Acta Medica Iranica
Volume:39 Issue: 3, May -June 2001

Abstract: The pediatric risk of mortality (PRISM) score is a measure of illness severity based on abnormalities observed on bedside examination and laboratory assessment at pediatric Intensive care Unit (PICU) admission to predict mortality probability. Our study was performed on 205 patients who were admitted to PICU of children’s Medical center (CMC) over a period of 6 months.Data were recorded prospectively from observations at the time of admission in PICU and PRISM score was measured at admission (PRISMa) and after 24 hours (PRISMI). The mortality probability raised from 0 at low scores, approaching 1 above a PRISM score of near 40. Based on PRISMa score of 11.36, (cut-off point), patients were divided in two groups; 71% with low risk of mortaligy, who had significant difference in length of stay in ICU, admission costs and mortality rates. Other variables such as referring from other centers, mechanical ventilation at admission, and length of stay in ICU had s significant statistical relation with mortality rate.For data obtained, observed mortality rates were near similar to predicted. Athough pre-ICU PRISM score cannot be used as a single certain predictive value, but it is useful in predicting severity of illness and mortality probablitiy. Further investigations is required to determine the effectiveness of PRISM scores in our country

Abstract: Brueclla is a gram negative bacteria that causes Brucellosis. Lipopolysaccharide (LPS) \, the pathogenic agent of Brucella is composed of O-chain, core oligosaccharide and lipid A. in addition, the structural and biological properties of different LPS extracted from different strains are not identical. The first defense system against LPS is nonspecific immunity that causes macrophage activation. Activated macrophages produce oxygen and nitrogen radicals that enhance the protection against intracellular pathogens.In this experiment LPS was extracted by hot phenol- water procedure and the effect of various LPSs on nitric oxide prodution by peritoneal mouse macrophages was examined.Our results demonstrated that the effect of LPS on nitric oxide production is concentration-dependent we observed the maximum response in concentration of 10-20 microgram per milliliter. Also our results demonstrate that LPS extracted from vaccine Brucella abortus (S 19) had a highe effect on nitric oxide production than the LPS from other strains

Abstract: Metronidazole, a synthetic derivative of the nitroimidazole class is a known antibacterial and antiprotozoal agent. The hypolipidemic effect of metronidazole was not known. The authors noticed it incidentally for the first time. After quazi experimental studies on several cases, it was revealed that 750 mg of metronidazole for 10 days significantly decreased serum cholesterol. This trial was performed in three stages of 14 days each as challenge, de-challenge and re-challenge on 30 subjects including 6 male and 24 female in the age limits of 40 to 73 years (mean 58.7 years). Results of present trial revealed that metronidazole 750 mg daily in divided doses for 14 days decreased the average of total blood cholesterol in 30 cases by 14.7% (P=0.025) and LDL cholesterol by 19.1%. (P=0.005). Decrease in serum cholesterol and triglyceride and increase in HDL cholesterol also accompanied fall of LDL cholesterol level. While comparing the mean of final results in 19 cases, with that of 30 subjects pre trial serum lipid profile it was revealed that treatment with 84 tobles of metronidazole in divided doses within six weeks of whole trial period was able to decrease the mean total choleterol, LDL cholesterol and serum triglyceride by 16.23%. 21.2% and 23.9% respectively along with a rise of mean HDL cholesterol in large scale to evaluate the long-term benefit of metronidazole in controlling lipid disorders.

Abstract: The relation between microchimerism and allograft tolerance is still a mystery. In this study we determined the presence of peripheral blood microchimerism (PBMC) in female renal transplant recipients from living male donors with second round polymerase chain reaction (PCR). Second round PCR was used to find Y chromocome products. The degree of PBMC in renal transplant recipinents must be below the rate of 1.104 and second round PCR provides the deterction of PBMC at the rate of 1.106. we divided our patients into two groups according to allograft function. Group 1 (16 patients) and normal allograft function. Group 2 (6 patients) had chronic allograft dysfunction. First PCR didn’t show PBMC. Second round PCR with SRY primers of Y chromosome showed PBMC in 13.22 (59%) of patients. PMBC was positive in 10.016 (62%) of patients in-group 1 and 3.6 (50%) of patients in group 2. There was acute rejection in 4.13 (30.7%) and 2.9 (22.2%) of patients with positive and negative PBMC, respectively, in our study, there was no significant correlation between the presence of PBMC and allograft function and the frequency or severity of rejection episodes.

Abstract: Endotrachial intubation can have serious deleterious hemodynamic changes. Hypertension and tachycardia are especially dangerous in coronary artery disease, intracranial hypertension. Magnesium sulfate is known for its vasodilating properties. Several studies have reported favorable protective hemodynamic properties of magnesium when used as a premedicant in cardiac or elderly patients. Our aim was to evaluate whether magnesium had the same properties if used just before laryngoscopy in young healty subjects undergoing elective non-cardiac surgery. This double-blind study was done in Ahwaz university during a 6-month period starting at November 2000. 90 American Society of Anesthesia class I and II patients scheduled for elective surgery under general anesthesia were included. Premedication was excluded and patients were anesthetized with sodium thiopental 5 mg/kg, morphine 0.1 mg/kg, atracurium 0.6 mg/kg. Patients then received either 50 mg/kg (not exceeding 4 g) magnesium sulfate (n=45), or normal saline as placebo (n=45) in a double-blind (n=45), or normal saline as placebo (n=45) in a double-blind setting. Systolic and diastolic blood pressures and heart rate were recorded at 6 times: before induction, after induction 30 seconds and 1, 2, 3 minutes after intubation. Magnesium ion plasma levels were measured before induction and 5 minutes after intubation. Only diastolic pressure at 30 second after intubation had a significant lower value in magnesium group (P<0.002) and other variables were statistically nonsignificant. In the magnesium group Mg++ plasma concentration was 5.936±1.009 meq/l (mean±SD) at 5 minutes after induction. We concluded that magnesium sulfate had a very limited usefulness in the attenuation of blood pressure and heart rate in young healthy patients if given during induction of anesthesia.

Abstract: est (RST) is the most commonly used electrodiagnostic test to asses the defect of neuromuscular transmission, which is reported to be positive in the diffuse and restricted ocular forms 60-95% and 14-50%, respectively. In a cross-sectional study, to determine the efficacy of repetitive stimulation test in myasthenia gravis, we evaluated the results in 30 cases who were hospitalized in Imam Khomeini Hospital during 1996-1999. Patients were first selected clinically and then confirmed by Tensilon test.Various clinical types including generalized and restricted ocular forms with different severity and duration were entered in this study. Considering the fact that the positiveness of the test is enhanced by assessment of more muscle groups, we evaluated decremental response in the facial, proximal and distal muscles of limbs. 90% of patients had the generalized form of the disease, whereas ocular myasthenia gravis was seen only in 10% of the cases. 74% of females and 73% of males showed positive response (overall: 73.3%). No significant association was found between the positive response, and age and sex. Peaks of incidences of the disease for the males were in fourth and sixth decades and for the females in thired decades

Abstract: The total vitamin C content in human plasma is widely accepted as an indicator of the tissue status of vitamin C. A liquid chromatography method with ultraviolet detector (264 nm) for measuring ascorbic acid in human plasma was developed. A C18 reversed-phase column and cetrimide as an ion-pairing agent was employed. Ascorbic acid (AA) was measured after reducing L-dehydroascorbic acid to L-ascorbic acid with dithiothreitol. The stability of the ascorbic acid in plasma, metaphosphoric acid and trichloroacetic acid was also evaluated. The analytical parameters, including linearity (1-60 µg/ml), accuracy (98.98%), repeatability (2.8%) and reproducibility (7.2%), showed that the method is reliable for measuring the total vitamin C content in plasma.

Abstract: Recurrent ear, nose, and throat (ENT) infections are common presenting symptoms in patients with primary antibody deficiencies, but sometimes they remain undiagnosed for many years and are subjected to different antibiotics because of a lack of experience in immunodeficiencies. In order to determin the frequency of ENT symptoms among the patients with antibody deficiencies, 83 antibody deficient patients were studied from 1980 during a 20-year period, and their ENT symptoms were registered.This historical cohort study comprised of 83 patients including 25 X link agammaglubulinemi, (XLA) 40 common variable immunodeficiency (CVID), 14 IgA deficiency (IgA-D); 50 male, 33 female. The average length of time between onset and diagnosis was 40 months in our patients. Seventy-two of our patients (86.7%), had recurrent ENT symptoms (sinusitis, otitis and/or mastoidits) during the course of their disease. Each XLA patient had experienced 3.6 episodes of otitis per year, but after diagnosis it decreased to 0.7 episode per year. This decrease was about 5.8 folds in CVID (3.8 to 0.65) and 1.4 folds in IgA (2.2 to 1.6) these results show that a significant number of antibody deficient patients can be present with ENT symptoms (48% in this study). Diagnostic dealy was not much different from other reports. Early diagnosisand treatment of immunodeficiencies significantly prevents recurrent infections hence preventing long time complications

Abstract: Polycystic ovarian syndrome is a hetrogenous condition with a broad clinical and pathologic spectrum that may reflect the effects of diverse etiologic factors. Polycystic ovarian syndrome is an abnormality in the maturation of the follicles which can result in abnormal composition of follicular fluid. By analysis and comparison of the biochemical composition of human follicular fluid in normal and polycystic ovaries, we undertook to find the etiology of arrested follicular development in this syndrome and to gain an insight into the role of biochemical constituents of follicular fluid on follicular development.The results of our study indicate hiher concentration of potassium, lower concentration of testosterone and higher level of pH in normal ovaries relative to polycystic ovaries. In conclusion, potassium and testosterone concentrations and pH level seem to be some of the most important factors in the oocyte maturation and the acquistion of follicular development; and changes in them may have important role in the etiology of polycystic ovarion syndrome.

Abstract: Allergic reaction to local anesthetics is very rare and most of the reported cases are due to ester local anesthetics. This case presents a parturient who experienced cardiac arrest due to hypersensitivity reaction to lidocaine after epidural injection for cesrarean section.