is the first case of GSM reported in Iran. The most common cause of GSM is psychological disorder, especially psychosis.

The patient was an unmarried 32-year-old man, who was hospitalized in Rasul-Akram Hospital in December 2018 for severe bleeding caused by GSM. He was diagnosed with type I bipolar disorder, which was treated from the late adolescence. Also, a history of drug abuse (amphetamine, opium, cannabis, alcohol) and multiple sexual relationships with different partners was reported. He abused tramadol tablets daily nowadays. His IQ was normal. He had lots of abrasions, scars and lacerations due to suicidal attempts in the past years. Two months before GSM, his auditory hallucinations about genital self-mutilation had started. He committed GSM after having sexual intercourse and was transferred to our hospital by an ambulance with severe hemorrhage, scrotum damage, and presentation of both testes, for which he received appropriate treatments.

It seems that a set of factors, such as patient's history of psychosis following bipolar disorder, substance abuse, mental retardation, multiple sexual relationships, and strong emotional relationship with the mother can contribute to self-injury that may lead to genital self-mutilation. It should be noted that genital self-mutilation cases are less likely to be reported in Iran, considering the cultural and religious background. Therefore, the pathology of this devastating phenomenon should be more thoroughly examined.