مجله علوم پزشکی رازی
سال چهاردهم شماره 1 (پیاپی 54، بهار 1386)

Factors such as improved medical technology, resource allocation, increasing costs, individual rights, and the changing role of a nurse can result in ethical conflicts that require the nurse’s abilities to recognize moral dilemmas and conflicts and make appropriate ethical decisions. The goal of this article is describing stress as the major reaction of nurses to the context of ethical decision making in taking care of patients. Patients & The present study was conducted by using grounded theory method. The participants were 17 Iranian nurses working in medical and educational hospitals. Semi-structured, unstructured and in-depth interviews were used for data gathering. All interviews were transcribed verbatim and simultaneously and coded according to Strauss and Corbin method (open, axial and selective coding). Job stress and moral distress were identified as the major reaction of nurses to the context of ethical decision making. The participants believed that decision making context consisting of individual and job characteristics, patient and patient's family features, physician’s traits, and structural and management conditions plays an important role in nurse's stress and their inability to respond morally to patient and patient's family needs and optimal caring for patients. Because of the negative effects of stress on physical and mental health of nurses, it is necessary that they consider the context in their own decisions. Also, the agents who are involved in structural conditions and nursing management should attempt to reform and improve the circumstances so that nurses can make better decisions without stress or moral distress.

Cornelia de lange syndrome(CDLS) is a rare syndrome which is characterized by multiple congenital anomalies, mental retardation, characteristic facial appearance, developmental delay, skeletal malformation, hirsutism, and various ophthalmologic problems. The diagnosis of this syndrome is clinical. Case Report: The patient of the present case report was an infant with cornelia de lange syndrome. An increased awareness of this syndrome may result in an early diagnosis and a decrease in morbidity.

Keloids and hypertrophic scars (HS) are proliferative dermal lesions with an overproduction of collagen and extracellular matrix which usually follow trauma to the skin. Keloid is a raised, erythematous, frequently pruritic or burning lesion which grows over normal tissues with no tendency to spontaneous regression while hypertrophic scar remains limited to the boundaries of the initial trauma and tends to regress gradually. Keloid is more frequent in African and Asian descent. No definite cure has been found for this lesion and existing treatments have high rates of relapse. Understanding the pathophysiology of keloid is necessary for development of newer, more effective therapies. Recently it has been shown that Gli1 oncogene (expressed in several of the human tumors) is involved in the pathogenesis of keloid. The aim of the present study is to determine the expression of Gli1 protein in keloids and hypertrophic scars and to define the probable role of this oncogene in the pathogenesis of keloid. Patients & In a cross-sectional study carried out between 2003 and 2005, paraffin-embedded formalin-fixed specimens with the diagnosis of keloid or HS were retrieved from the pathology archives of Rasoul-e Akram, Razi and Hazrat-e-Fatemeh hospitals and Iranian Dermatology Clinic. Clinical data were collected from patients’ records. Immunohistochemical staining with anti-Gli1 antibody(1:20) was performed on pretreated slides. The expression of Gli1 and the degree and intensity of positivity were compared between keloids and HS using Chi-square test. A total of 28 specimens (12 HS, 16 keloids) were studied. The patients’ mean age was 37.8 years, including 13 females and 15 males. The most frequent site of keloid was auricle (31.25%) and the most common cause was surgery (25%). Immunohistochemical staining for Gli1 was positive for all of the keloids but only 25% of HS (p<0.01). The degree and intensity of positivity was significantly higher in keloids compared to HS (p<0.01). Gli1 oncogene is highly expressed in all of the keloids and might be involved in the pathogenesis of this lesion. With regard to these results, drugs that block the Gli1 pathway might be effective in the treatment of keloids. We recommend in vitro and in vivo studies to evaluate the efficacy of anti-Gli1 therapies on keloids.

Laryngeal obstruction due to vocal cord paralysis has been treated in many ways. The purpose of the present study is to evaluate the outcomes of posterior cordectomy by co2 laser and its effects on respiratory complications due to vocal cord paralysis. Patients & In this pre and post-operative clinical trial, we made use of a 2-4 watt co2 laser which was connected to a laryngeal microscope with an x400 lens. The applied method was slightly different from Dennis and Kashima’s usual technique in terms of the application of mithomycin C on the surgical site. Ten cases including 3 females and 7 males underwent posterior cordectomy by co2 laser. The mean age of the subjects was 34.1 years, ranging from 11 to 60. The duration of follow-up ranged from 5 to 24 months with a mean of 17 months. All the patients were suffering from severe dyspnea before the surgery and 8 of them had tracheotomy for their dyspnea before the surgery. The day after the surgery all the patients got decanulated. The changes of breathing, voice and swallowing conditions were analyzed pre and post-operatively using paired t-test. The mean FEV1/FVC ratio that was 67% preoperatively increased to 80% postoperatively(P<0.8). None of the cases encountered aspiration after the surgery. Four of the cases needed a second surgery due to granulation or fibrosis on the site of the previous operation. Ultimately, the surgery resulted in regular breathing in all the patients. This surgery can decrease respiratory complications caused by vocal cord paralysis.

Epidural anesthesia is one of the anesthethic techniques for cesarean section. However, epidural anesthesia with lidocaine has some disadvantages such as delayed onset of action and short duration of analgesia. The goal of this study is to evaluate maternal sensory and motor blockade, neonatal Apgar score, and side effects of adding 50 and 100 mg tramadol to 2% lidocaine in epidural anesthesia for elective cesarean section. Patients & Ninety 20 to 40-year-old pregnant patients with ASA physical status I or II who were candidates for elective cesarean section under epidural anesthesia were included in this prospective and randomized study. Epidural anesthesia was performed in lateral position by means of a 18-gauge epidural needle, through L3-4 space. Epidural catheter for additional injections was indwelt. The patients were randomly divided into three groups including 30 each. Anesthetic solution in the control group(lidocaine group: L) contained 20ml 2% lidocaine with epinephrine(1:200,000), in the LT50 group 50mg tramadol, and in the LT100 group 100mg tramadol was added to the above-mentioned epidural solution. For additional intraoperative analgesia, at first 5ml 2% lidocaine through epidural catheter and then 5µg intravenous sufentanil were administered. Postoperative analgesia was provided by 100mg intramuscular meperidine. The onset of sensory block at T6, the highest level of sensory block, the onset of regression in two dermatomes, the onset and duration of complete motor block, sedation score, total intraoperative drug consumption(lidocaine and sufentanil), neonatal Apgar score, the duration of postoperative analgesia, the time of the first request for postoperative analgesics, total 12-hour consumption of postoperative analgesics, complications, and demographic data were recorded. There were no significant differences among the three groups in demographic data and the duration of anesthesia and surgery. Although in the LT100 group the onset of complete motor and sensory block at T6 was more rapid than two other groups, the highest level of sensory block(above T6), the onset of regression in two segments, and the duration of complete motor block were not different between LT50 and LT100 groups but were higher and more prolonged than L group. Also, the average intraoperative lidocaine and sufentanil consumption in LT50 and LT100 groups showed no difference but was lower than L group. The three groups showed no statistically significant difference in the incidence of maternal complications and neonatal Apgar score. In LT50 and LT100 groups, the time of the first postoperative requirement of analgesics was statistically prolonged and the average meperidine consumption was lower than L group. The present study indicates that adding tramadol to 2% lidocaine in pregnant patients undergoing epidural anesthesia for cesarean section offers advantages over using lidocaine alone in terms of intraoperative anesthesia and postoperative analgesia. Moreover, this addition does not increase maternal and neonatal complications.

Sarcoidosis is a chronic granulomatous disease of unknown origin characterized by the presence of non-caseating epitheloid cell granulomas in multiple organs such as lymph nodes, lungs, spleen, liver, skin, and salivary and lacrimal glands. The diagnosis is established when clinical and radiologic findings are supported by histologic evidence of non-caseating granulomas. Sarcoidosis shares several of the extragrandular features of sjogren syndrome as well as the involvement of the salivary and lacrimal glands, which makes it difficult to differentiate between the two diseases based on clinical grounds alone. Case Report: This article represents a 19-year-old lady who presented with parotid enlargement, dry mouth and dry eyes since 3 years ago. Chest x-ray was normal but HRCT(High Resolution CT-scan) revealed a bilateral ground glass lesion. Bronchial biopsy reported chronic granulomatous pneumonia with non-caseating granulomas. Angiotensin converting enzymes(ACE) level was elevated. The PPD skin test and acid fast smear were negative. The test results for anti-Ro, anti-La, and anti-nuclear antibodies(ANA) were negative too. Finally, the patient was diagnosed as a case of sarcoidosis and went under treatment. During the follow-up visits, the signs and symptoms disappeared and a normal ACE level was reported after 6 months. Since sarcoidosis with sjogren-like manifestations is unusual, we decided to present this case.

Today cardiovascular diseases are the most common causes of death. They constitute an important part of care costs every year. Considering the role of life style such as dietary habits in causing cardiovascular diseases, this survey was carried out to determine the relationship between eating habits and ischemic heart diseases in the patients of Shahid Beheshti Hospital in Kashan. Patients & This case-control study was performed on two groups of 200 ischemic heart patients and 200 non-ischemic patients in Kashan. Data were collected by a questionnaire including variables such as age, sex, job, education, place of living, marital status, the kind of fat and meat they used, overeating, using sugary and starchy foods, and the intake of salt, fat, fruit, vegetables, tea, coffee, alcohol and dairy products. The collected data was analyzed by EP15 program and X2 test. The study covered 400 cases including 200 ischemic and 200 non-ischemic patients. 70 cases (35%) were over the age of 66, 121 cases(60.7%) were male, 174 cases(87%) were married, 124 cases(62%) were illiterate, and 136 cases(68%) were living in Kashan city. The findings showed a meaningful relation between using salty food and ischemic heart involvement(P<0.0001). Also, the usage of fatty food and the above-mentioned disease were related meaningfully(P<0.0003). The relation between the intake of fruit, vegetables, dairy products, and starch and ischemic heart disease was meaningful too(P<0.001). In addition, we noticed a meaningful relation between meat and nuts intake and heart failure(P<0.00001). Ischemic patients used alcohol more than non-ischemic ones, a fact which indicates a meaningful relation between alcohol intake and heart involvement(P<0.02). Smoking and the prevalence of ischemic heart disease seemed to be meaningfully related(P<0.04). However, the findings did not reveal a meaningful relationship between the kind of fat and butter, overeating, tea, and coffee and ischemic heart disease. Considering the role of diet in causing ischemic heart diseases, it is advisable that people be encouraged to use more fruit, vegetables, low-fat dairy products, and white meat and avoid consuming extra salt, fat, red meat, and also alcohol.

Pleural effusion is seen in the background of many diseases, two major groups of which are tuberculosis and malignancies. At present pleural biopsy helps us differentiate these two causes from each other, but it is not only an invasive method but also an expensive one. For this reason, investigators are in search of simple and less invasive methods to diagnose the cause of pleural effusion. One of the new methods is measuring adenosine deaminase activity in pleural fluid. This method has been practiced worldwide and has come up with various results. The main objective of this study is to measure adenosine deaminase levels in pleural fluids of patients and compare them with the histopathological results, and if the outcomes are meaningful, this method can be recommended for clinically confusing cases. Patients & This descriptive analytical cross-sectional study was performed on sixty patients who were hospitalized in the infectious and internal wards on suspicion of tuberculosis or malignancy. First, pleural fluid was aspirated to measure the ADA level(cutoff point 35u/lit). Then biopsy was done and the results were compared with each other. The data was analyzed using SPSS 10 software and Chi-square test. Compared to biopsy, the sensitivity and specificity of ADA for the diagnosis of tuberculosis were 68.4% and 92.6% and for malignancies were 91.3% and 37.8% respectively. In comparison to biopsy, the positive predictive value of ADA to diagnose tuberculosis and malignancies was 81.2% and 47.8% respectively, and the negative predictive value of ADA for the diagnosis of TB and malignancies was 86.36% and 87.5% respectively. Based on the obtained data, raised levels of ADA in pleural effusion(over 35u/l) suggest tuberculosis with a more than 90% probability. Although low levels of ADA(below 35u/l) have great sensitivity for the diagnosis of malignancies, as the specificity of ADA level is 37.8%, it does not necessarily propound malignancy.

Because of the resurgence of tuberculosis in the world, cutaneous tuberculosis remains a clinical and diagnostic problem. Lupus vulgaris is the most common type of cutaneous tuberculosis. Case Report: Herein we present a 35-year-old male with multiple skin lesions in the face and neck since several years ago. Unfortunately due to unscientific manipulation, clinical appearance of the lesions had changed. Thus, the patient underwent laser therapy with the clinical diagnosis of psoriasis or hemangioma. However, because of unsatisfactory response to treatment, the lesions underwent biopsy. Histologic sections, revealed well-formed granuloma accompanied by langhans’ type giant cells and significant lymphocytic infiltration at periphery. Considering the site of lesions, histologic appearance and positive tuberculin test, the diagnosis of lupus vulgaris was confirmed. The above-mentioned patient’s history reemphasizes that clinical appearance of a skin disease by itself does not suffice for diagnosis and therapy. Therefore, biopsy and histopathologic investigation are recommended for atypical lesions.

The hazards of contact with low concentrations of anesthetics are undeniable. Nowadays N2O is one of the most common drugs used in anesthesia. The aim of this study is to assess the nitrous oxide contamination in pediatric operating rooms in Iran, Tehran and Shahid Beheshti University hospitals. This descriptive study was conducted in 15 pediatric operating rooms in 4 main pediatric educational hospitals. The rooms with continuous usage of N2O with 2-3 lit/min of flow for general anesthesia in pediatric operations were studied. For sampling and detection of N2O concentration in parts per million, a portable IR spectrophotometer(3010 model of Bacharach Inc.) was utilized. The sampling was done in 6 different points of the operating rooms and 3 different hours of work time(8:30-9AM, 10:30-11AM and 12:30-1:00PM). Independent t-test and one-way ANOVA were used to compare the means. There was no significant difference between the means of N2O concentration in different points of the operating rooms(2248±2202, 1325±1237, 1346±1234, 1792±1706, 2615±2590 and 2414±2593, P>0.05). The mean of N2O concentration in different points of operating rooms with standard ventilation system was significantly lower than that of operating rooms without standard ventilation. The kind of anesthesia, anesthesia system(with mask or endotracheal cuffed or without cuff tube), work time, the position of operating room door(opened or closed), and also the cooler(on/off) exert no significant difference on the mean of N2O concentration. The mean of N2O concentration in different points of pediatric operating rooms of educational hospitals is much higher than standards.

Iron deficiency and iron deficiency anemia which have been associated with multiple complications are among the most important public health problems in the world. Also, iron deficiency is the most important cause of nutritional anemia. The aim of this study is to investigate the prevalence of iron deficiency among school age children in the schools of Tehran. Patients & In a cross-sectional study, 1779 elementary students from 19 districts of Tehran Province were randomly selected and their blood samples were taken for ferritin measurement. After excluding 124 children, ferritin levels were compared among different age and sex groups in various areas of Tehran. Chi-square and Students’ t-test were used for data analysis. Iron deficiency, i.e. ferritin<12µg/l, was diagnosed in 4.6% of the students of whom 46.8% were girls and 53.2% were boys. The mean age of children with low ferritin was 9.10±1.54 years. Iron deficiency was more prevalent among boys than girls(5.7% vs 3.8%) but this difference was not significant(P=0.07). The prevalence of iron deficiency in the north, south, east and west areas of Tehran was 6.2%, 3.7%, 3.1% and 4.8% respectively. The most and least frequent sites of iron deficiency in Tehran were the north and west areas but the difference was not significant, however(P=0.1). According to the results, the prevalence of iron deficiency has decreased in our country in comparison to previous studies. This may be due to an increase in the knowledge of the community and to the nutritional and cultural developments.

Hydatid cyst is caused by Echinococcus Granulosus. On occasion human is an intermediate host in whom the disease is manifested by the presence of one or more hydatid cysts. Liver and lungs are usual sites for involvement whereas other organs are rarely involved. Case Report: The patient of the present case report was a 23-year-old woman who had been referred with RUQ (Right Upper Quadrant) pain. The hydatid cyst of diaphragm presented with a right cardiopherenic mass in PA chest x-ray. Also, a cystic lesion in the left lobe of liver was seen in her lung CT-scan. After making imaging studies, she was operated on and hydatid cyst of right hemidiaphragm with no relation to the liver or lung was reported. Hydatid cyst of diaphragm is a rare phenomenon which may present with a right cardiopherenic mass in PA chest x-ray.

Every surgery is followed by some changes in postoperative pulmonary function tests which can dramatically influence this period. Although the type of the surgery and its vicinity to diaphragm are the main determinants of these changes, anesthetic techniques are also responsible. Among different probable factors through which anesthesia could influence postoperative pulmonary function tests, we planned to evaluate the effects of drugs used during the maintenance stage of anesthesia on postoperative pulmonary function tests. Patients & This is a single blind randomized clinical trial in which the patients ranged in age from 15 to 35 and presented with ASA I(American Society of Anesthesiology). All the operations were elective extremity or lower abdominal surgeries and their length was between one and two hours. All the patients had normal preoperative pulmonary function tests. The total number of the subjects was sixty and they were randomly divided into two equal groups(n=30). For the maintenance stage of anesthesia, inhalational agents(N2O 50%, Halothane 0.5-1%) were used in one group and intravenous drugs in the other one (Midazolam 0.1mg/kg/h, Alfentanil 0.5µg/kg/min). 24 hours postoperatively, pulmonary function tests(PFT) were performed and the deviations of three indices(FEV1=Forced Expiratory Volume in 1 sec, FVC=Forced Vital Capacity, VC=Vital Capacity) from their preoperative values were measured and compared. Students’ t-test was used for statistical analysis. FEV1, FVC and VC decreased by 16.3%, 13.5% and 12.5% in the inhalational group and by 12%, 12.9% and 12% in the intravenous group respectively. Comparing the results showed no significant difference between the two groups. Among the factors which are related to anesthesia and can affect postoperative pulmonary indices, the above-mentioned drugs that we used for the maintenance stage, whether inhalational or intravenous, exert no significant influence on postoperative pulmonary function tests.

Septic arthritis is an inflammatory and septic process in the joints. The purpose of the present study is to assess the clinical features and determine the pathogens responsible for the treatment and outcome of infectious arthritis in patients admitted to two educational hospitals, i.e. Firoozgar and Rasoul-e-Akram in Tehran, between 1998 and 2003. Patients & Based on existing data, this study was conducted on all 100 patients who suffered from septic arthritis during 5 years, 1998-2003. The obtained data was analyzed by SPSS 11.5 software. Women constituted 48% of the subjects and men 52%. The mean age of the patients was 48.6 years. 67% of the cases had monoarticular involvement and the most common involved joint was knee(57%). The most common predisposing factor was rheumatoid arthritis. Elevated levels of CRP(C-Reactive Protein) were found in all patients. Synovial fluid culture was positive in 45% of the subjects(mostly S.aureus). Other microorganisms were gram negative bacilli, candida, M. tuberculosis, salmonella, and brucella. There were positive radiographic findings in 20% of the patients. 68% of the cases received empiric antibiotic therapy, mostly PRPs(Penicillinase Resistant Penicillin) and third generation of cephalosporins. The average duration of hospitalization was 15 days. The present study highlights the importance of characterizing the kind of microorganism causing septic arthritis. The proper management of this disease is mandatory to all physicians who work in emergency wards.

Diabetes is a heterogenous disease which results from complex reactions among heredity, nutrition and lifestyle. Some studies have shown that a high intake of saturated fatty acids(SFA) increases the risk of type 2 diabetes, while polyunsaturated fatty acids(PUFA) decrease diabetes incidence by increasing insulin affinity to the receptors. In this study, serum fatty acids and adipose tissue composition as a long-term biomarker for fatty acids intake are determined, and their correlation with type 2 diabetes is investigated. Patients & This was a cross-sectional study in which the healthy and the patient groups were compared. The fatty acid composition of fasting serum and adipose tissue was studied in 98 patients with type 2 diabetes and 76 healthy control subjects using gas-liquid chromatography. The serum lipids were measured by autoanalyzer. The means of variables were compared by using Students’ t-test. The percentages of palmitic acid and positional isomer of oleic acid(11c-18:1) in adipose tissue of the patients were higher than the control group(P=0.01, P=0.02 respectively). The percentages of palmitic acid, total saturated and monounsaturated fatty acids in the serum of the patients were higher than the control group too(P=0.001, P=0.006, P=0.02 respectively). Linoleic acid and polyunsaturated fatty acids were lower than the control group, however(P=0.02, P=0.02 respectively). Mean concentration of triglyceride in the patients was higher than the control group(t=-6.7, P=0.001). There was a negative correlation between serum PUFAs and cholesterol to HDL ratio in serum and a positive correlation between serum PUFAs and TG in serum. Also, PUFAs in serum had a negative correlation with TG in serum. Large amounts of palmitic acid and 11c-18:1 in adipose tissue may increase the risk of type 2 diabetes and it seems that patients with type 2 diabetes can have proper control over lipid parameters by having a higher intake of polyunsaturated fatty acids than saturated fatty acids.

Breast carcinoma is the most common malignant tumor and the leading cause of death from carcinoma in women. Tumor grading is important as a prognostic factor in the treatment of patients and is routinely done on histologic specimens. Although breast cytology is a proven diagnostic technique in clinical practice, its use is frequently limited to establishing the benign or malignant character of a given lesion. However, a number of authors have shown that this method can provide additional information about tumor grading and its prognosis. The main objective of this study is to evaluate the importance of cytologic grading of breast carcinoma and its association with histologic grading. In the present study, 73 samples of open biopsy for frozen section examination which were sent to the pathology department of Rasoul-e-Akram and Milad hospitals between 2004 and 2005 were selected. Touch-imprint or scraping was used to prepare smears which were then stained by pap and rapid H&E methods. The smears were evaluated based on the grading system described by khan et al which takes 6 parameters into account: pleomorphism, nuclear size, nuclear margin, naked nuclear size, nucleoli and mitotic counts. Histologic samples were evaluated based on the Nottingham modification of the Bloom-Richardson system. The 73 cases included 67 ductal carcinoma NOS(Non-Otherwise Specified), 2 papillary, 1 tubular, 1 lobular, 1 medullary, and 1 cribriform. The concordance rate between cytologic and histologic grading was 76.7%, which is nearly identical to the past study results. The concordance rate for grade-I tumors was 69.2%, grade-II 85.7% and grade-III 61.1%. 5 out of 6 parameters including pleomorphism, nuclear size, naked nuclear size, nuclear margin, and mitotic counts were statistically significant(P-value<0.05). Necrosis had a significant relation with histologic grading but was not used for scoring. Nucleoli, cell dispersion, cellularity, and tubule formation were not statistically significant. Also, there was no statistically significant correlation between cytologic grading and lymph node metastasis. In summary, expertise and sophistication in breast cancer cytopathology and cytologic grading have developed significantly in recent years. This information should be assimilated into the pre-operative plan so that the biologic behavior of the tumor can be determined in order to avoid a blind therapeutic approach. Prospective follow-up studies are needed to evaluate these cytodiagnostic criteria for cytologic grading of breast carcinoma.

Cardiac tamponade is rarely found in patients diagnosed with hypothyroidism, but pericardial effusion secondary to hypothyroidism is relatively common. Case Report: The patient was a 70-year-old female with cardiac tamponade who was later diagnosed as a case of myxedema. After the diagnosis of myxedema, pericardiocentesis was performed immediately and followed by thyroxine hormone replacement therapy. The symptoms subsided within a short duration and her clinical status improved. Impending cardiac tamponade is a rare manifestation of hypothyroidism. A strong suspicion must be maintained for timely diagnosis of pericardial tamponade which should be followed by prompt intervention.

In all societies, sexually transmitted infections(STIs) are among the most common infections. Approximately 90% of them occur in developing countries. Devastating consequences of these infections can threaten the society in different aspects such as health, economy and social. The above-mentioned infections are not always accompanied by the disease and most cases are asymptomatic or showing mild symptoms. Therefore, they can easily transmit to the others. The goal of this research is to assess the prevalence of STIs in women attending a family planning service. The specific goal is prevalence assessment on the basis of factors including age, parity, contraception, job, husband’s job, drug abuse and education. Patients & This case study was done on 150 women referred to Vali-Asr Family Planning Center through continuous sampling. Background variables were collected by questionnaires. The subjects were tested for three organisms named N. gonorrhea, C.trachomatis and T.vaginalis. The lab tests included culture for N.gonorrhea, direct fluorescent antibody(DFA) for C.trachomatis, and both direct smear and culture for T.vaginalis. The prevalence of STIs was found to be 11.3%(17 persons), which included N.gonorrhea 2%, C.trachomatis 5.3%, and T.vaginalis 4%. The highest rate of infection belonged to the following groups: women aged between 25 and 29, those with one or two deliveries, those whose husbands worked as drivers, and those who used other methods of contraception except condom. With regard to the high prevalence of these infections in the studied group and considering the large young population of Iran, more studies in this field seem quite necessary.

ntroduction: Cystic hydatid disease(cystic echinococcosis) is a zoonotic infection of humans caused by the larval stage of the tapeworm Echinococcus Granulosus. Most of the human infections are caused by eating the materials infected with dog’s feces. The oval form would penetrate into the bowels and reach the liver, lung and other organs through the portal vein. Then, there, it would turn into the cystic form. 50% of these cysts are seen in the liver, 30% in the lungs and 20% in other organs. Head and neck involvement is very rare. Case Report: The present article reports a case of isolated parotid gland hydatid cyst. The patient was a young woman who suffered from facial nerve palsy(temporal branch) due to the compressive effect of the cyst. A superficial parotidectomy was performed and the diagnosis was confirmed by the pathologist. The patient was then treated with albendazole(2 courses of a 2-week treatment). No other organ involvement was detected. The incidence of hydatid disease in head and neck is very rare. In endemic regions, the presence of head and neck masses with progressive enlargement should arouse suspicion as to hydatid disease. Iran is also endemic for hydatid disease and this should be considered as one of the differential diagnoses of head and neck masses.

Fascioliasis as a zoonosis is one of the important parasitic diseases which is caused when fasciola species enter the host’s body. Approximately 2.4 million people throughout the world are infected with this parasite and 180 million people are vulnerable to it. On time diagnosis and rapid treatment of the disease can substantially prevent the harmful effects of the infection on patients. In the present study, we have tried to separate, purify and assess a useful antigen and apply it as a sensitive and specific serologic method. In this experiment, first healthy worms were collected and then cuticles and the other organs of them were detached, homogenized and sonicated separately. Their levels of protein were measured by Bradford method. Then, all the samples were thickened and put on chromatography gel column(G200 sephadex). Four antigenic reactions for each part were observed. By using ultrafiltration method, the protein level of the samples was adjusted to a suitable level so that the obtained antigen could be used to immunize 36 rabbits. The antibodies taken from the rabbits as well as 30 samples of human sera with fascioliasis were tested with CIEP method. In the present study, fraction 2 antigen of fasciola hepatica’s cuticles showed 90.9% sensitivity and 94.4% specificity in CIEP test. The above-mentioned antigen which was identified by SDS-PAGE method had one distinct band of 60 KD, and no other band was recognized along the gel. This antigen, then, went under experiment by ELISA method which revealed that the antibody in 26 out of 30 samples of human sera and all 36 rabbits was detectable and measurable. Altogether, 60 samples out of 66 including 30 human sera and 36 rabbit sera showed positive sedimentary reaction in CIEP method whereas 62 samples did so in ELISA method. Therefore, it is suggested that 60 KD antigen of fasciola worm’s cuticles be used as a pure antigen in serologic tests such as ELISA and CIEP. However, the results indicate high sensitivity of ELISA method to CIEP method.

Pelvic organ prolapse which is defined as displacement of bladder, uterus or rectum from their normal position downward is very common in elder women and causes significant morbidity. It is necessary to have a standard staging to investigate this problem, factors influencing it, and the effect of different therapeutic procedures on the course of disease. The aim of this study is to estimate the prevalence of pelvic organ prolapse in menopausal women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse. Patients & 240 menopausal women with intact uteruses who were referred to gynecology clinics with any complaint were included in this cross-sectional study. The subjects underwent a POPQ examination during a maximal valsalva maneuver. In addition, they were asked to complete a questionnaire containing some risk factors associated with pelvic organ prolapse. Evaluation of the obtained data revealed the following: age= 58.6±6.1 years, BMI= 27.1±1.04kg/m2, median vaginal parity= 3(range 0-12), and mean years of age after menopause= 8.6 years. Using POPQ system, the subjects were divided into five stages: stage 0 4.2%(n=10), stage I 28.3%(n=68), stage II 61.7%(n=148), stage III 4.2%(n=10), and stage IV 1.7%(n=4). Age(P<0.001), BMI(P<0.001), education(P=0.001), the number of deliveries(P=0.001), age of the first delivery(P=0.001), age of the last delivery(P=0.001), asthma(P=0.001), and waist to hip ratio(P=0.001) correlated with the stage of prolapse. Some degrees of pelvic organ prolapse are quite common in elder women, a fact which should be considered in clinical approaches to these patients. The risk factors vary depending on the nature of supportive defects which involve anterior, posterior or apical walls.

Preeclampsia and eclampsia are threatening complications of pregnancy that influence the health of mothers and their fetuses therefore,the prevention of these complications is very important. The need for vitamin C increases during pregnancy and breast-feeding, so providing mothers with vitamin C through natural diet is very prominent. The aim of the present study is to evaluate the correlation between the consumption of diet rich in vitamin C and preeclampsia and eclampsia. Patients & In this case-control study, data collection was done through interviews and filling out questionnaires consisting of two parts. The first section included questions related to background variables and the second part contained some questions relevant to the frequency of the consumption of vitamin C-rich foods. Then, the reported amounts of ascorbic acid in urine and plasma were recorded. 154 women who participated in this study had been selected through a continuous sampling method. The subjects were divided into two groups of case and control. The case group included 75 women with preeclampsia and eclampsia, and 79 women not attacked by preeclampsia or eclampsia formed the control group. The age range of the subjects was between 18 and 35 years. Both groups were matched according to their gravida and multivitamin supplement consumption. The findings indicated that there was a meaningful relationship between preeclampsia, eclampsia and the consumption of vitamin C-rich foods. This relation was significantly meaningful according to the number of servings and also the amount of vitamin C received: for the number of servings for both fruit and vegetables (P=0.00), and for the amount of vitamin C received from diet(≥85mg/day)(P=0.00). Also, the concentrations of ascorbic acid in plasma and urine were(P=0.03) and(P=0.05) respectively, which was significantly related to the presence of preeclampsia and eclampsia. As the results showed, there were direct relations between preeclampsia, eclampsia and insufficient consumption of vitamin C. Proper educational programs about nutrition during pregnancy, especially during the first trimester of the first pregnancy, are recommended and prospective studies are also suggested in order to confirm the existing findings.

Nowadays one of the problems in developing countries is pediatric diseases and their mortalities. In this respect diarrhea plays a significant role. Cryptosporidium is recognized as an important widespread cause of severe and prolonged diarrhea mainly in immunocompromised or malnourished children, but there is no attention to identifying the parasite. The present study was designed and undertaken to assess the prevalence rate of agents causing diarrhea and determine the role of cryptosporidium and its relationship to some potential risk factors. In this cross-sectional study carried out during twelve months(from June 2002 to June 2003), stool samples from 420 children under 10 years of age with diarrhea who were admitted to Tehran Children Medical Center were screened. To identify parasites, direct smear, formalin-ether and modified acid fast staining techniques were applied. In addition, in order to distinguish pathogenic bacteria, differential media and polyvalent standard antisera were used. The obtained data was analyzed using descriptive and analytical statistics, i.e. Chi-square, t-test and Fisher exact test. This study showed that after bacteria, parasites were important causes of diarrhea, and cryptosporidium(2.4%) following giardia(2.9%) was the second parasite isolated in children with diarrhea. Statistical analysis of our results indicated that existence of cryptosporidium was significantly related to the presence of mucus in stool(P<0.003), immune deficiency(P<0.01), and age(P<0.017). This study emphasized that laboratories include appropriate diagnostic techniques for cryptosporidium in the routine examination of watery or mucoid diarrheal stool specimens, particularly for immunosuppressed patients.

Metronidazole-based quadruple therapy is widely used by physicians as the first line regimen for eradication of helicobacter pylori(H.pylori) in Iran. However, high rate of metronidazole resistance in Iran casts doubt on the efficacy of such regimens in this country. In this respect, this study tries to determine the efficacy of a quadruple therapy based on metronidazole as the first line treatment of H.pylori. Patients & Two hundred fifty-eight patients with peptic ulcer and proven H.pylori infection were included to take a two-week quadruple therapy consisting of metronidazole, bismuth subcitrate, amoxicillin and omeprazole followed by an additional two-week course of omeprazole. Eradication was described as negative 13C-urea breath test(UBT) one month after the completion of the treatment. The patients’ mean age was 45 years and 64.1% of the subjects were female. Seven patients could not complete the treatment course because of intolerable treatment side effects. Eradication rate was 34.9% based on intention-to treat analysis and 35.9% based on protocol analysis. Quadruple therapy based on metronidazole and amoxicillin has limited efficacy in Iran and should not be used for eradication of H.pylori in this country.

Epidemic acute post streptococcal glomerulonephritis(APSGN) usually shows a good prognosis in children, but some degrees of renal damage have been reported in sporadic forms. The aim of the present study is to evaluate the correlation between the severity of initial manifestations of APSGN and its prognosis in children. Patients & The medical records of 66 children with APSGN who were admitted between 1989 and 2003 were reviewed. This retrospective descriptive study included criteria such as hematuria, recent streptococcal infection, transient decrease in C3, and short-term follow-up for at least six months. The severity of the disease on admission and the severity of renal damage on the last visit were scored. We used Students’ t-test, Wilcoxon rank test and Spearman to compare the means, scores and correlation respectively. P<0.05 was considered significant. 66 children including 51 males and 15 females with the mean age of 8.94 years(±2.4) entered the study. The frequency of moderate to severe hypertension(P=0.03), hyperkalemia(P=0.01), azotemia(P=0.034) and proteinuria(P=0.01) was higher in children under ten. However, clinical, laboratory, and total scores on admission were not significantly different in the two groups. After 1.72 years of follow-up on average, 63% recovered, 6.34% showed some degrees of renal insufficiency, 7.57% had proteinuria, 28.78% presented abnormal urinalysis, and 4.54% remained hypertensive. There was a statistically significant correlation between the initial total laboratory scores and the final scores on the last follow-up(P=0.0001). Despite favorable course of APSGN, the persistence of some degrees of renal damage is not beyond expectations. Therefore, a longer period of follow-up, especially for patients with more severe initial clinical manifestations, is recommended.