فهرست مطالب

Research in Medical Sciences - Volume:13 Issue: 4, July & Aug 2008

Journal of Research in Medical Sciences
Volume:13 Issue: 4, July & Aug 2008

  • 70 صفحه،
  • تاریخ انتشار: 1387/06/15
  • تعداد عناوین: 10
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  • Mohammad Reza Najafi, Ali Mehrabi, Farideh Najafi Pages 161-165
    Background
    Most of the studies have shown that approximately one third of patients with single seizure will experience a second one. Data regarding seizure-free survival time and recurrence rate vary widely. We investigated the likelihood of a second attack and seizure-free survival time with and without early treatment in our epileptic patients.
    Methods
    Patients of the first unprovoked seizures were recruited between 2000-2005 years. They were randomized into two groups: one treated with carbamazepine and the other was not treated. After obtaining a written consent, all patients were followed up for a second seizure for a period ranging from 12 to 36 (19.1 ± 5) months.
    Results
    A total number of 150 patients were enrolled in this study, of which 13 patients were lost to follow up. The remaining patients (71 males and 66 females) were followed up during 5 years. They were randomized into two groups: treatment (50 patients) and non-treatment (87 patients); 30.2% of all patients were without relapsing, of which 48.9% were on treatment (case) and 19.5% did not receive any treatment (the control group). The mean seizure-free survival times were 6 months and 3.8 months in the treated and non-treated patients, respectively (P = 0.017).
    Conclusions
    We found strong correlation between relapse and treatment started after the first attack (P < 0.05); i.e., the patients who received treatment in their first attack may be at lower risk of relapsing.
  • Omid Aghadavoudi, Elahe Amiri Pages 166-174
    Background
    Different methods have been suggested to prevent postoperative nausea and vomiting (PONV), but the efficacy of these methods has not been fully studied in fast track cardiac anesthesia (FTCA).
    Methods
    In a randomized double blind clinical trial study, 120 patients aged 18-70 years with ASA II or III, undergoing elective cardiac surgery, were selected. They were divided randomly into four groups. In group M, group G and group P, intravenous (IV) metoclopramide (0.1 mg/kg), granisetron (0.01 mg/kg), and normal saline were administered, respectively, about thirty minutes before extubation in the intensive care unit (ICU). In group N, a nasogastric (NG) tube was inserted after tracheal intubation in the operating room and removed about thirty minutes before extubation in the ICU. The incidence and severity of nausea and the episodes of vomiting were recorded by a blinded investigator at the time of extubation and performed regularly for a maximum of 24 hours. Assessment of severity of nausea was scored using a visual analogue scale (VAS) device. Data were analyzed by using ANOVA, chi-squared and Kruskal- Wallis and repeated measures tests.
    Results
    Overall the 24-h incidence of PONV was significantly lower in the G and M groups than in the P and N groups (10% and 16.7% vs. 33.3% and 40%, respectively; P < 0.02). Postoperative rescue medication was significantly less required in the G and M groups compared to the other two groups (P < 0.01). Less satisfaction, according to PONV status, was observed in the P and N groups (P < 0.01).
    Conclusions
    According to this study, metoclopramide and granisetron, but not gastric decompression, are effective regimens for preventing PONV after FTCA. Given the economics and a considerable background incidence in patients exhibiting PONV, we suggest metoclopramide as a routine prophylactic antiemetic in FTCA.
  • Mehdi Motififard, Mohammad Javdan, Mehdi Teimouri Pages 175-180
    Background
    Heel pain is a common condition in adults that may cause significant discomfort and disability. This study was conducted to evaluate the therapeutic effects of corticosteroid injection accompanied by casting, compared with heel pad utilization in treatment of heel pain.
    Methods
    In this randomized clinical trial study, among patients referred to orthopedic clinics in Isfahan, Iran, from December 2004 to December 2006, 90 patients with heel pain were enrolled. They were randomly assigned into two groups. Heel pad was the only therapeutic method utilized in group A for six months. Corticosteroid injection accompanied by casting was performed for patients in group B. The evaluated information was compared before and after treatment.
    Results
    Among patients in group A, after 6 months of heel pad utilization, heel pain was completely improved in 3 patients (6.7%), relatively decreased in 22 patients (48.9%) and didn''t change in 20 patients (44.4%). However, among patients in group B, heel pain was completely improved in 11 patients (24.5%), decreased in 29 patients (64.4%) and didn''t change in 5 patients (11.1%) after the treatment completed.
    Conclusions
    It seemed that corticosteroid injection in companion with casting was a more effective therapeutic method in heel pain treatment than heel pad utilization.
  • Seyed Jalal Hashemi, Hassanali Soltani, Reyhanak Talakoob, Bahram Soleymani, Khadije Zeraatkari, Samireh Shahin Pages 181-185
    Background
    The intensivist should be avoided over or under sedation in mechanically ventilated patients. There are controversies in validity of bispectral index (BIS) in the management of intensive care unit (ICU) patients. The aim of this study was to evaluate sedation level in sedated and mechanically ventilated patients in our ICU using BIS and Richmond agitation–sedation scale (RASS, as a valid tool) and to determine the correlation between these two methods of evaluation.
    Methods
    Following the institutional research committee approval, we prospectively determined the sedation level in 33 patients aged 20-75 years who were mechanically ventilated and sedated routinely using intravenous diazepam (0.05 – 0.1 mg/kg/6 hr) combined with intravenous morphine (0.05 – 0.1 mg/kg/6 hr) in central ICU of Al-Zahra hospital. In each patient, we assessed BIS (0 to 100) values and also RASS (-5 to +4) twice a day, two hours after receiving systemicsedation in the morning and evening during mechanical ventilation period. Appropriate sedation score was considered -2 and -3 on RASS and 70 to 80 in BIS. Lower or greater values were considered as under- or over-sedation, respectively. Data were analyzed using chi-square and spearman''s correlation tests.
    Results
    In this study, sedation level was assessed in patients using RASS (201 times) and BIS (201 times) methods. The frequency (percent) of under-sedated, appropriately sedated and over-sedated patients with BIS assessments were 121 (60.2%), 35 (17.4%) and 45 (22.4%), respectively. These values for RASS assessments were 196 (97.5%), zero, and 5 (2.5%), respectively. There was a weak correlation between BIS and RASS for determination of sedation level (P = 0, r = 0.245).
    Conclusions
    This study showed that most of our ICU patients were under-sedated. BIS was poorly correlated with RASS in assessing the depth of sedation in mechanically ventilated patients.
  • Batool, Sharifi, Mood, Fatemeh Kheikha Pages 186-188
    Background
    Approximately 80% of HIV infections in women occur primarily during their reproductive years. Hence, pregnancy provides a unique opportunity for implementing prevention strategies against HIV infection. If we define the seroprevalence of infection in pregnancy, the effective and timely intervention will reduce the transmission of infection to newborns. To determine the prevalence of HIV infection in pregnant women in Zahedan, we conducted this study.
    Methods
    From January 2006 to November 2006, we evaluated a series of pregnant women referred to antenatal clinics in Zahedan, for obstetric consultation. Blood samples of all pregnant women were collected and tested for HIV antibodies by ELISA method. Positive samples were retested by Western-blot.
    Results
    A total of 1783 cases were evaluated. Three cases were found to be HIV seroreactive. Infection was confirmed in one case (0.05%).
    Conclusions
    Upon the results emerged from this study, we don’t recommend HIV screening on each pregnant woman in this area. HIV testing is recommended only for those with risk factors.
  • Majid Barekatain, Mohammad Haghighi, Leila Jahangard, Farzad Ranjkesh, Mohammad Reza Maracy Pages 189-195
    Background
    Attentional disturbances in Bipolar I Disorder (BID) have been increasingly reported but the majority of studies have not identified a model emphasizing component operations involved in attentional processes. In this study we sought to assess elementary attentional operations using the Posner paradigm for covert orienting of visuospatial attention, with and without cues, to dissect levels of attentional impairment.
    Methods
    The study was carried out with 11 fully remitted BID single manic episode patients and 11 age-matched normal control subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS) and Covert Orienting of Visuospatial Attention Task (COVAT) were administered. Reaction Times (RT) on the Posner task were examined with a multivariate approach by an Analysis of Variance (ANOVA) for repeated measures with Group as the between-subject factor and Stimulus Onset Asynchrony (SOA), Cue, and Visual Field as the within subject factors.
    Results
    The main effects involved Group, Cue, and SOA as well as interactions of Cue by SOA and SOA by Group. There was neither detectable effect of visual field, nor interactions involving visual field. The Group by Cue did not show a main effect. There was no abnormality in the covert orienting in patients (i.e., Group by Cue by SOA by FIELD). RTs in the valid cues were significantly faster than the RTs in the invalid cues in the both groups. Only SOA had a main effect on the reaction time differences between invalid and valid cues.
    Conclusions
    The main finding is that BID patients are generally slower compared to controls; however, the slowing is most pronounced at short SOA, suggesting that they are slower to initiate information processing following the cue. Interestingly, BID patients still show a cueing effects (valid RTs < invalid RTs) at short SOAs, suggesting that the RT deficit does not have any relationship with orienting attention, but rather is a deficit in general arousal.
  • Hajieh Ghasemian Safaei, Hamid Tavakkoli, Ali Mojtahedi, Rasoul Salehei, Bahram Soleimani, A. Pishva Pages 196-201
    Background
    Helicobacter pylori causes chronic active gastritis, peptic ulcer, non-cardia gastric cancer and mucosal– associated lymphoid tissue (MALT) lymphoma. Different genotypes of Helicobacter pylori are confirmed from disease geographical areas. Its association with clinical disease remained controversial. The aim of the present study was to investigate the relationship of the cagA genotype of Helicobacter pylori isolates with clinical manifestations and its relation to age and sex of patients.
    Methods
    A total of 100 patients (60 male and 40 female) biopsy specimens were obtained from 3 groups of patients (40 chronic active gastritis, 40 duodenal ulcers and 20 non-gastric gastric cancers). Biopsies were cultured on specific medium and after growth colonies were confirmed as Helicobacter pylori. DNA extraction and polymerase chain reaction (PCR) were used to detect the presence or absence of cagA gene.
    Results
    From a total of 100 positive samples of H. pylori, cagA genes were detected in 68% of patients and 32% of samples were negative. Mean age of normal gastritis, duodenal ulcer and gastric adenocarcinoma was 44.94, 44.97 and 67.5 years, respectively.
    Conclusions
    The present study showed no significant relationship between cagA genotype of H. pylori and chronic active gastritis, duodenal ulcer and non-cardia gastric cancer as well as sex of patients. But, in gastric adenocarcinoma, there was significant discrepancy between ages of patients in comparison with the other two groups.
  • Hamid Tavakoli, Farshad Sheikh Esmaeili, Mohammad Hasan Emami, Parvin Mahzouni, Saeid Haghdani Pages 202-206
    Background
    There are controversies about the importance of biopsies of normal colon mucosa in the investigation of patients with diarrhea predominant irritable bowel syndrome (IBS). On the other hand, microscopic colitis may bemissed based on normal colonoscopy and laboratory examination in this group of patients
    Methods
    The study took place in Alzahra and Noor hospitals and Poursina Hakim Research Institute, from 2002 to 2004. Eligible patients were those suffering from diarrhea for at least 4 weeks. A total of 138 patients were included in the study after meeting Rome criteria (II) with normal CBC, ESR, stool examination and no endoscopic abnormality.
    Results
    The histologic findings in 138 patients with diarrhea predominant IBS with mean age of 34.7 years (female 55.1% and male 44.9%) were as follows: 10 patients (7.2%) had collagenous colitis and 3 patients (2.2%) were compatible with lymphocytic colitis. No significant diagnostic histologic findings were seen in the rest of patients. Collagenouscolitis was detected in 13% of right colon biopsies and in 10% of sigmoid and transverse colon biopsies. Nocturnal diarrhea was found in 30% of collagenous colitis patients.
    Conclusions
    Total colonoscopy and multiple biopsies in diarrhea predominant IBS patients are necessary for earlydiagnosis of microscopic colitis.
  • Shaghayegh Haghjooyejavanmard, Mehdi Nematbakhsh Pages 207-221
    Over the past two decades, investigators have increasingly recognized the importance of the endothelium as a centralregulator of vascular and body homeostasis. The endothelial lining represents an organ of 1.5 kg in an adult, which is distributed throughout the body. The endothelium is versatile and multifunctional. In addition to its role as a selective permeability barrier, it has many synthetic and metabolic properties, including modulation of vascular tone and blood flow, regulation of immune and inflammatory responses, and regulation of coagulation, fibrinolysis and thrombosis. Endothelial dysfunction (ED) is a frequently used term, which can be referred to abnormalities in various physiological functions of the endothelium, and it is known as a key variable in the pathogenesis of several diseases and their complications. Finding suitable markers for endothelial damage or ED is certainly of interest. Established and emerging techniques to detect ED are divided into three large families of functional, cellular, and biochemical markers. Instead of performing single assessments, it may be much more valuable to determine various biological aspects of endothelium. It seems that there is likely a spectrum between normality, endothelial activation (by inflammatory cytokines), endothelial dysfunction (e.g., impairment of nitric oxide, resulting in loss of regulation of vascular tone) and endothelial damage (e.g., atherosclerosis). In this review we review the importance of endothelium and its activation, biomarkers and dysfunction.