Acta Medica Iranica
Volume:45 Issue: 6, Nov-Dec 2007

The most important and widely prevalent nematodes of sheep are the trichostrongyle group parasites, including nematodirus parasite. Accidental infection of man by nematodirus has been reported in Iran. Glutathione S-Transferase enzymes (GSTs) are detoxification enzymes in parasites such as nematodirus. Therefore, GST enzymes of these parasites could be a target for evaluation of drugs effect as triclabendazole (C14H9CL3N2OS). For this reason, GST enzymes were purified from nematodirus parasite and sheep liver tissue by glutathione affinity chromatography and prepared their SDS-PAGE banding pattern for GST fraction separation. GST enzymes specific activity levels are also assayed in the whole extract and purified solutions with reduced glutathione (GSH) and 1-chloro-2, 4-dinitrobenzen (CDNB) secondary substrate. Finally, GST inhibition assay was investigated in the solutions by powder and bolus forms of triclabendazole. The level of GST specific activity in purified solutions was detected 9.86 µmol / min/ mg protein for nematodirus parasite and 37.84 µmol/ min/ mg protein for liver tissue. Comparison of the effect of powder and bolus of tricla bendazole on solutions revealed inhibition concentration (IC50) 5.54 and 6.01 µg/ml for nematodirus GST and 8.65 and 9.70 µg/ml for liver tissue GST, respectively. These findings revealed the possibility of isolation and inhibition of nematodirus GST by triclabendazole, and more tolerance of liver tissue than parasite against this drug in vitro situation.

Extensive blood loss in total hip surgery is well known and is associated with a high transfusion rate of allogeneic blood. The aim of this study is to assess the effects of intraoperative tranexamic acid on post-operative bleeding and need for allogeneic transfusion during hip fracture surgery. We investigated 67 patients undergoing hip fracture surgery in a prospective, randomized, double-blinded study. 32 patients received tranexamic acid (TA) given in a bolus dose of 15 mg/kg before surgical incision. The remaining, 35 patients were allocated as control group. Postoperative bleeding, transfusions, complications, and hospital stay were recorded. The intraoperative bleeding was significantly lower in the TA group (652 ± 228 ml vs. 1108 ± 372 ml, p <0.003). Post operative drainage was lower in TA group (296 ± 85 ml vs. 375 ± 110 ml, p <0.195). There were no differences in coagulation parameters. The rates of transfused patients in TA and control groups were 37 % and 57 %. In TA group, hospital stay was 4.3 ± 1.6 days (vs. 5.8 ± 1.5 days in control group; p< 0.05). There is one in hospital mortality in control group. We conclude that tranexamic acid significantly reduces blood loss during hip fracture surgery.

The purpose of this study was to compare the efficacy and safety of misoprostol and oxytocin for induction of labor. In this prospective and randomized controlled trial one hundred twenty women with an unfavorable cervix who underwent labor induction were assigned to receive either intravenous high dose oxytocin(6mIu/min) or intravaginal misoprostol 50µg every 6 hours for two doses. Twelve hours later if labor was not stablished oxytocin induction was initiated per standardized protocol (3mIu/min). Mean Bishop Score change (± SD) over the initial 12 hours interval was significantly greater in the misoprostol group (11.98± 1.55) compared with the oxytocin group (8.83 ± 2.61). There were no statistically significant differences in the median duration of labor (449±261.1 min, 514.5±288.5 min, respectively;p=0.22), the mode of delivery or the adverse maternal /neonatal out come among the two groups.Use of misoprostol as a labor preinduction / labor induction agent results in greater Bishop score changes compared with high dose oxytocin and both of them are comparable.

Several methods have been used to relieve pain in neonates. The objective of this study was to assess the analgesic effect of 50% glucose and water during hepatitis B vaccination. In this randomized controlled trial, 90 term neonates were studied. Infants were randomly assigned to one of the three equal sized groups. First, heart rates were measured by EKG monitor. Then, 2mL of either 50% glucose or sterile water was administered into the mouths of infants in groups one and two, respectively. No intervention was done for group three. During vaccination until three minutes after, crying of babies was taped. Heart rates were measured during injection until 60 seconds. Mean values of duration of crying for glucose, water, and no intervention groups were 21.1 s, 33.3 s, and 56.9 s, respectively, which were significantly different (P= 0.0003). Post hoc test revealed substantial differences between groups one and three (P= 0.0001) and between groups two and three (P= 0.006). However, groups one and two were not statistically different (P= 0.19). Moreover, heart rate did not rise significantly in any of those groups. Both 50% glucose and water showed analgesic effects in neonates.

Tumors of the central nervous system (CNS), occur relatively frequently during the early years of life. They are the most common solid tumors of childhood and are second only to leukemia in overall cancer incidence and account for a high proportion of deaths. In different studied performed in several countries, astrocytomas and other gilomas (combined) account for half of the CNS malignancies, followed by PNET/MB, and ependymomas, and then craniopharyngioma. We have undertaken a perspective study with 349 brain tumor patients, ranging from 0-14 years of age, throughout a five- year period (1998-2003). Who were admitted in Tabriz children hospital or were diagnosed in Tabriz Hafez imaging center, during radiological evaluation by CT. Craniopharyngioma was the most common type of tumors among patients studied in our Series, and astrocytomas was second and medulloblastoma was third common type. The Male/Female proportion of patients in total brain tumors according to our results is 1.56 and it is similar to previous studies. About medulloblastoma and ependymomas, Male/Female proportion of patients in this study is less than 1 (0.88, 0.7), but in previous series it seems to be more than 1 (about 1.4). Age- related distribution of brain tumors in children under the age 14 was similar to that of other series to some extent. Also, since the causes and risk factors of CNS cancers remain largely undetermined, we could not reach a significant relationship between the tumors and residency of patients. Hope our results make a useful for the future studies in this field, and differences obtained in this study with results of other series, can help us more and more in management and treatment strategies in brain tumors in children of our population.

Determination of birth indices is essential for primary supportive care, evaluation of perinatal anomalies, determination amount of difference from standard values and for further follow up. In this study using a multicentre sampling, a number of 2832 healthy neonates selected. Mean and percentile values of four main birth indices; weight, height, head and chest circumference are presented. In this study, males outnumbered the females (50.8% vs. 49.2%). Mean (± SD) weight, height, head and chest circumferences were 3231.70 gr (±3.92), 49.77 cm (±1.76), 35.03 cm (± 1.27) and 33.34 cm (±1.56), respectively. Weight, height and head circumference had significant statistical differences in male and female. Chest circumference had difference in gender groups, but it seemed to be clinically not significant (mean difference= 0.416). Birth weight in both genders plus height and chest circumference in girls were significantly lower than NCHS standard values. But, head circumference was more. Height and chest circumference of males had no statistically difference.

There are many techniques for reconstruction after total pharyngolaryngoesophagectomy. The use of a transposed stomach to restore gastrointestinal continuity, and this combined cervical and abdominal approach for pharyngolaryngoesophagectomy and gastric pull up has become one of the most popular. This retrospective study is a review of 50 consecutive Iranian patients who underwent pharyngolaryngoesophagectomy and gastric pull up in Amir-Alam Hospital affiliated to Tehran University of Medical Sciences, to determine the complication and survival rates. The clinical data of 50 consecutive cases of cervical esophagus carcinoma and squamous cell carcinoma of the hypopharynx treated by pharyngolaryngoesophagectomy and gastric pull-up were analysed. The age, gender, operating room time, operative mortality, major postoperative complications and survival rate were retrieved. Survival time was studied using Kaplan-Meier method. The postoperative complications were wound infection in five patients, pulmonary complications in ten, Stomal stenosis in six, cutaneous fistula in four, Gastric outlet obstruction in three. There were no intraoperative deaths. One month mortality was 10 per cent. The median survival for patients who underwent pharyngolaryngoesophagectomy and gastric pull-up procedures was 21 months and the 5-year survival was 18%.

-------------------------------------------------------------------------------- The presence of anatomic variations of paranasal sinuses must be noted in order to attain a full understanding and accurate diagnosis of chronic sinusitis. The frequency of anatomic variations in chronic sinusitis is different in various studies. The purpose of this study is to assess the frequency of anatomic variations in chronic sinusitis patients admitted to Otolaryngology ward of Shahid Sadoughi hospital in the year 2004 and underwent functional endoscopic sinus surgery. Based on preoperative paranasal sinus CT scan the extent of patients diseases on a scale of 0-IV and the presence of anatomic variations was determined. A total of 120 patients were included. We found Agger Nasi cells in 43(36%), Haller cells in 5 (4.17%) conchae bullosa in 15(12.5%), paradoxical middle turbinate in 2 (1.67%) and septal deviation in 54 patients (45%). Patients with Agger Nasi (P.value: 0.015) and conchae bullosa (P.Value: 0.024) demonstrated significantly higher scores on sinus CT scan compared with patients without Agger Nasi cells and conchae bullosa respectively. Three months postoperatively we observed significantly less resolution of nasal congestion (P.Value: 0.006) in patients with septal deviation than patients without it. No significant difference was seen among patients with and without other anatomic variations with regard to resolution of rhinorrhea and nasal congestion three months postoperatively

Lecithin cholesterol acyltransferase (LCAT) plays a major role in the removal of free cholesterol from tissues via assisting HDL-C maturation, and its activity has been proposed as the main indicator of HDL-C function. The aim of the study was to measure LCAT activity in type 2 diabetic patients and to elucidate whether LCAT is associated with metabolic control, and insulin resistance. A case-control study was conducted in Imam Khomeini Hospital during 2006, recruiting 45 type 2 diabetes mellitus patients and 45 healthy subjects. Cases and controls were matched regarding gender, age and body mass index (BMI). FBS, lipid profile, LCAT activity, HbA1C, insulin were measured and insulin resistance (HOMA-IR)was calculated for both patients and controls. The studied variables were then compared between the two groups, and the association of LCAT activity with any of the variables was examined. Twenty-five subjects were female and 20 male both among patients and controls. Mean age of diabetics was 49.9 yrs (range, 40-64), and of controls 51.1 yrs (range, 39-64). FBS, HbA1C, HOMA-IR and TG in patients were significantly higher than controls, and HDL-C in controls was significantly higher than patients. LCAT activity of patients (73 9.1 µmol/L/h) was significantly lower than that in controls (88 4.5 µmol/L/h) (p<0.001). LCAT activity had significant inverse correlations with HbA1C and duration of diabetes. After multilinear regression analysis in patients, LCAT activity was only correlated with HbA1C level (ß= -0.9, p<0.001). LCAT activity had no significant association with HDL-C and HOMA-IR in any of the groups.LCAT activity is significantly decreased in patients with type 2 diabetes compared with healthy controls, and has an inverse correlation with the magnitude of hyperglycemia.

Rheumatoid arthritis is the most common inflammatory joint disease with 1 percent prevalence in community which presents with symmetrical polyarthritis of hands with inflammatory behavior. Several studies in recent years were conducted for evaluation of inflammatory cytokines such as IL1-α (Interlukin 1α) and TNF- α (Tumor necrosis factor) in rheumatologic disorders including rheumatoid arthritis to find new treatment methods base to pathogenesis. In this study different serum levels of IL1-α and TNF- α in 160 rheumatoid arthritis patients with active and inactive disease and also disease with or without bone erosion are assessed. 4% of our patients had rheumatoid nodule and 70% of all patients had positive RF, IL1-α, and TNF- α levels. Active with bone erosion patients had IL1-α and TNF- α serum levels higher than active without bone erosion patients; it was not significant in T-test but it was significant in Mann-Whitney Test. The results was the same as expected; IL1-α, and TNF- α serum levels were higher in active with bone erosion in comparison with inactive without bone erosion patients.

Heart failure (HF) is a common disease with high health care costs and high mortality rate Knowledge of the health-related quality of life (QOL) outcomes of HF may guide decision making and be useful in assessing new therapies for population. Yet little is known about QOL of HF patients in Iran. To assess health related QOL of patients with HF with two different instrument and to correlate these two measures and to assess the role of relevant factors. Analytic cross sectional study was conducted involving 230 adult patients hospitalized with HF, demographic data and health -related quality of life were determined by interview; for assessing of quality of life was used SF-36 and Minnesota questionnaires. Simple random sampling from ward patients list choose patients. Patients had no other man diseases that affected their quality of life. 118 female (53.3%) and 112 male (48.7%) with mean age of 51.4 +/-13.18 were collected. 61 patients (26.5%) were smoker and 100 patients (43.5%) had positive familial hearth disease history. Quality of life in some subscale: Physical functioning, Role physical and vitality, and Minnesota scare affected from patients age. Male patients had better quality of life than female in Minnesota scale and physical functioning, body pain, general health, vitality and emotional well-being. Duration of diagnosis affected Minnesota scale and role physical. Positive familial heart disease history affected physical functioning. Iranian patients have worse quality of life than other patients. This shows patients age, sex, duration of diagnosis, smoking and positive familial hearth disease history affected quality of life in heart failure patients.

The search continues for a safe effective and cheap method for mid-trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule is still not fixed. The objective of this study was to compare the efficacy and adverse effects of two dose regimens of vaginal misoprostol for second trimester termination. Prospective randomized double blind controlled trial was undertaken in 162 women at 14-24 weeks gestation in a teaching hospital. Subjects were randomized to receive either regime A: 400 µg of intra vaginal misoprostol every 6h, or regime B: 200 µg of intravaginal misoprostol every 6h. The main outcome measure was the success rate at 24h, total dose required, induction-abortion interval and adverse effects. Data was analyzed by student''s t-test, Mann-whitney U-test, the chi-squared test or Fisher''s exact test. There was a significant difference in the success rate at 24 and 48hr (regime A: 74% and 97.5%; regime B: 61.7% and 88.9% P=0.016 & 0.029 respectively) and in the mean induction abortion interval (14 Vs 20h, P=0.01) Mean Misoprostol requirement was significantly higher for regime A (731 µg ± 362 µg vs. 531µg ± 357µgm, P=0.001). Use of 400 µg vaginal misoprostol is superior to 200 µg vaginal misoprostol for second trimester abortion.

Urine dipstick is a useful and commonly used test because of its rapidity and low cost; however its diagnostic accuracy is debatable. This research were carried out To determine sensitivity, specificity and positive and negative predictive values of Nitrite (NIT) and Leukocyte Esterase (LE) testing in relation to urine culture. This research was conducted on 100 hospitalized patients with clinical signs and symptoms compatible with urinary tract infections (UTI). Urine culture and dipstick tests were carried out on urine samples of all patients. Urinalysis LE and NIT studies were performed in fresh and uncentrifuged urine by using a manual urine analyzer (rapignost, Co. Marburg, Germany). The urine culture was considered as gold standard. Urine cultures were positive in 75 (75%) patients. Dipstick tests of urine were positive in 79(79%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Dipstick test were 76%, 12%, 72% and 14% respectively. Although dipstick test of LE and NIT can avoid a large part of the cost incurred by urine culture, any method of urine screen (LE and NIT) shouldn''t be substituted for a urine culture in the symptomatic patients in childhood.

The birth weight is one of the important factors affecting the perinatal morbidity and mortality. Fetal macrosomia is associated with increased risks of cesarean section and trauma. To determine prevalence and outcome of the macrosomic infants, this case-control, prospective study is performed in the two university hospitals in Tehran during a 36- month period between 2002 through 2004. 1000 neonates with birth weight of at least 4000g (<90th centile) constituted the case group. Another 2000 Cases amongst the newborns delivered in the same period between 2500 and 3999g (10th-90th centile) formed the control group. A total of 17236 deliveries occurred during the study period. The prevalence of macrosomic deliveries was 5.8 and prevalence of the deliveries (>4500g or heavier) was 0.84%. The mean birth weight of study group was 4254215 and 3245310g of control group (P<0.001).While the cesarean section rate was 35.2% for study group and it was 18.5% for the control group (P<0.001) in the study group. 16 cases of clavicular fracture (1.6%), 13 cases of brachial plexus palsy (1.3%), (p<0.001). No perinatal mortality was recorded in two groups. There were 12 cases (1.2%) of asphyxia related to delivery in the study group (p<0.01). The rate of maternal complication, were significantly higher in the study group (p<0.01). The macrosomic infants are in increased risk for birth trauma and asphyxia. The risk of birth trauma for the infants weighing 4500g or more is even greater. The majority of factors which lead to the delivery of macrosomic infants are preventable.

To determine the clinical features and treatment outcomes of infant with immune thrombo-cytopenic purpura (ITP). Retrospective analysis of 96 infant ITP patients treated from 1995 to 2005. The data abstracted comprised age, gender, clinical features, and treatment outcomes. The 56 male and 40 female infants had a median age of 3 months. Eighty presented with purpura, sixteen with active mucosal bleeding. The median platelet count was 13000 /l. Seventy-seven infants received intravenous immunoglobulin (IVIG), eighteen steroids and one patient was observed. Ninty-sex (96%) responds to a single course of treatment. Infant with ITP respond favorably to treatment.

Short rib polydactyly syndrome (SRPS) is a very rare congenital anomaly that is classified into four subtypes. It is an autosomal recessive inherited disease. We report a case of this syndrome without a previous family history of congenital defects.

To report a case of buphthalmos with neurofibromatosis (NF-1) who suffered with blindness suffered enucleation. Physical examination & histopathology were performed. Physical examination revealed Buphthalmos & vascularized cornea with lower lid ectropion and orbital deformity. Histopathologic findings shows plexiform neurofibroma in orbital tissue with scleral wall involvement. And hamartomatous proliferation in choroid & cilliary bodies with melanocytic elements. Few NF-1 cases with buphthalmos have been reported. But cases with complicationg buphthalmos (retinal Detachment & optic nerve Atrophy) suffering enucleation are very rare.

Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 (91 patients) with half-dose (1.87 mg) depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 (91 patients) with standard daily dose (0.5 mg) buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin (HMG) stimulation. No significant differences were found among those who received HCG in terms of clinical pregnancy rate (34.4% in both groups), implantation rate (14.8% in group 1 versus 11.1% in group 2), fertilization rate (93.3 versus 95.6%), poor response rate (11.1 versus 6.7%), and miscarriage rate (11.1 versus 7.8%). No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 (11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, p = 0.030). A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections.