مجله فیض
سال دهم شماره 1 (پیاپی 37، بهار 1385)

Pressure ulcers are the result of immobility and continuous pressure on an area of body. Aside from imposing further restriction of movements and thus creating a vicious circle in the healing process, these ulcers are of significant importance in decreasing the life quality and adding to the treatment costs of these patients. There are currently 1800 spinal cord handicapped war veterans in Iran and according to the 1998 figures, 21% of them are suffering from at least one ulcer at pressure sites. In this study we compared the outcome of treatment of pressure ulcers with (Gallium- Aluminum-Arsenide) & (Gallium-Aluminum-Indium-Phosphate)-Diode LASERS, both made by Azor-2k TM, on Contact, Continuous Emission mode at an every other day dose of 4-6 J/cm2 for 3 weeks plus conventional treatments of pressure ulcers, with that of conventional treatment alone in 2 groups of veterans with spinal cord paralysis who reside in Tehran, the capital of Iran. The study was a triple blind clinical trial conducted on 16 veterans who were randomly divided into case and control groups. The diameter of the ulcers was measured and staged by one person who was unaware of the subjects’ case-control status. Digital photographs of the ulcers were initially taken and a combination of conventional treatment (wet dressing, irrigation) with low-level LASER and conventional treatment alone was allocated to the case and control groups respectively. After 3 weeks the subjects were evaluated again. The result demonstrated a statistically significant enhancement of the healing process by combination of low-level LASER with conventional treatments of pressure ulcers.

In this study, the effect of methylene blue in differentiation of necrotic and vital areas of traumatic liver of rabbit was studied. Twenty healthy rabbits were selected and divided in two equal groups randomly. Through a midline incision, rabbit's abdomen was opened. In the case group liver was traumatized for necrosis by hemostat. Then, through portal vein a blue catheter (22 G) was inserted. Sterile water was added to 0.2 cc of 2% methylen blue whose volume reached to 2 ml. Then, it was injected through the catheter. the times related to painting and discoloration were recorded. Wilcixon and linear regression analysis were used to analyze the data. The mean time of liver painting and discoloration were 17.7 ± 1.4 and 53.6 ± 3.2 in controls. In the case groups, there was no painting. There was a linear correlation between painting and discoloration times (r=0.51, P=0.012). Methylen blue can be used to differentiate necrotizing liver injuries.

Health care workers (HCW) are always at risk of hepatitis B. This study was carried out to evaluate the response to hepatitis B vaccination and determine Anti HBs Antibody serum level in the vaccinated HCW. This descriptive study was performed in 128 HCW of Beheshti Hospital who were vaccinated against hepatitis B virus. Titer of Anti HBs antibody was determined by ELISA method. Statistical analysis were accomplished by using Chi-square, Fisher exact test. 60.1% of HCW were females and the rest were males (39.9%). The titer of Anti HBs was above 100IU/lit (good responder) in 73 cases (57%), between 10-100IU/lit (low responder) in 33 cases (25.8%), and lower than 10IU/lit (non responder) in 22 cases (17.2%). 81.8% of the females and 84.3% of the males were responders. 18.2% of the females and 15.7% of the males were nonresponder. There was no statistically significant correlation between age/sex and Anti HBs titer. But there was a significant statistical correlation between the interval of the last vaccination and Anti HBs titer. Enough level of Anti HBs antibody was detected in the majority of personnels. There was no statistical correlation between age/sex and Anti HBs titer but there was significant correlation between Anti HBs titer and the time.

The most common form of ocular infection is conjunctivitis. The aim of this study is to determine the most prevalent causes of bacterial conjunctivitis and antibiotic sensitivity in Mostafa Khomeini Hospital. In this descriptive cross-sectional study, we evaluated symptom, pathogen and effective antibiotic sensitivity in bacterial conjunctivitis. In the present research, 150 cases of conjunctivitis referred to Shaheed Mostafa Khomeini Hospital were studied from Jun. 1999 to Mar. 2000. Our study was carried out based on questionnaires, examinations, cultures and antibiograms. The prevalence of conjunctivitis and bacterial conjunctivitis were 3.2% and 2.1%, respectively. The age limit of the patients under study was 3 days to 65 years. Positive culture in cases was 66.6%. The frequency of conjunctivitis was equal in both males and females. The most frequent age of conjunctivitis was in 0-1 group. The most frequent symptoms in patients were hyperemia & tearing. The frequency of isolated pathogens were: staph. Aurous (38%) penumococcus (11%) pseudomonas (10%) haemophilus (8%) enterobacter, klebsiella, ecoli, staph. Epidermis (each 7%) entrococcus (4%) and moraxella catarrhal (1%). The percentages of antibacterial sensitivity of isolated pathogens were: chloramphenicol 80% gentamycin 76% erythromycin 71% and tetracycline 65%. This study showed that the most common causes of bacterial conjunctivitis are pneumococcus, haemophilus influenza and staphylococcus. Empiric therapy with new local antibiotics seems to be appropriate. Culture is not necessary except in severe, recurrent or epidemic form of conjunctivitis.

Hemiparesis is the most common cause of disability after stroke. The role of concentric exercises has not been recognized in anticipatory postural adjustment due to controversy on the effects of these exercises on upper motor neuron lesions. The purpose of this study was to determine feed forward responses disturbances of postural control mechanism and the effects of concentric exercises of involved lower-extremity muscles on the treatment of these impairments in hemiparetic patients of Kahrizak Charity Foundation in 2003. Methods and Materials: Thirty four secondary hemiparetic patients to stroke were participated in this clinical trial. All patients were screened to ensure that their time since onset of stroke was at least 12 months. Patients were assigned randomly to either an experimental group or a control one. The isometric strength (kg) of seven muscle groups was measured with a hand-held dynamometer. Feed forward responses (ordinal scale) were assessed using Functional Reach Test (FRT) before and after 12 sessions of intervention. All patients were assessed by two raters who were blinded group allocation. The experimental group received strengthening exercises in addition to functional and balance exercises. The control group received only functional and balance exercises. Independent and paired t-tests, Mann-Whitney and Wilcoxon tests were used to compare the pretreatment and post-treatment results. The mean age of experimental group and control group was 49.3 ± 7.1 and 55.5 ± 3, respectively. In parallel feet position, anticipatory postural adjustments increased only in the experimental group, significantly from 1.29±0.2 to 2.9±0.17 after intervention (P<0.0001). In this position, the comparison of post-treatment results showed that mean of anticipatory postural adjustments in experimental group (2.9±0.17) was higher that in control that in (1.18±0.18) (P<0.0001). A significant improvement (P<0.0001) was seen in the experimental (1.59±0.21) compared to control group (0.12±0.08) with respect to mean difference of FRT. All muscular groups strength was correlated significantly with the FRT scores in tandem (r=0.483-0.726) and parallel (r=0.401-0.645) feet position. The results of this study support the effectiveness of muscle strength training of involved lower extremity to improve feed forward responses of postural control mechanism for anticipatory postural adjustment in hemiparetic patients in the chronic stage of rehabilitation following stroke. The results also are in support of using the involved lower extremity muscle strength to evaluate postural anticipatory control.

Considering the roles of cockroaches in transmission and distribution of pathogen agents, their prevalence and lack of data on this kind of parasitic and fungal infections in this region, this study was carried out to determine the cockroaches species and their parasitic and fungal agents at the Hospitals of Kashan, Iran in 2002. This descriptive study was performed on 158 samples of cockroaches caught from three major medical centers. Species of cockroaches, their parasitic and fungal infections, external and internal levels of infection and isolated parasitic and fungal species were determined. Prevalent infection in cockroaches was determined and their exact amount was estimated. From 158 cockroaches, 85 (53.8%) were American and 73 (46.2%) were German. 58 (36.7%) of cockroaches had parasitic infection. The prevalence of human intestinal parasites in American and German cockroaches was 21.5% and 15.2%, respectively. Blastosystis huminis and Ascaris lumbricoides had maximum and minimum prevalences (32.3% and 3.2%), respectively. Of 158 Hospital cockroaches studied, 101 (63.9%) had fungal contamination. The prevalence of fungal agents in American and German cockroaches was 41.1% and 22.8%, respectively. Aspegillus had maximum (27.3%) and Epicocum and Curvularia had minimum prevalences (0.8%) among fungi observed. Two cases of Candida albicans were separated from American cockroaches. Cockroaches of Naghavi Hospital had more infection (43.9% parasitic and 80.7% fungi infection) than those of other Hospitals. Parasitic and fungal infection of cockroaches is a worriment problem at Kashan Hospitals. Therefore further studies are suggested to reduce the cockroaches and their parasitic and fungal infection.

Red eye is the main sign of ocular inflammation rsulted from external eye vessels dilatation. red eye is one of the most common complaints in patients referring to eye clinics which can be a sign of wide variety of ocular problems, from mild conjunctivitis to vision- threatening infections, diseases or trauma. Most disorders characterized by a red eye are relatively benign. But more serious causes may be misdiagnosed from the Self-Limited ones. Inappropriate or delayed management may result in serious visual problems. This study was conducted to survey the effect of the variation of season on the causes of red eye and the ability of general practitioner on its management in 2004 at Shaheed Rahnemoon Hospital-Yazd. In this descriptive case series study, 400 patients with red eye referred to eye clinic in summer and winter of 2004 were evaluated. The red eye criterion was episcleral or conjunctiva hyperemia that changes the external eye color which was detected by observation and slit lamp examination. Data were collected through questionnaires and analyzed by SPSS software and chi-square test. The patients were classified in three age groups: less than 15 years (18%), 15-39 years (51.5%) and more than 40 years (30.5%). In two first age groups conjunctivitis and trauma were the most common causes of the red eye while in the third age group conjunctival degenerative changes were most frequent. Conjunctivitis was the most common cause of the red eye (35.8%) and other causes were trauma (22%) and conjunctival degenerative changes (15%). 59% of patients were males and 41% were females. Conjunctivitis was the most common cause of red eye in both genders (P.V= 0/000). Irritation was the most common symptom (91.3%), followed by tearing (85.8%) and itching (68.8%) (P.V=0.000). There was no relationship between the causes of red eye and the variation of seasons. The red eye was more frequent in males than in female and there was no difference between the causes in two seasons. The most common causes of red eye are conjunctivitis, trauma, and conjunctival desenerative changes. Uncommon but high risk cases such as uveitis, scleritis and hidden globe rupture must be referred to ophthalmology at once to prevent serious consequences. Appropriate instrutruction can also decrease some serious problems.

With regard to the high prevalence of osteoarthritis and importance of its classification we evaluated the association between the severity of clinical signs, level of pain and function of joints, and radiological classification. This cross sectional study evaluated 100 knee osteoarthritis patients who were diagnosed by ACR (American College of Rheumatology) criteria. It was performed in Bagyiatallah Hospital in Iran during 2003-2004. In clinical evaluation, Lequesne’s index of pain and function were used. Knee radiographies were classified using Kellgrn-Lawerence. The results were analyzed statistically through chi-square test. There were 84 females and 16 males (mean age: 52 years old) in this study. The results of clinical classification were as follow: mild (10%), moderate (21%), severe (58%), and very severe (11%). The results of radiological classification were as follow: normal (12%), suspicious (0%), mild (25%), moderate (47%), and severe (16%). There was no significant association between clinical and radiological classifications (p=0.104). There was also no significant difference between males and females (p>0.2). There was no significant association between clinical classification and radiological grading.

Concerning the adverse effects of bacterial infections in the lesions due to cutaneous leishmaniasis sush as: diagnosis, treatment and increased cost, duration of treatment and progress of healing in skin lesions, this study was carried out in cutaneus leishmaniasis patients refered to the central laboratory in Kashan, Iran, 2003. A descriptive study was condacted on 117 of 164 patients with skin lesions in the central laboratory of Kashan, Iran, 2003. Speciemens were collected and inoculated in blood agar and cosin-methylen blue agars chioglycolate. Identification of the tsclates was determined baccording to a standard method and antimicrobial susceptibility of the isolated was done by disk diffusion method. The results were analyzed statistically There was bacterial infection in 32 acses (19.5%). Staphylococcus aureus was the most common pathogen and showed the most rate of antibiotic sensitivity to ceftriaxon and erythromycin. To treat these lesions by antibiotic, diagnosing the secondary bacterial contamination due to cutaneous leishmaniasis is necessary.

Varicoceles are vascular lesions of the pampiniform plexus and the most common identifiable abnormality found in men being evaluated for infertility. There are some reports in the literature indicating that varicocele may be a progressive lesion, however, this remains a controversial subject. The purpose of this study was to determine the incidence of varicocele in men with primary versus secondary infertility. The records of 2234 consecutive couples with male factor infertility, refering to two infertility centers were studied. The incidence of varicoceles and also some other factors affecting male infertility were assessed in these patients. The frequency of primary and secondary infertility were 82.2% and 17.8%, respectively. The mean age of the men with primary infertility and their wives were 30.2 and 26.0 years, respectively. The men with secondary infertility and their wives were significantly older. (33.8 and 29.1 years, respectively). The incidence of varicoceles was not significantly different among the men with primary versus secondary infertility (42.4 and 43.5%, respectively). The results of this study do not support the progressive adverse effect of varicoceles on men fertility overtime.

ADEM (acute disseminating encephalomyelitis) is an autoimmune disease in which immunologic reaction to myelin is activated by an unknown factor. The incidence is not known and in the developed countries it is now seen most frequently after non-specific upper respiratory tract infections with the etiological agent remaining unknown. Young adults and children are most commonly affected. Systemic symptoms like fever, malaise, headache, nausea & vomiting often precede the neurological symptoms of ADEM but the hallmark is the development of initial clinical features including coma, hemiparesis, seizure, cranial nerve palsy and fever. ADEM is one of the causes of sudden coma in adolescents which has similar pattern of abnormalities on conventional MRI images with multiple sclerosis, but probably in primary approach with patients it is misdiagnosed. This paper presents a case of ADEM referring to Hamadan Sina Hospital in 2005. Case Report: The patient was a 22-year old female, complaining of sudden and acute coma and then status epilepticus.The patient’s past medical and drug history was negative. Positive finding in physical examination was low grade fever and in neurological exam, involvement of bilateral cortico spinal tract was remarkable. After intubation and control of status epilepticus and routine tests brain CT scan lumbar puncture was done which was normal. Patchy areas of increased signal intensity on conventional T2-weighted images in cortical and subcortical hemispheres was apparent on MRI. Corpus callosum was not involved. After diagnosis of ADEM high dose of cortico therapy within 10 days showed to improve the outcome So that, the patient was discharged for physiotherapy. White matter disorder is responsible for determining the occurrence of neurological coma in patient because metabolic, infectious, toxic, trauma, vascular lesion (absence of focal neurological deficit) sol, developmental and congenital factors could be ruled out. The criteria emphasizing ADEM disorder (against MS) are: 1-Fever, loss of consciousness & epilepsy 2- Absence of oligoclonal band in CSF 3- Intacted corpus callosum 4- Absence of new lesion after first attack in MRI and 5- shorter duration of symptoms & more severe initial symptoms. According to the report, in every young adult patient with acute onset neurological coma without previous, metabolic, infectious, toxic, and traumatic etiology, and negative developing space occupying lesion, demyelinating disease should be suspected.