Journal of Research in Medical Sciences
Volume:11 Issue: 1, Jan & Feb 2006

Refractory status epilepticus usually defined as a seizure lasting at least 60 minutes which is uncontrollable by Diazepam, Phenytoin, or Phenobarbital. The aim of this study was to compare the effect of interavenous Midazolam and rectal Sodium valproate in controlling refractory status epilepticus. In this case-control study; 76 children with (mean age of 37± 20 months) with refractory status epilepticus were randomly divided into two groups to receive IV Midazolam and rectal Sodium Valproate. The effect of the two drugs were compared in control of seizure during first 20 minutes of treatment. In 84.2 percent of children treated with IV Midazolam, the seizure was under control within 4.5 ± 0.5 minutes, while in 63 percent of those receiving Sodium Valproate, the seizure was completely controlled within 16.5 ± 0.8 minutes (P < 0.00001). The IV Midazolam was more effective than Sodium valproate, but the latter can be used in hospitals or pediatric emergency wards without ICU for controlling of refractory status epilepticus.

The purpose of this study was to evaluate whether a random urinary protein / creatinine ratio is a clinically useful predictor of significant proteinuria (300 mg/24 hr) instead of 24- hours urine protein, among women with suspected preeclampsia. Women with suspected preeclampsia and gestational age of 20 weeks were included in a prospective study. Patients with chronic hypertension, diabetes mellitus, or preexisting renal disease were excluded. Protein/ creatinine ratio was obtained before 24-hours urine collection. Positive and negative predictive values and sensitivity and specificity of the protein/creatinine ratio for significant proteinuria (300 mg) were calculated, based on 24-hours urine total protein. 100 women were evaluated totally. Mean maternal and gestational ages were 27.3 years and 33.26 weeks, respectively.73% of cases had significant proteinuria based on 24-hours urine collection. Good correlations were found between the protein/creatinine ratio in random urine samples and both the 24-hours urine protein excretion and the 24- hours urine protein/creatinine ratio in patients with mild preeclampsia (r=0.484, P 0.18 is a good predictor of significant proteinuria. P: C ratio could replace the 24- hours urine collection as a simpler, faster, and more accurate method for the diagnosis of significant proteinuria.

Diffuse Large B-cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s Lymphoma. DLBCL patients have different survivals after diagnosis. 40% of patients respond well to current therapy and have prolonged survival, whereas the remainders survive less than 5 years. In this study, we have applied artificial neural network to classify patients with DLBCL on the basis of their gene expression profiles. Finally, we have attempted to extract a number of genes that their differential expression were significant in DLBCL subtypes. We studied 40 patients and 4026 genes. In this study, genes were ranked based on their signal to noise (S/N) ratios. After selecting a suitable threshold, some of them whose ratios were less than the threshold were removed. Then we used PCA for more reducing and Perceptron neural network for classification of these patients. We extracted some appropriate genes based on their prediction ability. We considered various targets for patients classifying. Thus patients were classified based on their 5 years survival with accuracy of 93%, in regard to Alizadeh et al study results with accuracy of 100%, and regarding with their International Prognosis Index (IPI) with accuracy of 89%. Combination of PCA and S/N ratio is an effective method for the reduction of the dimension and neural network is a robust tool for classification of patients according to their gene expression profile.

In young adults, a family history of premature coronary artery disease (CAD), as well as genetic and environmental factors are independent risk factors for coronary artery disease. Endothelial function was studied in 30 children (21 boys and 9 girls with mean age of 14.9 +/- 2.3 years old) of patients with documented CAD (men 45 and women 50 years old). Chidren did not have any history of diabetes mellitus, dyslipidemia, hypertension, and smoking (active/passive). Using vascular ultrasound, we measured resting Basal Brachial artery Diameter (BBD) and Endothelium-Dependent Dilatation (EDD) in response to increased flow and sublingual glyceryltrinitrate (GTN), an Endothelium-Independent Dilation (EID). These parameters were also measured in 30 control subjects with normal parents (18 boys and 12 girls with mean age of 14.2 +/- 2/5years old) and results were compared with each other. Adolescents in CAD group had abnormal Endothelial Dependent Dilatation or EDD/BBD (8.5 +/- 3.4% vs 11.8 +/- 4.5% in control subjects; P= 0.003).Endothelial Independent Dilatation (EID/BBD) in the positive fimily history group was significantly more than control subjects (18.5 +/- 6.7% vs 11.9 +/- 5.2%; P

The incidence of depression is 0.9% in preschoolers, 1.9% in school age children, and 4.7% in adolescents. Current antidepressant treatment of mood disorders in children and adolescents is still in the early phases of being validated with double-blind efficacy studies. In this study the efficacy of nortriptyline has been compared with fluoxetine in the treatment of major depression in children and adolescents. This was a double–blind clinical trial for 8 weeks, undertaken in the Isfahan Child and Adolescent Guidance outpatient Clinic, Isfahan, Iran. Subjects were 40 outpatients children and adolescents (20 boys and 20 girls) aged 7-16 years of old who met the Diagnostic and Statistical Manual of Mental Disorders, Forth Edition, for Major Depression. To determine the scores of two groups (Baseline and after treatment), we used Children Depression Inventory (CDI). Subjects were randomly assigned to receive nortriptyline 2mg/kg/day for 8 weeks (group A) or fluoxetine 1mg/kg/day for 8 weeks, (group B). Paired t-test was used to compare the mean of CDI score of each group before and after treatment. To compare the reduction in the Children Depression Inventory score, an unpaired t-test was used. The mean depression score was 28.9 (SD±8.46) before intervention in fluoxetine group while that was 28.4 (SD±8.76) in nortriptyline group. Independent t-test showed a significant difference between after treatment mean depression scores in both groups (t=2.97, df=38, P=0.004). The changes at the endpoint compared with baseline were - 10.95±2.61 and –2.6±0.8 for fluoxetine and nortriptyline, respectively. t- Paired test showed a significant decrease in mean depres

Primary intracerebral Hemorrhage (PICH) is a devasting illness with high early mortality which causes 10 -12 percent of stroke cases. Survivors of PICH are at risk for recurrence of hemorrhage. We wanted to determine the frequency of recurrence of ICH in patients with PICH at Alzahra and Noor hospital Isfahan, Iran. A descriptive retrospective study was did on the hospital records of patients with a discharge diagnosis of intracerebral hemorrhage to identify the cases. Data were gathered by means of a check list and were analysed by using SPSS statistical software. A total number of 660 cases were identified by computer search. After abstraction, 400 patients with primary hypertensive intracerebral hemorrhage were identified. Widespread distribution of recurrence of ICH were 65 cases which 33 cases of them were men and 32 cases were women. Totally, 16. 25 percent of patients had recurrence which is greater risk of recurrence in comparison to other studies.

Post traumatic stress disorder (PTSD) in war veterans has been linked with symptoms in their children, including symptoms resembling those of the traumatized parents, especially aggression. This study aims to examine the effectiveness of cognitive-behavioral group therapy in reducing aggressive behaviors of male adolescents whose fathers have war related PTSD. 36 male children (aged 11 19 years) whose fathers had PTSD, were randomly assigned into three groups for Rational-Emotive- Behavioral Therapy (REBT), Relaxation Therapy, and Wait-List control group. Each method had a course of ten therapeutic group sessions of 60 minutes once a week. Rates of aggression were assessed by Aggression Questionnaire (AGQ) at baseline, end of intervention, and two months later. The difference between AGQ scores of three groups was statistically significant. The behaviors of the three groups were not homogenous across the time (group × time interaction) and showed a statistically significant difference. This study revealed that the intervention groups were superior to control group in reduction of aggressive behaviors in male adolescents of war veterans with PTSD. Further studies with greater sample size, prolonged duration of follow up, and multiple assessment procedures may be needed for better conclusions.

A significant proportion of infertile men with azoospermia and severe oligoazoospermia have a genetic etiology for their reproductive failure. Genetic analysis has major effects on finding the causes of infertility in last decade, but still in some cases, we still do not have clear answer for our patients. During last years it has become evident that endogenous estrogens and estrogen receptors (ER) play role in the regulation of testicular function. Present study was performed to evaluate the significance of RsaI and AluI single nucleotide polymorphism in the ER gene in infertile patients in comparison with normal fertile male control. From 120 infertile men referred to our center after ruling out all the known causes of the infertility such as chromosomal abnormalities, Y-chromosome microdeletion, and other pathologic disorders, 5 ml peripheral blood were obtained for DNA extraction. PCR amplification of the polymorphic region was carried out and after running the PCR products on 1.5% agarose gel, the frequency of the polymorphism were calculated. A 3 times higher frequency of the heterozygous RsaI genotype was found in men with low sperm concentration compared to control (P=0.003). In contrast, the proportion of homozygous AluI genotype was only 1/3 in severely oligoazoospermic men in comparison with control (P=0.03). Our results could suggest that ER and RsaI and AluI single nucleotide polymorphisms on this gene are important for spermatogenesis in humans, and could play an important role in the spermatogenesis process in males. Also it is possible to conclude that different conditions of infertility may not have genetic predisposition in common.

A significant proportion of infertile men with azoospermia and severe oligoazoospermia have a genetic etiology for their reproductive failure. Genetic analysis has major effects on finding the causes of infertility in last decade, but still in some cases, we still do not have clear answer for our patients. During last years it has become evidentthat endogenous estrogens and estrogen receptors (ER) play role in the regulation of testicular function. Present study was performed to evaluate the significance of RsaI and AluI single nucleotide polymorphism in the ER gene in infertile patients in comparison with normal fertile male control. From 120 infertile men referred to our center after ruling out all the known causes of the infertility such as chromosomal abnormalities, Y-chromosome microdeletion, and other pathologic disorders, 5 ml peripheral blood were obtained for DNA extraction. PCR amplification of the polymorphic region was carried out and after running the PCRproducts on 1.5% agarose gel, the frequency of the polymorphism were calculated. A 3 times higher frequency of the heterozygous RsaI genotype was found in men with low sperm concentration compared to control (P=0.003). In contrast, the proportion of homozygous AluI genotype was only 1/3 in severely oligoazoospermic men in comparison with control (P=0.03). Our results could suggest that ER and RsaI and AluI single nucleotide polymorphisms on this gene are important for spermatogenesis in humans, and could play an important role in the spermatogenesis process in males. Also it is possible to conclude that different conditions of infertility may not have genetic predisposition in common.

Unless performing a timely and appropriate correction, congenital anomalies can conduce to irrecoverable complications. There are different reasons for delay in referring such patients to physician for surgery. By understanding these considerations, we can make an effective approach to reduce the severity of this problem in our community and this is the aim of our study. In a cross sectional study, all 359 eligible cases (neonates and infants suffered from a correctable anomaly which were referred to our centers) and 110 physicians were included for a period of 15 months (2000-2001). Two main hospitals in our city were set as the data collection centers (Al-Zahra). Parents'' views were extracted by interview. Physicians'' knowledge about study subject was assessed by self administered MCQs. In this study 65 percent of all cases who were operated on had been taken to hospital with delay (male to female ratio was 4:1). Among the cases who received delayed surgical treatment, inguinal hernia was the most prevalent one (39 percent). Surgery in 32 percent of cases who had delay in their operation caused some degrees of complications. Physicians'' misadvise (42 percent), economic problems (25 percent), and hospital terror (17 percent) were accounted as the most prevalent reasons for delayed referrals. Physicians'' knowledge about the correctable congenital anomalies in infants was estimated very poor (3 score from 10). Delay to refer for operation in correctable congenital anomalies is an important dilemma in our community. Public education and also health professional education about this matter can play an admissible role improving the situation. Also, it is needed to make decisions for improving assurance supports in such cases.

The purpose of this study was to investigate outcomes of surgical repair of esophageal atresia (EA) or tracheoesophageal fistula (TEF) in newborns, with respect to incidence of death and other complications in early or late operations. Charts of all 80 infants with EA/TEF, operated in Alzahra hospital (A tertiary hospital of Isfahan University of Medical Sciences) from 2002 to 2004 were reviewed. Patients were designed in two groups as, primary and delayed repair groups. Patients demographics, frequency of associated anomalies, and details of management and outcomes were studied. There were 48 male and 32 female patients with a frequency of 28(35%) preterm infant and mean birth weight of 2473±595 g. Overall survival rate was 71.2%. Mortality rate in delayed repair group was significantly higher than the other one (22.5% vs. 6.3%) but with matching, according to full term/preterm proportion, the significant differences were failed. Female sex and being preterm were the most powerful predictors of death (nearly odds ratio=7 for both). in this study mortality and complications rates are higher in delayed repair than early one, although our data proposed that in absence of sever life threatening anomalies the most important factor for death is gestational age and female sex, and primary repair is opposed to it. Although mortality rate and complications are equal in two strategies, with matching cases for being preterm, but primary repair stays the better choice due to economic considerations.

Myasthenia gravis (MG) is the most common autoimmune neuromuscular disease that may occur in any age. Regarding to the controversies about the epidemiology of MG and lack of sufficient data about MG status in Iran, the present study was performed on patients referred to Shafa hospital, in Kerman, between 1998-2003 in order to determine clinical manifestations, accompanying diseases, complications, and thymus pathologies in patients with MG. It was a descriptive study including 102 patients with MG. Initial data about sex, age of disease onset, disease severity according to Osserman classification, respiratory crisis, thymus pathology, and accompanying diseases were recorded. Chi- square and independent t-test were used for statistical analysis. The study population included 69(68%) females and 33(32%) males. For patients aged >40 years, female to male (F/M) ratio was 1:1. Disease manifestations were commenced before 20 and 40 years of old in 15.8% and 76.2% of patients respectively. Follicular hyperplasia of thymus was reported in 61.5%, whereas in 23% the pathology was normal or atrophy and in 15.4% was thymoma. Ocular involvement was found in 20.6% of patients. Based on Osserman classification, severity of IIA, IIB, III and IV were reported in 43.1, 21.6, 10.8, and 3.9% of the subjects, respectively. F/M ratio, age of disease onset, pathology of thymus, disease severity, and accompanying diseases have shown slight differences with prior studies. Epidemiological studies in other parts of the country are suggested.

This study has been conducted to compare anti inflammatory effect of topical diclofenac with topical dexamethason following strabismus surgery. In this study 50 patients who had undergone strabismus surgery were evaluated. They were divided into two groups randomly. 25 patients received topical 0.1% diclofenac sodium (group A) and 25 patient received 0.1% dexamethason (group B) for 6 weeks. The baseline parameters were similar in both groups. At each visit ocular examinations was performed to record ocular discomfort, conjunctival inflammation, conjunctival repair, and intra ocular pressure (IOP). Follow-up visits were 1, 2, 4, and 6 weeks, post operatively. There were no statistically significant difference in the rate of resolution of the inflammation, conj healing, and intra ocular pressure (IOP) except a non significant rise of intra ocular pressure (IOP) at the end of fourth postoperative week and statistically significant rise in intra ocular pressure (IOP) at 6th week post operative visit in group B. The results of this study suggest that diclofenac may be used as an alternative for dexamethason after strabismus surgery.