Acta Medica Iranica
Volume:46 Issue: 1, Jan - Feb 2008

Biophysical profile (BPP) test is the most commonly used antenatal test of fetal well-being. Purpose of this study is determining the influence of acoustic stimulation (AS) on BPP testing time. About 55 pregnant women at 35 to 42 weeks who referred to department of Obstetric & Gynecology at university of medical sciences, Tabriz, Iran, were selected randomly. We used abdominal ultrasound guidance to place buzzer like device with power of 110 dB at the skin surface of the maternal abdomen, close to the fetal head. BPP test performed and BPP mean testing time calculated before and after AS. Data compared and analyzed by paired t-test. The results showed that fetal AS reduces the overall mean testing time from 24 minutes to 5 minutes. This clinical application can be helpful in busy clinics when rapid assessment of fetal health is required.

Acute idiopathic peripheral facial paralysis (Bell''s palsy) is the most common disorder of the facial nerve. Most patients recover completely, although some have permanent disfiguring facial weakness. Many studies have attempted to identify an infectious etiology for this disease. Although the cause of Bell''s palsy remains unknown, recent studies suggest a possible association with Herpes Simplex Virus-1(HSV-1) infection. In this case-control study we investigated the presence of DNA of HSV in the saliva of 26 patients with Bells palsy in first and second weeks of disorder compared to normal population who were matched in sex, age, as well as history of diabetes mellitus, hypertension and labial herpes. In the case group 3 and 7 patients had positive polymerase chain reaction (PCR) for HSV in first and second weeks of disease respectively compared to 4 in controls. It means that there was not any relationship between Bell''s palsy and HSV in saliva either in first or in second week. Two and 6 of positive results from the sample of first and second weeks were from patients with severe (grade 4-6) Bell''s palsy. Although the positive results were more in second week in patient group and more in severe palsies, but a significant relationship between Bell''s palsy or its severity and positive PCR for HSV was not detected (P >0.05).

The etiopathogenesis of dementia in Alzheimer''s disease (AD) is still unclear. However, long-term oxidative stress is believed to be one of the major contributing factors in progression of neuronal degeneration and decline of cognitive function in AD. In order to assess the presence of oxidative stress in AD, we examined the enzymatic activities of the erythrocyte Cu-Zn superoxide dismutase (Cu-Zn SOD), glutathione peroxidase (GSH-Px), catalase (CAT), and plasma level of total antioxidant status (TAS) in AD and control groups (age and sex-matched). The results showed that the Cu-Zn SOD activity was significantly higher and the level of GSH-Px and TAS activities were significantly lower in AD subjects than that in the control group (2111±324 U/grHb, 43.7±11.6 U/grHb, and 1.17 ±0.23 mmol/L compared with 1371±211 U/gHb; t= -2.17, p=0.036, 56.3±9.5 U/gHb; t=3.8, p=0.014, and 1.54±0.2 mmol/L; t=11.18, P<0.001, respectively). While, the erythrocyte CAT activity was lower in AD subjects compared to the control group, the difference was not statistically significant (t=1.3, P=0.15). These findings support the idea that the oxidative stress plays an important role in the pathogenesis underlying AD neurodegeneration. In addition, the enzymatic activity of the erythrocyte Cu-Zn SOD and GSH-Px and the plasma level of TAS can be used as a measure of the oxidative stress and a marker for pathological changes in the brain of patients with AD.

Arteriovenous fistulae traditionally have been placed in the upper extremity. Experience with groin hemodialysis access has been discouraging because of high infection rates and associated limb amputation. The aim of this study was to determine infection rates, patency rates, and possible predictive factors for prosthetic thigh angioaccess outcomes in our hemodialysis patient population. A prospective study was performed for 53 patients who underwent placement of thigh vascular access graft at Sina Hospital, Tehran University of Medical Sciences, between Jan 2000 and July 2005. Demographics, complications, and subsequent treatment were recorded. Survival distributions were plotted using the Kaplan-Meier method for graft survival (primary patency). Log rank tests were used to evaluate for statistical differences in survival distribution between different groups. The primary patency rates were, 78.4%, 61.2%, 56.2%, and 50% at 3, 6, 9 and 12 months, respectively. There were 15 (28.3%) access failures, related to infection in 2 cases (3.7%), thrombosis in 10 cases (18.9%) and bleeding in 3 case (5.7%).There was no limb ischemia.No significant differences in infection rate or graft patency rates were found by patients'' age and gender. A PTFE vascular access in the thigh is not associated with higher morbidity compared with the upper extremity, and should be considered as a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. The incidence of infection and thrombosis in our series is comparable with rates reported in the literature for lower extremity polytetrafluoroethylene angioaccess grafts.

The health and therapeutic employees are facing with some particular hazards. The existing insurance system has a lot of different shortcomings. Determination of the frequency and type of accidents in a hospital was the main objective. All accidents were recorded and the study period was divided in to 3 periods. The victims who reported their accident were classified from personality point of view and the accidents of highly reliable employees were analyzed. Although number of needle-stick was relatively high (4.5%), cuts (45.4%) were on top. Youngsters had the highest injury rate. Creation of a unique record keeping system for the country or even for the world was the final conclusion.

Diagnosis of hepatitis B is routinely based on of serological assay of hepatitis B surface antigen (HBsAg). Occult hepatitis B virus (HBV) infection is generally defined as the detection of HBV -DNA in the serum or tissues of subjects who have negative test for HBsAg. Transmission of HBV infection has been documented from HBsAg negative, anti-HBc positive blood and organ donors. The aim of this study was to determine the rate of occult HBV infection among HBsAg negative and anti-HBc positive blood donors of Rafsanjan blood transfusion center. Sera from 270 healthy blood donors who were negative for both HBsAg and anti-HCV, were tested for anti-HBc antibodies by use of ELISA technique. The samples that were negative for HBsAg but positive for anti-HBc markers also examined for the presence of HBV-DNA by polymerase chain reaction (PCR). Out of 270 HBsAg negative blood samples, 14 samples (5.18%) were positive for anti-HBc antibodies. HBV-DNA was detected in 4/14 (28.57%) of HBsAg negative and anti-HBc positive samples. Moreover, anti-HBs antibody was detected in 2/4 (50%) of HBV-DNA positive samples. These results indicated that HBV-DNA found in the majority of HBsAg negative and anti-HBc-positive donors. In addition, the present study recommend the incorporation of routine anti-HBc screening of blood as a surrogate marker of occult HBV infection to prevent some transfusion-transmitted HBV infections.

The aim of this study was to compare the efficacy of antireflux therapy with both conventional management and those with no treatment in children with chronic otitis media with effusion (COME). In this prospective randomized clinical trial ninety children with COME which lasted more than 3 months or more, documented by physical examination and Type B tympanogram in at least one ear without clinical signs and symptoms of active infection that were refractory to 3 period of antibacterial treatment, were randomly allocated to receive a 3 month course in three groups of antireflux treatment (AR group, Cisapride 1 mg/kg/day), conventional antibacterial treatment (AB group, Co-amoxiclave 40 mg/kg/day TID) and those with no treatment (Control group, no medication). All patients were followed every month. The favorable response was considered as complete resolution of effusion clinically and type A or more than -200 peak in tympanometry. Of the 30 patients assigned to AR group, 10 (33.3%) were judged to be clinically cured and in AB group 12 (40%) were cured while only 3 (10%) in control group were cured. The cure rate in AR and AB groups was significantly higher compared with control group but there was no significant difference between cure rates in AR and AB groups (P=0.59). No subjects experienced complications during or after the study. There may be a possible role for GER medical management in patients with COME. Further investigations are necessary in order to confirm this hypothesis.

Impaired fasting glucose identifies individuals at high risk of progression to diabetes but the role of IFG as a coronary artery disease risk factor, independent of its progression to diabetes and its association with other coronary artery disease risk factors, is unclear. A cross-sectional study was conducted to evaluate the hypothesis that impaired fasting glucose increased the likelihood of atherosclerotic plaque formation. Blood chemistry data as well as traditional coronary artery disease risk factors from 812 patients referred for coronary angiography to heart centers in Shahid- Chamran and Sina hospital, Isfahan, Iran were recorded. The population were stratified into three groups according to American Diabetes Association criteria: normal fasting glucose (n=608), impaired fasting glucose(n=92) and diabetes mellitus(n=112).We use extent, Vessel and stenosis scores to indicate the coronary artery involvement. KrusKal-Wallis test showed that the means of extent, Vessel and stenosis scores are not significantly different between three groups(P> 0.05). Multivariate linear regression analysis, using extent score of coronary artery disease as dependent variable and traditional risk factors and impaired fasting glucose as independent variables did not show any significant difference either. Our data suggested that impaired fasting glucose is not associated with increased risk of coronary atherosclerosis.

A standard breakfast was evaluated as a screening test (BT) for gestational diabetes in a case-control study. Blood sugar (BS) was measured 1 hour after a breakfast that had 50gr simple sugar and was designed based on women preferences. In the same women glucose challenge test (GCT, 50gr 1hour glucose screening test) was performed one week later in randomized sequential. Cutoff values for both tests was 130 mg/dl. For both or one positive test GTT (100gr-oral glucose tolerance test) was performed. Sensitivity and specificity; optimal cutoff and concordance of both tests with GTT were calculated by X2, receiver operating characteristic (ROC) curve and kappa test. 41 women (29.3%) had positive GCT and 28 women (20%) had positive BT. 12 women (8.57%) had positive GTT. For BT and GCT, a sensitivity of 83.3% and 91.7% and specificity of 85.9% and 76.6% with cutoff level ≥ 130 mg/dl at 60 minute were found respectively. Optimal cutoff for BT and GCT were 130 mg/dl and 135 mg/dl respectively. Concordance of GTT with GCT and BT was 0.429 and 0.432, respectively. Standard breakfast can be used as an alternative method for assessing carbohydrate intolerance in pregnancy with same physiological response, better compliance and low cost.

Latex allergy has become an occupational hazard among healthcare workers. Atopy, intensity and duration of exposure have been recognized as predisposing factors for latex sensitization. Frequency of sensitization varies among countries. So we decided to investigate the prevalence of latex sensitization and potential risk factors among healthcare workers in a general hospital. In a cross sectional study by distributing a questionnaire among 876 employees of a general hospital, we investigated the prevalence of latex allergy and the potential risk factors for latex sensitization. We collected information about occupational history, including specific tasks performed, time of first exposure to latex, number of pairs of gloves used, and duration of weekly exposure. We also investigated the interval between first exposure and onset of symptoms. We asked about pre-existing rhinoconjuctivitis, asthma, atopic and contact dermatitis, hay fever, autoimmune diseases, and food allergies. This survey documented a high prevalence of adverse reaction to all latex containing materials (52.5%). 37.7% of responder had adverse reaction to latex gloves. The highest prevalence of adverse reaction to all latex containing materials was found in the surgical operating room, followed by emergency unit and internal medicine wards. According to this study, frequency of adverse reaction to latex was high among health care workers. This may be due to relatively low response rate, low quality of latex products in Iran, and the method of measurement. Whenever, the need for implementing prevention program, using latex-free methods and training of employees to reduce adverse reaction to latex is apparent.

Bacterial endocarditis is a serious disease that could occur after invasive dental procedures. Despite a large number of papers written about the knowledge of prevention of bacterial endocarditis among health care workers in western countries, little is known about awareness of this subject among practitioners and students in other countries. The purpose of the present study was to assess the knowledge of recommendations for prevention of bacterial endocarditis among a group of Iranian dental and medical students. A multiple choice test that included 15 questions about bacterial endocarditis and antibiotic prophylaxis was developed. The questionnaires were distributed to 136 dental and medical students who had passed a theoretical course about bacterial endocarditis successfully in the past. Success was defined as correct answers to at least 8 of the 15 questions. Of 136 students participating in this study, 34 (25%) passed the test successfully. The pass-rate of dental students (38%) was significantly higher than that of medical students (13.5%) (P < 0.05). The mean mark of dental and medical students was 6.74 ± 2.28 and 4.81 ± 2.1, respectively (P < 0.05). No significant difference in success rates or mean marks found according to sex or age in the present study.The results of the present study demonstrate an important lack of knowledge regarding prevention of bacterial endocarditis among a group of Iranian dental and medical students and the need for improved education in this field.

A number of studies has shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. The present study aimed to compare the pain-reducing effect of EMLA cream with that of orally administered glucose during venipuncturing in newborns in Yazd city. A randomized, controlled, double-blind Clinical trial was done on the 220 newborns undergoing venipuncture for clinical purposes. One hundred- six of the newborns received EMLA on the skin and orally administered placebo (sterile water) and 114 received orally glucose 30% and placebo (Vit A+D) on the skin. Symptoms associated with pain while venipuncturing measured by Neonatal/ Infant pain scale (NIPS) and crying time were compared between two groups. There were no differences in background variables between the 2 groups. The results showed that the NIPS scores were significantly lower in the glucose group (Median: 2) compared with the EMLA group (Median: 3) (P=.000). The duration of crying in the first 2 minutes was significantly lower in the glucose group (Median: 2sec) than in EMLA group (Median: 9sec) (P<.01). 12.3% and 29.2% of neonates in glucose and EMLA groups had NIPS above 3 respectively where the observed difference was found to be statistically significant (P<.05). Our study showed that compared with EMLA cream, orally administration glucose can be more effective, tolerable and convenient in reducing of pain resulting from venipuncturing in neonatal period.

Patients with syndrome X coronary disease represent a heterogeneous group of patients. Medical treatment with dilators and calcium channel blockers are not very effective. We evaluated the use of transmyocardial laser revascularization (TMLR) in treating 5 patients with this syndrome. Between May 2002 to December 2005, 5 patients with cardiac syndrome X (mean age of 49.7 years) underwent TMLR. All our cases were postmenopausal women. Mean class of Canadian class of angina was 3.4. Patients were none responding to maximum medical treatment. Angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on Thallium scan. We used Co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. Our patients were followed for 2.8 years. During follow up our patients remained asymptomatic and without any need medical treatment. Mean of Canadian class of angina after intervention was 1.8. Our patients returned to full activities. TMLR is an effective treatment in patients with syndrome X and coronary insufficiency.

There is a challenging debate on the effect of premature luteinization on the clinical outcome of ‘controlled ovarian hyperstimulation'' (COH) using long ‘gonadotropin-releasing hormone agonist'' (GnRHa) cycles. Premature luteinization is defined as late follicular progesterone/estradiol ratio more than 1 on the day of human chorionic gonadotropin (HCG) administration. We carried out a retrospective case-control study on 75 conceived cases versus 75 not-conceived control women, receiving long GnRHa cycles in their first cycle of treatment. Premature luteinization developed in 15% of the case group vs. 22% of the control group. Neither the late follicular progesterone/estradiol (P/E2) ratio was significantly different between the two groups, nor the day 3 follicle stimulating hormone (FSH), serum estradiol level on the HCG day, total amount of human menopausal gonadotropins ampoules, number of follicles, retrieved oocytes and transferred embryos. Endometrial thickness was significantly more in the pregnant women than in the non-pregnant group. Premature luteinization seems not to adversely affect the clinical outcome of COH.

Early recognition of Gestational Trophoblastic Neoplasm (GTN) will maximize the chances of cure with chemotherapy but some patients present with many different symptoms months or even years after the causative pregnancy making diagnosis difficult. Clinicians should be aware of the possibility of GTN in any reproductive age woman with bizarre central nervous system, gastrointestinal, pulmonary symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported five cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, acute abdomen, neurologic symptoms presenting without gynecological symptoms.

Pheochromocytomas are cathecolamine producing tumor arising from chromaffin cells of adrenal medulla and extra adrenal tissues. This is a report of a boy presented with headache and hypertension. In radiologic exams, an adrenal mass detected in the left side, with no renal tissue on that side. It was reported an adrenal pheochromocytoma in histopathology. Renal agenesis confirmed during surgery. All of the patients symptoms alleviated after the resection of tumor.

Langerhans cell histiocytosis (LCH) is the most common type of childhood histiocytic disorder with an incidence of 0.2 to 1 per 100,000 children under the age of 15 years (1). The clinical picture of LCH varies from single system (S-S)bone or skin disease to multi-system disease (M-S) (2). We report a neonate with disseminated papulonodular eruption containing mononuclear CD1a and S100 positive histiocytic cells infiltration at epidermis and underlying dermis. The diagnosis of a congenital self healing Langerhans cell histiocytosis (CSHLCH) was made and follow up showed a complete recovery of the eruptions, leaving hypopigmented macules in the sites corresponding to the initial findings.