مجله مطالعات علوم پزشکی
سال نوزدهم شماره 1 (بهار 1387)

Gingival enlargement is a known side effect and one of the most cumbersome complications of Cyclosporine A (CsA). It affects patient's life style due to the effects of this immunosuppressor on esthetics and function of masticatory tract. Since there was not enough available data in this regard in Iran, this study was conducted to determine the prevalence and risk factors of CsA-induced gingival enlargement. A total of 200 patients (mean age 39.7±13.2) who met the inclusion criteria of the study were selected from 1320 renal transplanted patients of Imam Khomeyni General Hospital. All subjects were dentate and took CsA for at least 12 months prior to the study. Factors such as age, gender, CsA dose, plasma concentration duration of CsA, plaque, and gingival indices were evaluated to gingival enlargement.Thirty-five percent of the subjects showed various degrees of gingival enlargement. Multiple regression analysis revealed an independent association between gingival enlargement and either plasmatic concentration of CsA or plaque index (p<0.05). The other variables failed to show a significant relationship to gingival enlargement.The prevalence of CsA induced gingival enlargement is slightly greater than the mean prevalence. Changing the drug and oral hygiene reinforcement may lower the prevalence or the intensity.

Domestic violence is a cultural and hygienic socioal problem. It has different prevalences in various societies that trace on gestation's outcome through direct and indirect form. Regarding the lack of sufficient data in this field specially in pregnant women, this study was performed to investigate and determine the prevalence and outcome of domestic violence in pregnant women referring to delivery rooms of Sanandaj hospitals.This cross-sectional study was carried out on 840 pregnant women hospitalized to terminate pregnancy (labor or abortion). The sampls were selected by systematic random sampling. The data were collected by constructional interviews and labors documents. Pregnancy outcomes included LBW, PROM, abortion, preterm labore, and still birth and brith, weight average. The results were analysed by descriptive and analytical tests. The study findings showed that 60.5 of research cases had domestic violence during pregnancy incidance of physical domestic violence was 8.5% sensational domestic violence was 57% and sexual domestic violence was 18.8%. Also severe damages due to physical domestic violence was 3.4% for sensational domestic violence was 9.8%, and about sexual violence was 2%. Compared with dosent reporting domestic violence, These women were more likely to have marriage age under 18 years (p<0.028), laps more than 20 years from marriage (p<0.048), housewife (p<0.03), illiterate (p<0.048), unemployed hasbands (p<0.0 25), more than 4 childern (p<0.002). According to the study results of pregnancy outcomes, there were a significant association between domestic violence, PROM (p<0.0 5), and brith weight average (p<0.007). According to the unsuitable outcomes of domestic violence during pregnancy, domestic violence in pregnancy should be screened regularly and men should be convinced to change their violent conduct. Empowerment of women and reforming the defective cultural structure of the society are possible solutions to health promotion.

Carpal tunnel surgery is mostly performed in the field of hand surgery. During the procedure the transverse carpal ligament is cut. This ligament has an important role in the strength of the hand. Objective evaluation of the hand strength can be used as a judgment of patient’s ability to return to the previous level of their hand function. The purpose of this study was to evaluate the effect of carpal tunnel surgery in the strength of the hand. In a prospective study, patients who had idiopathic carpal tunnel syndrome, were diagnosed by subjective, objective and electrophysiological findings and underwent carpal tunnel surgery. Their hand strengths were evaluated by power and pinch grip before and 6 months after carpal tunnel surgery. Paired T-test was used for statistical analysis. P-values less than 0.05 indicated statistically significant effects. From an initial group of 103, 66 patients with the mean age of 48.98 and mean duration of symptoms almost 4.3 years were included in the study. The mean of the power grip strengths were 52.21 ±16.09 and 48.11 ± 13.98 before and 6 months after the surgery respectively. The mean of the pinch grip strengths were 14.16 ± 4.34 and 15.24 ± 3.3 before and 6 months after the surgery respectively. There were not statistically significant differences between the parameters before and 6 months after the surgery. Carpal tunnel surgery and cutting the transverse carpal tunnel ligament does not have negative effects on the hand strength. The patients have the ability to return to their normal level of hand function 6 months after the surgery.

Performing spinal anesthesia is sometimes difficult. The present study was designed to determine the predictive values of different variables specially spinal column process landmarks of patient as a major predicting factor for difficult spinal anesthesia. 190 patients, in different age groups, ASA I-II who were subjected to surgery on lower limb and caesarean section were enrolled in an analytic cross-sectional study. Demographic data, body mass index, and spinal landmark grading score were recorded. During block, space of spinal puncture and quality of block were also recorded. The data were analyzed by correlation coefficient, Spearman's rho test to evaluate difficult spinal anesthesia. Spinal landmark grading score was strongly correlated with difficulty in performing spinal anesthesia (correlation coefficient =0.750, p<0.01). There was a weak correlation between patient weight and difficult spinal anesthesia (correlation coefficient =0.330, p< 0.01), but a direct correlation was found between body mass index and difficult spinal anesthesia (correlation coefficient =0.466, p<0.01). No correlation existed between patient height and difficult spinal anesthesia (correlation coefficient = -0.013). It seems that incorporation of spinal landmark grading system in preoperative evaluation, alike mallampati classification in difficult endotracheal intubation, is valuable in predicting difficult spinal anesthesia.

Tuberculosis is a known infectious disease for human being from ancient times. Although there are worldwide improvements in treatment of patients, especially in developed countries, it is still a major health problem in some developing countries. In this study perieardial involvement of patients with pulmonary tuberculosis is investigated.Methods & Material: In this case-control study, 100 patients with pulmonary tuberculasis were randomly selected from Bandar Abbas tuberculosis center as cases and 50 healthy persons were selected as the control group. Pericardial involvement of both groups were investigated using electrocardiography and echocardiography. The data were statistically analysed using SPSS software. Moderate pericardial effecusion was observed in 11% of the patients. In 31% of the cases pericardial thichness was more than 5 mm, where as in the control group, pericardial tickness was not more than 5 mm. Negative relationship between pericardial thickness and treatment duration, indicated the positive effects of antituberculosis medication on pericardial thickness. In 8 HIV positive patients, pericardial effeusion increased. A Negative relashionship between pericardial involvement and medication duration exists. Moreover there is a clear relationship between pericardial inveolvement and HIV positivity.Echocardiography study of all patients with pulmonary tuberculosis and thick pericard or pericardial effusion is recommended.

Ciprofloxacin is a synthetic antibacterial agent belonging to the family of fluoroquinolones with a very broad spectrum against microbial pathogens, especially Gram-negative infectious diseases that has been approved in more than 100 countries world-wide. This study was planned to search the effects of ciprofloxacin after inducing in rat Spermatogenesis. Twenty male Wistar rats were selected and randomly divided into two groups control (n=10) and experimental (n=10). The test group was fed 12.5 mg/kg (gavages) ciprofloxacin daily for sixty days however, the control group was fed vehicle. In the sixtieth day, the epididymis tissues of rat were removed in both groups and sperm was collected from cauda epididymis then it was prepared for analysis. Light microscopic observations showed that TUNEL positive apoptotic cells increased in cauda epididymis in the experimental group when it was compared to the control group (P<0.01). Sperm analysis revealed remarkable decrease in fertility index, sperm count percentages of motile sperm, and viability in the experimental group as compared with the control group. The statistical analysis used was Fishers test (P<0.05). Since our study revealed that ciprofloxacin had harmful effects on spermatoa in rats and induced apoptosis in epididymal epithelium, it can be suggested that ciprofloxacin may decrease fertility rate indices and must be prescribed carefully.

Cancellation of surgery has an important impact on patients and their families and suggests a need to review some protocols for screening patients prior to surgery. To determine the causes of case cancellation in patient's surgical population, we designed a retrospective observational study at Imam Khomeini hospital.In a retrospective-observational study we evaluated the medical documents of all patients whose operations had been cancelled on the day of surgery, 1382-84. We found the mean 18.6% cancellation for three years. The most common cause of cancellation in 1382 was postponing due to surgeon's opinion 105 (14%) in 1383 was due to patient's problems 192 (15%), and in 1384 was postpon due to operating room end time at morning shift, 211 (15%). We conclude that close cooperation between the surgeon, anesthesiologist, operating room manager, preoperative assessment, examination, and preparation of patients before surgery can reduce the cancellation of surgery day in patients.

Overpopulation, advancement of technology and automaton have caused human rest to be exposed to dangers. Orbit and middle third of the face are more vulnerable than other organs. The aim of this study was to assess the characteristics of maxillofacial fractures in patients referring to Urmia Imam Khomeini hospital during a 10-year period and to delineate comparisons with worldwide facial fracture patterns. This descriptive-cross sectional study was carried out on 320 patients referring to ENT ward of Imam Khomeini hospital during a 10-year period, 1375-1384. The data on the patient's age, sex, cause, type of injury, job and living place were collected by filling some questionnaires and were analyzed under descriptive statistic's by means of SPSS software, version 13. A total of 320 patient, 252(78.75%) males and 68(21.25%) females were retrieved (ratio m:f=3.7: 1), mostly (32.5%) in 21-30 year age group. The most common frequency of maxillary fractures were combined fractures in 140(43.75%). Most fractures were caused by motor traffic accidents 160(50%) followed by falls 60(18.75%) work accidents 52(16.25%) assault 24(7.5%) and other causes 24(7.5%). The findings of this study conforms the results of worldwide maxillofacial fracture studies. The causes and patterns of maxillofacial fractures reflect trauma patterns within the community and can provide a guide to the design of programmes geared toward prevention and treatment.

Pancreatic Elastase–1 (EL-1) is a human specific protease enzyme, produced and secreted by pancreatic acinar cells. This enzyme is stable and is not affected by prescriptions of supplement pancreatic enzymes, and it has good connection with pancreatic stimulation function tests. The Purpose of this study is to compare fecal pancreatic elastase–1 concentration in patients with Cystic Fibrosis (CF) and pancreatic insufficiency with the patients without Pancreatic Insufficiency and control group. In this case-control study, 49 persons in 3 groups including control (30 patients), CF without pancreatic insufficiency (8 patients) and CF with pancreatic insufficiency (11 patients) were studied in Tehran Medical Center for Children in 2005. sweat CF was proved with using medical and laboratorial criteria (minimum 2 tests for sweat chloride concentration more than 60 m mole / liter), and the pancreatic function of the patients has been determined by clinical and laboratory methods. Then Fecal Pancreatic elastase–1 and trypsin were measured. Average concentration of fecal pancreatic elastase–1 in patients with CF and pancreatic insufficiency was significantly lower than 2 other groups. But there were no significant differences between the control group and the patients with CF and without pancreatic insufficiency. The best discrimination level of fecal pancreatic elastase–1 for dividing patients into two groups including patients with and without pancreatic insufficiency is 96.5µg/g. With this level, sensitivity of this test will be 100% (at 95% confidence level, from 90.82% to 100%) specificity of this test 81.82% (at 95% confidence level, from 52.30% to 94.86%) and accuracy of this test 95.92% (at 95% confidence level, from 87.16% to 98.79%). Decrease in Trypsin among the patients with CF and pancreatic insufficiency is significantly higher than thecontrol group and the patients with CF and without pancreatic insufficiency (100% against 50% and 37.50%, P=0.004). therefore, the sensitivity of this test will be 52.63% (at 95% confidence level, from 37.26% to 67.52%) specificity of this test 100% (at 95% confidence level, from 74.12% to 100%) and accuracy of this test 63.27% (at 95% confidence level, from 51.61% to 74.32%). Sensitivity and accuracy of the test for fecal pancreatic elastase–1 is significantly higher than fecal trypsin (P<0.001), but specificity of trypsin is significantly higher than fecal pancreatic elastase–1 (p<0.005). Fecal pancreatic elastase–1 concentration in patients with CF and pancreatic insufficiency is significantly lower than control group and patients with CF and without pancreatic insufficiency. Sensitivity and accuracy of this test is significantly higher than Trypsin.

The aim of the current study is to compare the effects of intermittent and daily intake of complementary iron on clinical indices of iron and zinc in the sera of pregnant women. This study was done on 76 volunteer pregnant women who referred to some Health and Remedy Centers of Urmia using clinical trial and double blind methods. The studied group consisted of healthy pregnant women with the age range of 18 to 26 years old, 1st to 3rd time of pregnancy, 13 to 16 weeks of pregnancy and hemoglobin concentration equal or more than 11g/dl. 40 of studied group women took daily complementary iron (as 150 mg ferrous sulfate tablets) and 36 of them took these tablets periodically every other day. They took the tablets in a 60 day period of the study. The blood samples of the studied individuals were taken as 10 ml vein blood in the first and the last day of the study. We evaluated hemoglobin factors, hematocrit, RBC, MCH, MCHC, TIBC, transferrin saturation percent, serum ferritin, and serum zinc in the studied group. We evaluated diet patterns of the group by studying 24 hours reference of 3 days food intake as well as the side effects of consumption of iron complementary drugs on the studied pregnant women. Referring to the results of the current study, there were no meaningful differences in the studied factors between the groups, although TIBC, transferring saturation percent, and serum iron levels were lower in the group using complementary iron tablets periodically every other day than the group using every day. On the other hand, the serum level of zinc was significantly lower in the group using complementary iron periodically every other day than the group using every day (P < 0.03). The results of this study show that we may be able to substitute every day administration of complementary iron to pregnant women by periodically every other day administration of it. So it could be considered as an appropriate alternative method for consumption of complementary iron tablets in preventing anemia in pregnant women that has the least effect in increasing absorption of other food stuffs including zinc

Achalasia is a well characterized esophageal motor disorder but the rarity of the disease limits performing large studies on its clinical features and also the results of the surgery. This study examined the results of Heller cardiomyotomy on achalasia and treatment of recurrence of achalasia and esophageal resection. From 1995 to 2005, 25 patients (16 women and 9 men) underwent nitial surgical treatment for achalasia. Ages of the patients ranged from 15 to 70 (mean 35.2 years). They were treated previously with cardiomyotomy with or without antireflux procedures that had been done through standard left posterolateral thoracotomy. The etiology of symptoms recurrence was incomplete myotomy in three (12%), end staging megaesophgus in two (8%). The patients were studied by clinical (dysphasia, regurgitation, heartburn, and weight gain), radiological, and endoscopic evaluation, in the pre and postoperative periods. Twenty one (84%) improved from dysphagia but Mild dysphasia maintained in four (16%). Peak contraction pressures (measured in 24% of patients) became significantly weaker: from 42 mmHg to19 mmHg in the distal esophagus. Weight gain maintained or increased in 84%. Operative complications were perforations occurred in four patients that were repaired primarily with antireflux procedures. In one case of megaesophagus perforation widened and reversed to laterolateral esophagogastric anastomosis with antireflux procedure. There was no complication in the late postoperative period. No deaths were observed. Initial cardiomyotomy with or without antireflux procedure via thoracic route has good and effective result in the treatment of the achalasia. In recurrence of symptoms and when myotomy is incomplete, when scars of fibrosis were present completed cardiomyotomy via abdominal route was preferred. In cases of mega esophagus surgical resection of esophagus is indicated.

Thuracolumbar Unstable Fractures (T, L.U.F) are common after spine truma. Posterior pedicular fixation is a technique that is use for fixation of these fractures. This study evaluates the accuracy of pedicular screw placement in T, LUF with the assistance of plain radiography in operation rooms. This study is a case-control and analytical study. 35 patients with T, LUF underwent fixation with 180 pedicle screws placement by s33 spinal system with the assistance of plain radiography and anatomic landmarks. The first plain radiography shows that accuracy point and direction of 30 screws were unsuitable. In the second radiography, after correcting the entry point and direction, 10 screws had unsuitable position. In the third radiography, 3 screws had unsuitable but acceptable position. Plain radiography and recognition of spine anatomic landmarks are helpful in accuracy posterior pedicular screw placement.

Aplasia Cutis Congenital (ACC) is the most common benign isolated defect but it can be associated with other physical anomalies or malformation and syndromes. No unifying theory can account for all lesions of ACC. Because this condition is the phenotypic result of more than one disease process it is likely that more than one mechanism is involved. Mechanisms include genetic factors, teratogens, compromised vasculature to the skin, and trauma. Frieden created a classification system for ACC consisting of 9 groups based on number and location of acc and the presence or absence of associated malformations1. In this observational cross-sectional study, a census method for gathering information was used. The obtained data were analyzed descriptively via EP16 software. we have studied 20 newborns, 9 males, and 11 females with skin defects, from September 1997 to September 2005 in Akbarabadi hospital. In this study, the skin lesions of 85% were single, 65% on the scalp, 50% on the vertex, 5% on parietal, 15% on parietoocciputal, 15% on lumbosacral, 20% on extremities, and 15% with trisomy13. Mothers of two newborns had the history of drug use and abuse during pregnancy. Extensive skin lesions during neonatal period have high mortality rate, in our study also the rate of mortality with extensive lesions were 55%.According to this study isolated skin defect was observed in most of the cases (85%), and the most signifant cause of newborns’ mortality with skin defect was sepsis.

Complete traumatic maior amputation of through proximal Humerus is extremely rare. Selection of a amputated limb for replantation is based on the type, time, location, age, and underling disease of patients. There are many factors which control the functional prognosis of reattached arms. The most important factors are the level of amputation, the severity of crush, ischemic time, and the age of patients.A 35- yr- old man sustained a right upper extremity amputation approximately 6 cm distal to shoulder. Amputated limb was not clean and the patient was admitted to the emergency ward after 1-hour post injury with hypovolemic shock. Resuscitation was performed and amputated part and the limb was cleaned. The first bone stability was done by pin and plaque fixation, and then vascular reconstruction was done by using saphenous vein interposition graft for vein and then to arterial repair. Median, ulnar, and radial nerves were anastomosed with epinural sutures. Ischemic time was approximately 3 hours. The immediate postoperative course was complicated by the infection of the wound and skin necrosis around the wound were treated with repeated debridment and skin grafting. Two years after reimplanation the senses of temperature and response to touch returned to fingertips. Although the function of the replanted arm is far from perfect, the patient was satisfied with his arm. Numerous cases of limb replantation have been reported by many authors with various functional results. We reported a replantation in a patient with proximal part of upper limb amputation that has incomplete function but satisfaction to the patient. In general the recovery of function appears to be more incomplete in proximal limb reimplantations

Discoid lupus erythematosus is known as a rare disease in children manifesting itself with erythematose scaly plaque in area exposed to sunlight. In case of extensive disease, it could progress toward SLE. In this study, we report a case of a 5 year-old boy, residing in Tabriz, who had erythematose and atrophic scaly lesions on scalp, face, and fingers. Pathologic studies showed typical changes of disease including degenerative liquifaction in basal layer, along with epidermal thining and degereative change in connective tissue and patchy lymphocytic in filtration. ANA test was positive and anti-DNA was negative, therapy with sunscreen and oral chloroquine led to an improvement in patient's lesion.Although DLE is rare in children, if erythematose plaque is resistant against treatment that exacerbate with sunlight, it is necessary to consider the probable existance of the disease.

Bartter syndrome presenting in neonatal or early infancy is characterized by salt loosing tubulopathy, hypokalemia, and metabolic alkalosis. Failure to thrive is one of the most common findings in neonatal bartter syndrome. Angiotensin converting enzyme inhibitors are one of the therapeutic options for improving growth in these patients.We describe a case of neonatal bartter syndrome with mild impairment of renal function for whom captopril started to promote better growth but she presented later with clinical and laboratory signs of exacerbation of renal impairment which were significantly resolved after discontinuing captopril.In patients with Bartter syndrome and underlying renal dysfunction angiotensin converting enzyme inhibitors should be used with caution and low dose