Iranian Red Crescent Medical Journal
Volume:10 Issue: 2, 2008

Cardioembolism is among the most important causes of ischemic stroke around the world. A pilot double-center study evaluated the subtypes of cardioembolic mechanisms in stroke patients in two different racial subtypes. This prospective clinical study was conducted on 100 stroke patients in Mackenzie Hospital in Canada and 100 stroke patients who were age and sex matched in Ghaem Hospital in Mashhad, Iran in 2007. All of the Canadian patients were of white North American race and all of the Iranian ones of white Persian race. The diagnosis of ischemic stroke was made by stroke neurologists. Assessment of the cardioembolic mechanisms was made based on the standard method. The frequency of ischemic heart disease, congestive heart failure and atrial fibrillation was detected in the two studied groups. 92 males and 108 females with ischemic stroke were studied. The influence of race on the frequency rate of ischemic heart disease, congestive heart failure and atrial fibrillation was not significant. However, rheumatic mitral valve disease was significantly more frequent among the Iranian group. The effect of race on the frequency rate of other cardioembolic mechanisms was not significant in each gender separately. However, atrial fibrillation was significantly more frequent in Canadian females. There was no significant difference in the frequency rate of cardioembolic mechanisms between North American and Persian stroke patients except for rheumatic mitral valve disease.

Amblyopia is a relatively common condition with an incidence of 2-2.5% in which visual acuity through an eye is subnormal despite no overt pathology. The use of pattern visual evoked potential (P-VEP) has been the primary technique for electrophysiologically detecting amblyopia in patients unable to undergo conventional testing. This study was performed to evaluate the effectiveness of P-VEP parameters in amblyopic patients under monocular and binocular conditions. Visual function was measured using P-VEP and Snellen acuity test in 30 children with amblyopia (12 strabismic and 18 anisometropic amblyopes) and 30 visually normal control subjects. Totally, visual evoked potentials elicited by high contrast small checkerboard patterned stimuli were significantly reduced in amplitude and prolonged in latency in amblyopic eyes. The mean intraocular amplitude difference was significantly larger in amblyopics than in normal groups. There was also no difference between the healthy eye in the amblyopic group and the control one. On binocular viewing, the amount of VEP amplitude was significantly greater in normal subjects than that in both amblyopic groups. Regarding the type of amblyopia, the mean binocular VEP amplitude as compared to that in the non-amblyopic eye was greater for the anisometropic than the strabismic groups. In both amblyopic groups, the VEP responses were significantly reduced in amplitude and prolonged in latency. In binocular viewing, the amount of VEP amplitude was greater in normal subjects than both amblyopic groups. The mean binocular amplitude was significantly greater for the anisometropic than for the strabismic group Amblyopia is a relatively common condition with an incidence of 2-2.5% in which visual acuity through an eye is subnormal despite no overt pathology. The use of pattern visual evoked potential (P-VEP) has been the primary technique for electrophysiologically detecting amblyopia in patients unable to undergo conventional testing. This study was performed to evaluate the effectiveness of P-VEP parameters in amblyopic patients under monocular and binocular conditions. Visual function was measured using P-VEP and Snellen acuity test in 30 children with amblyopia (12 strabismic and 18 anisometropic amblyopes) and 30 visually normal control subjects. Totally, visual evoked potentials elicited by high contrast small checkerboard patterned stimuli were significantly reduced in amplitude and prolonged in latency in amblyopic eyes. The mean intraocular amplitude difference was significantly larger in amblyopics than in normal groups. There was also no difference between the healthy eye in the amblyopic group and the control one. On binocular viewing, the amount of VEP amplitude was significantly greater in normal subjects than that in both amblyopic groups. Regarding the type of amblyopia, the mean binocular VEP amplitude as compared to that in the non-amblyopic eye was greater for the anisometropic than the strabismic groups. In both amblyopic groups, the VEP responses were significantly reduced in amplitude and prolonged in latency. In binocular viewing, the amount of VEP amplitude was greater in normal subjects than both amblyopic groups. The mean binocular amplitude was significantly greater for the anisometropic than for the strabismic group

Methotrexate (MTX) is one of the most widely used anti-cancer agents. The administration of a high-dose methotrexate (HD-MTX) can be safely administered to patients with normal renal function, using alkalinization, hydration, and pharmacokinetically guided leucovorin (LV) rescue. The aim of this study was to determine the side effects of HD-MTX in patients with for neoplastic diseases. In a prospective study on all admitted patients in Hematology and Oncology Ward, receiving MTX for chemotherapy and without any other underlying disease, after full physical examination and performing necessary paraclinical exams (Na, K, Ca, BUN, Cr, Uric acid, SGOT, SGPT, bilirubin and ECG), the information form was filled for all at admission and in follow up visits to be used in a final assessment. Renal and hepatic function was assessed at the beginning of chemotherapy and systematically during subsequent cycles on the basis of available laboratory methods. The follow up included liver and renal function and other necessary laboratory tests. There were 98 cases, 48 of whom suffered from acute lymphoblastic leukemia and received high dose MTX (at least 2.5 gr) and 50 with choriocarcinoma received at least 800 mg per cycle. 31 cases were male and 67 female. The mean age was 26.4 years. The most common side effects were nausea and vomiting in 28 cases (28%). Hepatotoxicity (a rise in alanine aminotransferase > two to three times of the upper limit of normal) was not observed in any patient. Nephrotoxicity (at least 30% increase in BUN or creatinine or 30% rise in creatinine clearance) was not observed. In 8 patients, a rise in alanine aminotransferase less than two times the upper limit of normal was noticed. All these minor abnormalities were resolved in closed follow ups. None developed bone marrow suppression, serum electrolyte imbalance, and severe allergic reactions. Our study revealed that MTX side effects in southern Iran were minimal and toxicity was absent at the end of treatment. The side effects of MTX should be revised in different populations with different genetic and HLA profile.

Determining the factors associated with increased risk of transfusion in coronary artery bypass graft (CABG) surgery can help to decrease the rate of transfusion. This study was performed to determine the rate of blood transfusion in our CABG surgeries and the clinical and demographic variables associated with increased risk of blood transfusion. Data were prospectively collected from patients undergoing CABG surgery in Emam Reza Hospital affiliated to Mashhad University of Medical Sciences in Mashhad, Iran from March 2005 and April 2006. Patients'' variables including age, sex, height, weight, body mass index, surface body, estimated blood volume and preoperative hemoglobin concentration in relation to the need for blood transfusion were evaluated. Transfusion rate was 77.6%. Whole blood transfusion rate was more than that of packed red blood cells. In 70% of patients, transfusion was 1-2 units. The prediction rule included surgeon and height of patients. This study and other transfusion guidelines help to change individual physician behavior and restrict factors in relation to the need for blood transfusion in CABG, such as hemoglobin. These changes result in a major reduction in the transfusion rate.

Laparoscopic cholecystectomy (LC) is now used in the management of acute cholecystitis, but still at the expense of a high conversion rate. The aim of this study was to evaluate the role of LC in acute cholecystitis and compare it to acute open cholecystectomy (OC) in terms of complications, conversion rate, hospital stay and operation time. 94 patients with acute cystitis were admitted to the Emergency Department and non-randomly were divided into acute LC (n=46) and OC (n=48). The mean of hospital stay was 3.4 and 5.4 days in acute LC and OC groups, respectively. There was a statistically significant difference between acute LC and OC in terms of hospital stay. The operation time mean was 58.8 and 53.2 minutes in acute LC and OC, respectively. Conversion occurred in 7 patients (15.2%) in the acute LC group. Major complications occurred in two patients (5.1%) in acute LC and five patients (10.4%) in OC. In patients with acute LC, there was a decreased hospital and post-operative stay and major complications compared with OC. Laparoscopy appears to be a good approach and the first choice for emergency cholecystectomy in patients with acute cholecystitis.

Activity based costing or (ABC) is one of the new costing methods with an increasing application throughout the world. This study uses ABC method for calculating the cost price of services in governmental hospitals in southern Iran. After finding out the present method’s weaknesses, with regard to the services offered, all hospital units were divided into three main categories including administration, diagnostic services and hospitalization. Then, by using activity analysis method, activity centers in each one of the above-mentioned parts were defined followed by costing in each activity center. The costs of Administrative activity centers were divided into diagnostic and operational based on cost driver using “concurrent equations method” to find the percent of giving and receiving services to/from other centers. After determining the costs of diagnostic and operational activity centers, based on the volume usage of activities, the cost price of the hospital services was calculated. The cost price from ABC method differed significantly with that from Tariff method. ABC method represented useful information about the volume and combination of cost of activity services, cost price of hospital services and could calculate the cost level constituent services. ABC can be used as an efficient method in health centers in developing countries which is beneficial for both managers and the policy and decision makers

Transitional cell carcinoma (TCC) of the bladder is the most common malignancy of the urinary tract. Staging and grading of TCC of the bladder and its biomarkers can be indicators of the prognosis. This study was performed to evaluate the expression of Ki-6, EGFR and c-erbB2 in bladder TCC and their correlation with the tumor grading using immunohistochemistry method. Immunohistochemical staining of paraffin blocks of 60 cases of primary TCC was performed and the results were correlated with grading of the tumor on H & E staining. The expression of EGFR was significantly higher than c-erbB2 and Ki-67 in TCC of the bladder (p<0.05). This increase was higher in 3 and 4 grades for EGFR and c-erbB2 when compared with EGFR and Ki- 67 (p<0.05). Expression of EGFR and c-erbB2 is useful in the prognosis of grading and tumor aggressiveness.

Human cytomegalovirus (HCMV) is a ubiquities infection in women of childbearing age and is the most common cause of congenital malformation resulting from viral intrauterine infections either in developed or developing countries. This study was performed to evaluate the seroprevalence of HCMV-IgM and IgG antibodies and some of epidemiological risk factors in women of childbearing age in southern Iran. 844 women of childbearing age from Fars Province, southern Iran who referred to Health Genetic Consulting Center of Shiraz from 2001-2005 were enrolled. The serum of the collected blood samples were separated and stored at -20°C and HCMV-IgM and IgG antibodies were detected by IgM capture and IgG ELISA tests. 45 (5.4%) samples were seropositive and 778 (94.6%) were seronegative for HCMV-IgM antibodies, respectively. HCMV-IgG antibodies were seropositive in 764 (93%) and seronegative in 8 (7%) blood samples. A negative significant correlation was observed between IgG titer of HCMV and previous abortions. A significant positive trend was detected between HCMV-IgG titer and increase in age. Also, a higher sensitivity to primary infection was observed in Shiraz population than the other cities of this province. For the negative correlation of HCMV-IgG titer with the history of abortion, and for protection of women of child bearing age, the design of effective vaccines may be useful for provoking IgG titer against HCMV infections.

Mitomycin–C (MM-C) is an alkylating anti-tumor antibiotic, which interrupts DNA replication and inhibits routine synthesis and cell mitosis. This study was undertaken to evaluate the effect of MM-C on the epithelial ingrowth which is a sight threatening complication after corneal surgeries. This study was conducted on 50 corneas of 25 Dutch Albino rabbits. Lamellar keratectomy was performed and after the application of MM-C 0.02 % or balanced salt solution (control group), the epithelial cells were implanted on the stromal bed. After sixty days, light microscopic exam was performed on the excised corneas. Three eyes in the MM-C group and no eye in the control group showed epithelial cell growth under the corneal flap. In this study, application of MM-C 0.02% drop at the time of operation had no preventive role in the corneal epithelial cell proliferation under rabbit’s corneal flap. So, implantation of the epithelial cells under the corneal flap is not the sole causative factor of epithelial ingrowth in the stroma of the rabbit’s cornea.

Nurses and midwives may require answering patients’ questions on religious rites while performing their clinical duties. The present study was conducted to find out the nursing and midwifery students'' knowledge on some prayer rites for the patients in Fars Province, southern Iran. 323 students of nursing and midwifery were enrolled, among them 290 filled out the questionnaire. The scores of 9 questions, i.e. those about the rituals of prayer were based on 20. Although the majority of the students were regular prayers (72%), the score on some obligatory prayer rites for the patients was less than 10 out of 20 in 83.4% of the subjects. In 14.8% of participants, it was 10 to 13.99, and in 1.7% it was equal to or more than 14. The majority of the students were not only regular prayers, but also they insisted on doing it on time. Including courses on the obligatory rites for the patient''s prayer as well as other rites was mentioned by the students as a necessity. It is suggested that such courses be included in the educational program for the students of nursing and midwifery.

Cardiovascular disease is the most common cause of mortality in patients with end-stage renal disease. Determining the spectrum of echocardiographic abnormalities in these patients can help the prevention of mortality in this group of chronically ill patients. 123 adult patients with chronic renal failure who underwent hemodialysis and echocardiography during February till November 2006 were enrolled. Complete 2-D, M-mode, Doppler and color Doppler study were performed by a single operator for each patient and the abnormalities were recorded. The mean age was 38.3+13 and 61.5 % were female. The mean cardiac dimensions were right ventricular diastolic dimension: 1.89+0.05 cm, inter-ventricular septal dimension: 1.3+1.23 cm, enddiastolic dimension: 6.1+0.6 cm, endsystolic dimention: 3.84+2.5 cm, ejection fraction: 59.2+11 %, left ventricular mass: 238+90 gr. The prevalence of LV systolic dysfunction (EF < 50 %) was 20.3%, valvular regurgitation > mild, mitral regurgitation: 52.8%, aortic regurgitation: 24.4%, and tricuspid regurgitation: 35.8%. Valvular calcification was seen in 14.5% of the patients but no significant stenosis was noted. The prevalence of pulmonary hypertension (SPAP>30 mm Hg) was 14.7% and that of pericardial effusion (> mild) was 14.7%. Cardiac ejection fraction was lower in patients requiring more hemodialysis sessions (p value <0.036). Echocardiographic abnormalities are very common in patients suffering from end-stage renal disease (ESRD), so periodic echocardiographic examination for diagnosis and treatment of cardiac abnormalities is highly recommended.

During recent years, in-hospital cardiopulmonary resuscitation (CPR), management has received much attention. However, the rate of survival after in-hospital resuscitation in Nemazee Hospital is not known. Therefore, this study was designed to evaluate the outcome of in-hospital cardiopulmonary resuscitation (CPR) in Shiraz, Iran. A cross-sectional study was conducted on all cases of in-hospital cardiopulmonary resuscitation. Age and sex of patients, shift, time from the onset of cardiac arrest to the initiation of CPR, and also defibrillation, duration and result of CPR were recorded in a checklist. 459 cases of CPR (62.3% males and 37.7% females) were enrolled. The survival rate was similar for both sexes. 1st hr survival was observed in 10.6% of cases and only 0.4% survived to discharge. The key predictors of survival to hospital discharge were CPR duration, time from the onset of cardiac arrest to the initiation of CPR, and defibrillation within the first few minutes of cardiac arrest. More attention must be paid to cardiopulmonary resuscitation managements to promote the survival after cardiopulmonary resuscitation and provide accurate data on our performance with regards to the chain of survival.

The authors report a case of epilepsy presented as infantile masturbation. The patient was a 3-year-old girl with paroxysmal attacks of masturbation mimicking seizures. Her physical examination was completely normal, with no other neurological problems, although her EEG showed abnormal changes. By administration of anticonvulsant, the number of attacks reduced primarily and with the increment of the dose, subsided totally.

A 38 year-old man with a history of painful swelling in the left mandibular angle region and skin lesions on the upper chest is reported. The symptoms, findings, diagnostic criteria and the approach for treatment are reviewed. Histological examinations of mandibular cystic and skin nodular lesions were reported as “Inflamed Keratinous Cyst” and “Basal Cell Carcinoma”. It is important to consider the syndrome encountering multiple jaw cysts because of the high recurrence rate, associated medical problems, and need for close life-long follow-up of this syndrome.

Primary retroperitoneal seminomas account for approximately 2% of all seminomas. Despite the availability of ultrasonic examination, differentiating the primary retroperitoneal tumor from a metastatic tumor with an occult testicular primary remains difficult. We present a case of primary retroperitoneal seminoma with totally absent testicular tissue in ultrasonography.

Dear Editor, Breast cancer is the most common malignancy among women, accounting for nearly one in three cancers diagnosed among women, excluding skin cancers.1.2 In contrast to the western countries, the common age for this disease in Iran is between 35-45 years.3 The American Cancer Society suggested screening methods for early diagnosis of breast cancer in asymptopatic patients such as monthly self-examination from age 20, clinical breast examination every 2-3 years between 20-40, annual examination in women over 40 and a primary mammography between 35-39 and then, every 1-2 years in 40-44 and annually from 50 years of age.4 This study was carried out on employed women of Shiraz University of Medical Sciences in Shiraz, Southern Iran. 395 female employees of Shiraz University of Medical Sciences completed a questionnaire consisting of three sections including demographic information, nine questions on the partcipants'' knowledge on breast cancer and the screening methods and five questions about women''s practice in order to prevent breast cancer. The participants'' knowledge about the incidence of breast cancer fatality, its common incidence, symptoms, time and methods, breast self-examination, mammogrophy and its importance were high, but their level of awareness on breast self-examination for early cancer diagnosis and the importance of the time of clinical examination, mammography complications and breast cancer risk factors was low. 47% of the participants were trained to correct the principles of breast examination, while 31% had not done any breast self-examination and 9.4% had their last self-examiniation more than one year ago, among whom 13.5% performed it 2-12 months ago and 46.2% in the last two months. 76% of them had never done breast examination and 17.5% had it doneonly one once by a physician or a midiwife about 1-2 years ago, and 6.5% had done it more than two years ago. Among 90.4% of women over 35 years of age, mammography had never been conducted and 7.3% had been examined during the last 1-2 years whereas 2.3% of them had done their last mammography more than two years ago. In all, breast cancer is considered as one of the most important health problems which threatens the women''s health and is one of the main research priorities of a country (Table 1). Our participans had a good knowledge on breast cancer which could be due to their job at university with 79% having academic education. Breast self-examination could lead to a reduction in the number of patients when the disease is diagnosed, mammography and clinical examination are recommended.5 Mammography, particularly during 50-70 years of age, is considered as the best early diagnostic method.5,6 Screening by mammography for breast cancer diagnosis at an early stage has led to a 30% decrease in mortality among 50-65 year-old women.7.8 It was found that 76% of women had not referred for clinical breast examination at all, only 9.6% had done mammography, and 31% had never done breast selfexamination. The female employees of university as other Iranian women had a poor practice in breast cancer screening, being significant compared with the women in other countries. Regarding the importance of screening, providing training pamphelets for this group of women is recommended