Acta Medica Iranica
Volume:42 Issue: 6, Nov-Dec 2004

Every year, millions of Moslems depart to Saudi Arabia from more than one hundred countries around the world for paying to Hajj precept. High percentages of these pilgrims suffer from an influenza-like illness (ILI). This study was designed and conducted on 32370 Iranian pilgrims (36% of total number of Iranian pilgrims) to evaluate the incidence of the illness and determination of influenza vaccine’s efficacy to prevent it. A total of 3465 individuals, 10.7% of under studied population, had vaccinated themselves voluntarily against the influenza and the rest were not vaccinated. As a whole, 70% of the studied population suffered from ILI. In this study, the incidence of illness among those vaccinated was about 56% and among those not vaccinated about 72%; the difference was significant (P < 0.001), with odds ratio (OD) = 0.50 and (1 - OD) = 0.50; thus the efficacy of the vaccine in this study was estimated to be 50% and it was efficient in reducing the cases of ILI. We recommend administration of the influenza vaccine to Iranian pilgrims one month before departure to Saudi Arabia for Hajj pilgrimage.

Prevention of coronary heart disease, mainly by reducing the levels of known risk factors in the population, remains a priority in public health. This cross-sectional study on randomly selected medical students during their internship was conducted from July 2001 to April 2002 in order to determine the prevalence of major coronary artery disease (CAD) risk factors. This survey was done by filling the questionnaire, measuring physical parameters, and taking a fasting blood sample. Two hundred and sixty four medical students were evaluated in this study (48 female, 216 male) with the mean age of 26.5 ± 2.8 years. The main risk factors in descending order of frequency were physical inactivity (43.5%), low high-density lipoprotein cholesterol (26.2%), family history of premature CAD (15.9%), smoking (10.3%), abdominal obesity (10.2%), high triglyceride level (5.3%), high blood pressure (3.4%), and high low-density lipoprotein cholesterol (1.5%). Also, 25% of married females were using oral contraceptives regularly. The number of risk factors per person was 2.2 on average (1.1 in females and 2.5 in males). Prevalence of CAD risk factors in this medical students’ population was unacceptably high. Additional studies should be done to gather more information and determine the need for preventive, educational or curative interventions.

The acceptability of hearing aids in people with presbyacusis has been improved but assessment of whether there is a need for more counseling to increase the number of regular hearing-aid users seems to be important. The aim of this study was to determine if the hearing aid was worn regularly and over a long period of time in people with presbyacusis. A questionnaire survey of patients with presbyacusis who had been fitted with a monaural behind the ear hearing aid for the first time was undertaken. The patients were divided into four groups ranging from 6 months to 3 years after fitting. Overall regular long-term use of the hearing aid was found in the majority of patients with presbyacusis. The main dropout point was within the first year after fitting the hearing aid. The study furthermore revealed a relatively high demand for further help and advice with the hearing aid in all groups.

Behçet’s disease (BD) is a multisystem disorder with potential ability to influence the pregnancy outcome and pregnancy is associated with several physiologic alterations which can lead to potential changes in the course of the disease. We studied 77 pregnancies in 69 women with BD. The disease activity was calculated by two methods for three periods of before, during and after pregnancy to evaluate changes induced by pregnancy. The pregnancy outcome and the newborns’ status were also evaluated. In 31 pregnancies (40.3%) no change was observed in the disease activity during pregnancy. The disease activity improved in 21 (27.3%) and aggravated in 25 (32.4%) pregnancies. After the delivery, the disease activity did not change in 31 patients (40.3%). It improved in 23 (29.85%) and aggravated in 23 patients (29.85%). We had full term delivery in 62 pregnancies (80.5%) and a failure in 15 cases (19.5%). Our results show that the effect of pregnancy on BD was not the same in all patients. The delivery had variable effects on the disease activity, with changes in 59.7% of cases. Comparison of the disease manifestations between patients with and without abortion showed no significant difference except for the peripheral joint and eye involvement which were significantly higher in patients with abortion. No neonatal BD was seen in our cases. The 19.5% failure rate of pregnancy must be a major concern when deciding for a new pregnancy in a patient with BD. It would be even more important in patients with eye and joint involvement.

Larger tumor burden leads to higher serum CA-125 levels and the ability to perform optimal tumor cytoreduction of advanced ovarian cancer is also a function of tumor bulk. The purpose of this study was to identify the ability of preoperative serum CA-125 to predict possibility of optimal primary tumor cytoreduction in epithelial ovarian carcinoma (EOC). A total of 90 patients with EOC were evaluated in a prospective study from 2000 to 2002. Preoperative serum CA-125 levels were determined, using a solid phase immunoassay. We used a receiver operating characteristic curve to identify the CA-125 level with the maximal prognostic power in predicting optimal versus suboptimal debulking. The median CA-125 level for the 90 patients was 500 U/ml (range 13 to 5000 U/ml). Seventy patient (78%) had stage III or ΙV based on staging system of the International Federation of Gynecology and Obstetrics (FIGO) for ovarian carcinoma. Optimal cytoreduction (diameter of largest residual tumor less than 1 cm) was obtained in 44 patients (62.9%) with stage III-ΙV. Preoperative CA- 125 value less than 450 U/ml had a positive predictive value for optimal cytoreduction of 78%, but a poor negative predictive value of 50% in advanced EOC. In patients with advanced EOC, at a cutoff 450 U/ml, 78% underwent optimal debulking, whereas 50% of patients with preoperative CA-125 level above 450 U/ml were still able to undergo optimal debulking. Preoperative CA-125 does not seem to be a reliable predictor of optimal cytoreduction.

There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. Statistical programs used were Student’s t test and Chi square for demographic characteristics. The most important factors which influenced patients’ attitude were nausea and vomiting (27%), fear of pain (34%), fear of needle puncture (15%) and discomfort during return of sensory and motor functions (6%). Being awake during surgery and witnessing birth of neonate were the most pleasant stages of anesthesia (19%). It seems that providing enough and appropriate information about the procedure at preoperative visit can increase acceptance of this regional anesthetic technique.

Different contraceptive methods are used by breastfeeding mothers. In general, these methods are classified into two major groups, hormonal and non-hormonal. A number of studies have shown that combined oral contraceptive pills may adversely affect the quality and the quantity of human milk. In other studies it has been shown that estrogen and progesterone seem to reduce the risk of cardiac and ischemic brain injury by enhancing anti-oxidant mechanisms. Since infants are at increased risk of oxidative stress and free-radical mediated diseases are partly related to deficient antioxidant state, we performed a study to investigate if contraceptive method has any effect on the maternal milk total antioxidant content. A cross-sectional study of total antioxidant capacity of mature human milk of two groups of healthy breastfeeding mothers who were on the hormonal (Lynestrol) or non-hormonal contraceptive regimen with 92 mothers in each group was performed. The total antioxidant capacity was determined by ferric reducing antioxidant power method. The body mass indexes (BMI) of hormonal and non-hormonal groups were 23.67±2.88 and 22.93±3.33 kg/m2,respectively, with no significant difference. The hemoglobin concentrations of hormonal versus nonhormonal groups were 12.94±0.90 and 13.14± 0.76 g/dl which were not significantly different. The mean total antioxidant contents of the hormonal and non-hormonal groups were 575±139 and 583±135 µmol/l, respectively, with no significant difference. It seems that progesterone has no effect on the antioxidant contents of mature human milk; in other words, the Lynestrol has neither positive nor negative effect on the antioxidant capacity of the human milk.

Miliary tuberculosis (TB) is due to hematogenous spread of Mycobacterium tuberculosis. Clinical manifestations are nonspecific and protean, depending on the predominant site of involvement.We evaluated the clinical manifestations of 15 patients with miliary TB. The diagnosis of miliary tuberculosis was based on the identification of miliary nodules on chest radiography and one of the three following criteria: 1) positive acid-fast bacilli smear and/or culture (14/15), 2) histopathological identification of TB histopathological granuloma (4/15), or 3) radiological and clinical improvement after anti-tuberculosis treatment (14/15). The median age (±SD) of the patients was 52.6±19.1 years. Only one patient had underlying diseases, diabetes mellitus. Three patients developed acute respiratory distress syndrome (ARDS), one of whom died during intensive care. ARDS caused by miliary TB is associated with a high fatality rate, scope remains for improvement in its management.

Hemodynamic changes are major hazards of general anesthesia and are probably generated by direct laryngoscopy and endotracheal intubation. We designed this prospective randomised study to assess the cardiovascular changes after either laryngeal mask airway (LMA), face mask (FM) or endotracheal tube (ETT) insertion in the airway management of adult patients anesthetised with nitrous oxide and halothane. A total of 195 healthy normotensive adult patients with normal airways were randomly assigned to one of the three groups according to their airway management (n= 65 each) for transurethral lithotripsy procedures. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) values were recorded before the induction of anesthesia, and then every three minutes until 30 min thereafter. The mean maximum HR and MAP values obtained during 15 and 30 minutes after insertion of LMA were 81±13, 73±8 bpm and 82±14, 79 ±11 mmHg, respectively which were significantly smaller compared to those with FM (84±12, 80±6 bpm and 86±10, 83±13 mmHg) and ETT (96±8, 88±7 bpm and 91±11, 82±9 mmHg) (P< 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation during general anesthesia, but why hemodynamic changes in LMA were smaller than facemask needs further study. In healthy normotensive patients the use of LMA for the airway management during general anesthesia results in a smaller cardiovascular change than FM and ETT.

Detection of lymph nodes (LNs) involvement by various pathological processes has great therapeutic and prognostic implications. The purpose of this study was to evaluate the usefulness and accuracy of triplex sonography (gray scale, color mapping and spectral Doppler) in differentiating benign from malignant cervical LNs. We used triplex sonography to evaluate 120 LNs in 50 patients. The gray scale features which were considered included LNs margin, nodal shape (length/width ratio) and echotexture. Vascular patterns and arterial resistive index (RI) of the LNs were assessed by color mapping and spectral Doppler. Finally sonographic findings were compared with pathologic results. There was significant difference between benign and malignant LNs in shape, echotexture, RI and vascular pattern. Study results showed that malignant LNs, especially metastatic nodes, are accompanied with significantly high RI, rounded shape, heterogenous echotexture and peripheral vascularity. Among these sonographic findings, nodal shape (L/W ratio) and RI were more accurate for differentiating benign from malignant LNs. LNs with ill-defined margin were all metastatic. In this study triplex sonographic findings had relatively high accuracy in differentiating benign from malignant cervical LNs, however, because of some overlapping in triplex sonographic appearances of benign and malignant nodes, this modality may not have definite diagnostic value.

Nucleolar organizer regions (NOR) are defined as nucleolar components containing a set of argyrophilic proteins which are selectively stained by colloidal silver nitrate staining. Although studies have shown that the number of NOR dots or particles is directly related to the rapidity of cell proliferation in cancer cells, prognostic or diagnostic value of NOR remains controversial. The aim of the present study was to asses the proliferative activity of the NOR in different gastric epithelial lesions. For these purposes 60 biopsy and surgical specimens of stomach from pathology files of Khatamalanbia and Imam Hospitals were chosen. For each patient, 3-5 paraffin sections were prepared and stained by one step colloidal silver nitrate solution. In each section intranuclear dots in 100 cell nuclei were counted by two of authors in randomly selected fields and data were analyzed by ANOVA. Statistical analysis showed significant difference for NOR number between gastritis, different grades of dysplasia and carcinoma. The shape and number of NOR showed a grater variability in carcinoma compared to other lesions. It seems that NOR could reflect the proliferative activity of cells.

طPersistent cough unrelated to respiratory infections was strongly associated with the positive history of atopy in the children or maternal age at the child birth less than 20 yr or more than 30 yr. Furthermore a physician-diagnosed asthma was significantly associated with positive history of atopy in child. The results suggest a relatively high prevalence of history of wheezing or current and exercise-induced wheezing, but underdiagnosis of asthma among studied children needs more studies to be confirmed.

Abnormalities of blinking in childhood are not uncommon. To determine the characteristics and causes of excessive blinking, this prospective, non–comparative consecutive case series study was carried out. In outpatient clinics of ophthalmology and neurology of our hospital, 60 children aging 2-16 years old with excessive blinking were examined. Detailed ophthalmologic and neurologic evaluation (history and physical examination) was done and etiology of excessive blinking and demographic characteristics of patients were determined. Of 60 children, 39 (65%) were male and 21 (35%) female. The most common causes were habitual tic in 25 (41.7%), uncorrected refractive error in 20 (33.3%), ocular surface abnormalities such as blepharitis in 6 (10%), psychogenic in 6 (10%) and central nervous system diseases in 3 (5%) cases. Excessive blinking in pediatric age group may occur because of a large number of potential problems. Most cases are caused by benign and self–limiting conditions. The causes can usually be determined after careful history and clinical examination. Neuroimaging techniques are not necessary to be done routinely.

Lymphangioma circumscriptum is a benign lymphatic malformation which is localized to the skin and subcutaneous tissues. It consists of dilated lymph channels lined by normal endothelium.Primary vulvar involvement is very rare and only 28 cases have been reported till 2002. Here we report a case in an 18 years old girl who was referred to our gynecologic clinic with symptoms of pain,swelling and erythema of both labia majors of 5 years duration. She had taken various drugs but all had failed and the lesion was exterminated only after wide local excision surgery. Histological examination revealed multiple dilated vascular channels with an inflammatory infiltrate in papillary dermis and diagnosis of vulvar lymphangioma circumscriptum was made. After ten months follow up, there was no evidence of recurrence. Wide local excision may be the best treatment for extensive vulvar lymphangioma circumscriptum.

In this report we explain a case of primary hyperparathyroidism in a 45 years old diabetic woman that was initially presented with recurrent nephrolithiasis of more than 10 years duration leading to right complete and left partial nephrectomy and complicated by end-stage renal failure. After diagnosis of primary hyperparathyroidism and parathyroid adenectomy, she developed severe hypocalcaemia due to severe and advanced osteitis fibrosa cystica. Despite starting hemodialysis and treatment by high dose calcium the general condition did not improve and the hypocalcemia was not corrected. Severe hungry bone syndrome did not get better and the patient died finally.

Although splenic metastasis is fairly common in disseminated cancer, solitary splenic metastasis in the absence of diffuse dissemination is rare. We report a case of 44 year-old man who developed isolated splenic metastasis of colon cancer. The patient had undergone right sided hemicolectomy for colon cancer in 1988. In 2001, he underwent reoperation because of local recurrence of tumor in the anastomotic site. The patient was admitted to our hospital on Sep 2003 with abdominal pain. Chest X-ray was normal. Abdominal CT scan showed a large cystic lesion in the spleen. Splenectomy was performed for the patient. The spleen was enlarged, firm and irregular. Histological examination showed metastatic mucinous adenocarcinoma. Based on this case, we recommend that clinicians consider possibility of metastasis in cystic lesions of spleen, especially in patients with a history of a malignant disease.