Acta Medica Iranica
Volume:47 Issue: 1, Jan - Feb 2009

Lymphocyte CD4+count, a standard laboratory test for staging of HIV infection, is expensive and unavailable in resource-restricted countries. Total lymphocyte count (TLC) and hemoglobin (Hb) are recommended as simple & inexpensive surrogates. The aim of this study was to assess the correlation, sensitivity and predictive power of these parameters as substitutes for CD4 count. One hundred HIV patients enrolled in this analytic descriptive study in Ahvaz, a city in the South of Iran, from 2005 to 2006. They were tested for CD4 count, TLC, Hb, and hematocrit (Hct). The cutoffs were determined as: 200 cells/µL, 1200 cells/µL, 12 g/dl and 30%, respectively. We used Sys Max SE 9500 for CBC and Flow cytometry for CD4 count. The correlation coefficient established correlation between values. Sensitivity, specificity and positive predictive values were calculated. 2 females (%2) and 98 males (%98) of the mean age of 32±5 years were studied. 87 cases (%87) were IV drug users, the majority having a history of imprisonment. The mean CD4 count, TLC, Hb and Hct were 279±225, 2102±1250, 10.7±2.4 and 30.4±9.0, respectively. A strong correlation was observed between CD4 count and TLC (R = 0.645, P = 0.001), but no correlation was seen between CD4 count and Hb or Hct (R= 0.451, P=0.056 and R= 0.375, P=0.816 respectively). This study shows that TLC is a suitable surrogate marker for CD4 count. Hb and Hct are of limited value in predicting CD4 counts and should not be substituted for CD4counts.

Isolated hematuria and its association with proteinuria, and urinary cast and systemic lupus erythematosus (SLE) disease activity, and decision for renal biopsy is a dilemma for physician in SLE patients. The aim of this study was to investigate 1. whether isolated hematuria is associated with active SLE, 2. to determine duration between hematuria and proteinuria and urinary cast, and 3. to determine renal histological type in SLE patients with isolated hematuria. All episodes of isolated hematuria between 1981 and 1997 were identified from Lupus Unit, Rheumatology Research Center database. Isolated hematuria was defined as >5 RBC/hpf in the absence of urinary infection and other renal manifestations. Relation of hematuria was assessed with proteinuria and urinary cast and SLE disease activity. Needle renal biopsy was done in 19 SLE patents with isolated hematuria. 4.42% (31/700) of our cohort had at least one episode of isolated hematuria. Out of 31 patients in whom the isolated hematuria was the first documented renal manifestation, 11 patients (35.48%) developed another renal manifestation (25.8% proteinuria and 9.67% casts). 54.54% (6/11) of patients developed proteinuria and urinary cast within 3 months. The mean time for development of a second renal manifestation for the patients with isolated hematuria was 19.9 months. Renal needle biopsy was performed for 19 patients (5.78% type IV, 63.15% type III and 21.50% type II). The results of the present study indicate that isolated hematuria is not rare in SLE patients. Also, there was no significant relationship between isolated hematuria and anti ds-DNA, C3, C4 and major organ involvement in patients with SLE. Our study suggests that SLE patients who have isolated hematuria should undergo renal biopsy and that isolated hematuria should be considered a manifestation of active renal SLE.

Carbamazepine is commonly used in a variety of indications. Poisoning by this drug, can lead to coma, seizures, cardiac disorders and respiratory distress. The treatment of poisoning is generally supportive. 68 poisoned patients with carbamazepine, who referred to poisoning ward of Loghman Hospital, from July 2003 to September 2004, were studied. These patients were investigated for demographic details, complications and types of treatment. Patients were grouped into two, receiving either single dose of activated charcoal (30patients) or multiple doses of activated charcoal (38patients). 58.8%of patients were female and 41.2% were male, the average age being 24.2 years old. The most obvious clinical symptom was a decreased level of consciousness, in 69% of cases. Therapeutically, those taking multiple doses of charcoal, were about 24 hours faster in recovery from clinical symptoms and leaving the hospital than other patients. Conclusion and Recommendation: The results of this study are compatible with previous ones. Factors like education for suitable management, good care and psychiatric consult have important roles in prevention and treatment. Furthermore, administration of repeated doses of charcoal is therapeutically very important.

Ingested corrosive substances produce different injuries, ranging from minor gastro esophageal burns to death, depending on the agent type, amount, concentration, and duration of substance exposure. The purpose of this study was to investigate the outcomes and different causes of mortality in patients ingesting caustic substances. In a prospective study, between April 1999 and January 2006, a total of 1260 patients with a history of caustic agent ingestion were admitted to Loqman-Hakim hospital emergency ward. Patients who died despite our management were included in this study. Mortality rate was stratified as early (during the primary hospitalization) and delayed (after discharge from the hospital) based on the etiologies. Sixty-two patients died during follow up. Among patients who died, mean arrival time to the hospital was 12 hours from exposure, ranging from 30 minutes to 120 hours. Aspiration and airway obstruction were the leading causes of mortality accounting for 25 patients'' death. Twenty-seven of them underwent surgical intervention, among whom 21 deaths occurred after early operations and 6 deaths after delayed reconstructive surgery. In cases of caustic ingestion, early admission and airway protection besides surgical intervention, if indicated, can reduce the mortality rate.

Ferropenia and consequent iron deficiency anemia (IDA), β-thalassemia, and glucose 6-phosphate dehydrogenase (G6PD) deficiency are three main common hematological problems in Iran. This study was conducted to investigate the prevalence of these problems in Turkish migrating nomads in southern Iran. From June to October 2006, the blood sample of 152 Turkish migrating nomadic children including 79 (52%) males and 73 (48%) females were evaluated for iron indices and G6PD deficiency in southern Iran. The family history of thalassemia, favism, and signs and symptoms related to anemia of participants were determined. RBC count, different types of Hb, Hct, MCV, MCH, MCHC, RDW, SI, TIBC and SF were measured immediately after blood sampling. Twenty-seven (17.7%) children had serum ferritin (SF) level <12 ng/dL, while this low serum ferritin level was similar in both genders. The low hemoglobin (Hb) level had a statistical correlation with the low serum ferritin level. Among all participants, the prevalence of G6PD deficiency was 7.2% which was more frequent in males compared to females (8.9% vs. 5.5%). Seven (4.6%) children had Hb  3.5 g/dL; and the prevalence of β-thalassemia trait was higher in female children compared with males (5.5% vs. 3.8%). The prevalence of IDA was 17.7%. Although this figure is less than the prevalence found in other developing countries (25-35%); but it shows that Turkish ethnic nomads in southern Iran are still behind the health statues in the industrialized countries (5-8%). The relatively high prevalence of β-thalassemia trait also is a major potential risk; and careful performance of Iranian thalassaemia program is highly suggested. It seems that G6PD deficiency is a prevalent disease in migrating Turkish nomads, and again establishment of educational programs, and investigation of dietary habits of Turkish migrating nomads on how and by whom the fava beans are consumed; seems to be a good way to prevent favism.

Group B streptococci (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. GBS normally colonizes the vagina in many women asymptomatically. During labor this organism may infect the newborn, leading to neonatal sepsis and meningitis. This study aimed to investigate the prevalence of group B streptococcus in pregnant women by a rapid and easy culture method. It seems that in cases in which GBS carriage is not suspected until the time of labor, using such a quick and specific culture method would be valuable. A total of 330 vaginal swabs were collected from women attending delivery room at Hedayat hospital, Tehran, Iran, from April through July 2008. Cotton swabs contaminated with vaginal fluid were placed into Amies transport medium and transported to the Avicenna laboratory daily. Vaginal specimens were cultured on selective GBS Agar Base medium (ISLAM) for isolation and detection of group B streptococcus. The plates were incubated at 35-37°C under anaerobic condition for 24 hours. Incubated S.agalactiae developed orange/red pigmented colonies in GBS agar plates. Among the 330 women, the results of the culture were positive for GBS in 68 women (20.6%). Statistical analyses showed no significant relationship between demographics, reproductive histories and obstetric characteristics of subjects with the test results. Solely the antibiotic therapy was associated with GBS colonization. The results are indicating that the relatively high maternal GBS colonization rate in pregnant women warrants a routine screening and prophylactic treatment of the infected women. Colonization with group B streptococcus can be identified directly by GBS agar medium and decrease the time to detection of GBS.

To determine the rate of different types of arthritis in children. We prepared a retrospective descriptive study and included the whole 100 cases of arthritis referred to 17-Shahrivar Hospital, Rasht, Guilan during a 3 years period. Using their medical files, data including age, sex, season of admission, history of trauma, signs and symptoms, lab findings and duration of hospitalization were collected. SPSS 13.0 (statistical software) applied for statistical analysis. The most common age of involvement ranged 6-9 years. Septic arthritis, brucellosis, and rheumatoid fever were the most frequent causes of arthritis in our study. Fever and restricted range of motion had the highest rate among different signs and symptoms. Lab data demonstrated leukocytosis, positive CRP, and increased ESR among 74, 79.5, and 73 percent of our patients, respectively. According to the high prevalence of septic arthritis and the arthritis due to brucellosis and rheumatoid fever, it seems that mentioned diseases are still major problems in the issue of hygiene management.

Biofilm is a community of bacteria which are attaching to a surface. They are responsible for many of catheter related or dental plaque related infectious diseases. Different approaches have been used for preventing biofilm related infections in health care settings. Many of these methods have disadvantages such as chemical based complications, and emergent antibiotic resistant strains. Therefore antibiofilm effect of Dentol was evaluated on two important medical bacterial biofilms in this study. Minimum inhibitory concentrations (MIC) of Dentol was calculated by serial dilution method by microtiter plates against standard bacteria. Antibiofilm effect of Dentol was evaluated by microtiter plate assay and after measuring absorbance in 550 nm, the difference between groups was calculated by Cruskal-wallis and Mann-withney tests. 1:80 (12.5 μl/ml) & 1:20 (50 μl/ml) dilutions of commercially available Dentol were measured as MICs for S.aureus and P.aeruginosa, respectively. Two-fold dilutions of Dentol MICs completely eradicated and inhibited biofilm formation. Statistical analysis between test groups revealed significant differences. Disscussion: Dentol is a medicinal herbal essential oil derived from Satureja khuzestanica (SKEO). Several in vitro studies have reported its antidiabetic, analgesic, anti-inflammatory, and anti-hyperlipidemic effects. So because of complications that have been encountered in health care settings from routine methods of catheter processing, and biofilm related problems, efficacy of Dentol for destruction of bacterial biofilms as a safe material was studied.

Surgery on the skeleton frequently requires harvesting of autogenous bone graft from the pelvis, but this procedure is complicated by problems. The purpose of this retrospective, comparative descriptive study was to compare the efficacy of metal-derived bioactive glass (Novabone) versus autogenous iliac crest bone graft in adolescent idiopathic scoliosis surgery. The study was carried out on forty cases (aged 14-20 years) with 55 total curves fused for AIS. Posterior spinal fusion was performed using local bone grafts combined with autogenous iliac crest bone graft in 20 patients (group 1), and combined with Novabone in another twenty ones (group 2). The patients were observed for a minimum of 24 months after surgery, with a mean postoperative observation time of 34.7 months. The results were assessed clinically and radiologically. In group 1, average preoperative curve was 66° with immediate correction to 24.2° (59.7%) and final follow-up of 27.4° (54.3%), but in group 2 the calculated numbers included 63.8°, 25.8° (59.6%) and 28.4° (55.5 %) respectively. There were 5 indeterminate fusions (3 cases in group 1 and 2 in the other group), 1 acute infection, and 1 hook dislodgement in the synthetic group. These results justify and favor the use of bone substitutes for instrumented posterior spinal fusion in AIS. Potentially hazardous harvesting of pelvic bone is no longer necessary for such operations.

This study was undertaken to define the prevalence of the upper Gastrointestinal (GI) lesions, dyspeptic symptoms, H.pylori infection, and the impact of duration of dialysis on upper GI symptoms and lesions of children with End-stage renal disease. We studied 69 children with ESRD who were under regular hemodialysis therapy in our department. The age of the patients were between 4-18 years (mean: 11.3). 57(82.6%) of 69 patients had GI symptoms and 12(17.4%) were symptom free, the prevalence of each symptom in 57 symptomatic children was as follows: anorexia 48(84.2%), nausea/vomiting 39 (68.4%), belching/heartburn 20(35%), abdominal distention 15(26.3%), and epigastric pain 8(14%). 65(92.4%) of 69 patients with ESRD had pathologic lesions and the most common lesion was gastritis. There was no case of gastric angiodysplasia in our patients. 15(21.7%) of 69 patients had H. pylori infection. The prevalence of H.pylori infection in non-uremic children with upper GI symptoms is about 27% in our pediatric gastroenterology department, so there was no significant difference in prevalence of H.pylori infection between uremic and non-uremic children in our study (p value = 0.4735). There was no significant relationship between duration of dialysis and dyspeptic symptoms or upper GI lesions (p values were 0.8775 and 0.7435, respectively). Upper GI disorders are very common in children with ESRD, even when they have no upper GI symptoms, the most common lesion is gastritis. The prevalence of H.pylori infection is not different between children with ESRD and non-uremic children with upper GI symptoms, and duration of hemodialysis therapy has no significant effect on prevalence of GI symptoms and lesions.

Nausea and vomiting of pregnancy (NVP) are often alleviated by eating dried biscuits or foods. Natural products such as ginger have been suggested as herbal remedies for its treatment. The purpose of this study was to determine the effectiveness of ginger in biscuit form for the treatment. Sixty-five women with NVP at or before 17 weeks of gestation, who attended the antenatal clinic of Yahyanejad hospital in Babol town, Northern Iran, during 2005-2006 were included in the study. The subjects were randomized in a double-blind design and divided into two groups to take biscuits. 0.5g of ginger as fine powder was incorporated in each biscuit. Subjects received 5 ginger biscuits per day or an identical placebo biscuit for 4 days. They graded their severity of nausea using visual analog scales (VAS) and recorded the number of vomiting episodes in the previous 24 hours and again during 4 consecutive days. Five-item Likert scales were used to assess the severity of their symptoms. The average VAS scores of day 1 to 4 of post-therapy minus baseline nausea was decreased significantly in ginger (2.6±1.77) compared with the placebo group (1.4±1.62) (P=0.01). The number of vomiting episodes was also decreased in ginger (0.96±0.21) and placebo (0.62±0.19), the difference being insignificant. A significant difference was seen in inter-group variations per day in both groups. Likert scale showed an improvement in symptoms in both groups (P=0.43). Therefore, ginger in biscuit form is effective for relieving the severity of nausea and, to some extent, of vomiting in pregnancy.

Hyperglycemia, in trauma patient, is commonly associated with a hyper metabolic stress response. Our objective is to determine the effects of hyperglycemia on the overall outcome of head trauma patients. In this descriptive study data were collected from head trauma patients'' admitted to Intensive Care Unit (ICU) of Poursina University Hospital in a one-year period (Jan 2004-Jan 2005), retrospectively. All patients had stayed in the ICU for more than 48 hours post-injuries. They were divided into two groups according to their serum glucose levels at the time of admission (<200mg/dl or >200mg/dl), age, gender and Injury Severity Score (ISS). Patients with diabetes mellitus were excluded. We determined the outcome according to duration of hospitalization and ICU stay as well as mortality rates. Variables were analyzed with t-test and chi square test. Out of 115 patients, 89.6% were men. About 36 % of patients had serum glucose levels ≥ 200 mg/dl over the study period and this group had significantly greater mortality rate but without necessarily longer ICU or hospital stay. In this study we have shown that admission hyperglycemia has significant effect on patient''s mortality but it is still unclear whether it can be a cause for longer ICU/hospital stay.

This prospective study, conducted in 8 cities of Iran from 1999 to 2000. Out of total 16,573 trauma patients, 106 (0.63%) included in this study had renal injury. This study aimed at investigation of incidence, etiology and management of renal trauma patients in Iran. They were 87 (82.1%) male and 19 (17.9%) female patients. Renal trauma mechanism was mainly blunt injury (93.4%). Road traffic crashes (61.3%) and falls (22.7%) were the most leading causes of trauma. These patients had different grade of traumas as follow: Sixty-six (62.3%) grade I, 14 (13.2%) grade II, 10 (9.4%) grade III, 8 (7.5%) grade IV and 8 (7.5%) grade V. Out of 106 patients, eighty-three (78.3%) patients managed conservatively, most had grade I injury (P<0.0001). Twenty-three (21.7%) patients underwent different kinds of operation including: 5 (4.7%) nephrorrhaphy; 6 (5.7%) partial nephrectomy, and 12 (11.8%) total nephrectomy. More invasive intervention was needed in patients with higher grades of trauma as all with grade V injury underwent total nephrectomy (P<0.0001). Six patients (5.66%) passed away, three due to severe renal injury and hemorrhage, and three because of reasons unrelated to renal trauma. We concluded that most renal traumas are blunt injury and low grade with stable hemodynamic state which can be managed successfully non-operatively. © 2009 Tehran University of Medical Sciences. All rights reserved.

To access the surgical progress of patients with long segment aganglionosis and long-term evaluation. During the past 15 years, we reviewed the therapy and outcome of 15 patients with Long-Segment Agangelionosis (LSA) in Mofid children''s hospital. 2 with Agangelionosis to the midtransvers colon (MTA(, 8 to the ascendant and cecum (A/CA), 4 with total colonic and distal ileum involvement (TCA), and one child with total intestinal Agangelionosis (TIA). The patient with TIA had only laparatomy and staged biopsies. 12 were treated by Swenson technique and 2 patients by other procedures. All patients received total parenteral nutrition up to 10 days postoperative to ensure appropriate fluid and electrolyte status. The patients with TCA needed supplementary therapies (Diet, Drugs) up to 4 months to reduce the stool frequency. 2 patients died. The patient with TIA died 6 months after Biopsies. Another one died 5 months after pull-through: small bowel ileus with total intestinal necrosis. 9 Of the 13 alive patients have normal stool pattern: 1-3 times per day. 2 patients have 3-6 stools per day with 1-2 soiling per week. An adolescent patient has occasionally nightly soiling (1- 2 per month). No actual data about one patient (A/CA). One TCA patient doing well immediately postoperative becomes obstipated 3 months later (after having Entrocolitis). He had washout enemas for 9 months. Now stools regularly. Awareness of long-segment Agangelionosis should lead to earlier diagnosis. Appropriate surgery and improvements in supportive care led to a significantly increased rate of survival. Patients with LSA even involving ileum (but no more than 50 cm of ileum) should attain a normal stooling behavior. Long-term outcome is quite favorable.

Epilepsy is a chronic disease that affects different aspects of life; so we studied the quality of life of epileptic patients and compared it with general population of Tehran. We collected clinical and demographic data and studied quality of life by using the Iranian translation of Short Form 36 questionnaire version 2 (SF-36). The questionnaires were filled out by 200 patients with epilepsy referred to the Epilepsy Institute as outpatients. The mean age of our patients was 32.6 years. 54.5% were male. More than 60% of our patients had generalized tonic colonic seizures and seizure frequency was more than once a month in about 40% of them. Patients had lower scores in all subscales of SF-36, which were significantly lower than the general population. Mental health and vitality were the most affected by the disease and physical functioning was the least. Age, marital status, number of children, type of seizure and duration of disease had no effect on quality of life, but gender, educational level, occupation and income did influence quality of life. Clinical factors with significant effects on quality of life were as follows: number of taken drugs, number of adverse effects of drugs, frequency of seizures, and the time passed from last seizure. So we recommend treating patients using least number of drugs with minimum side effects. Striving for seizure free patients is very important and it is vital that we regard quality of life as an important factor in selecting appropriate treatment for patients.

Limb bud first appears during the third week of gestation with the upper limb buds appearing a few days before the lower limb buds. Complete absence of one or more limbs, called Amelia, occurs prior to the eighth week of gestation. We report a case of Amelia in a twin gestation.

It is an autosomal recessive, and occasionally autosomal dominant mutant extremely rare disorder with only 100 reported case in literature. This fatal disorder occur in both sexes and all races. In most circumstances the newborn die soon after birth Also it is known as harlequin fetus, alligator baby or keratosis diffusa fatalis.Because of its rarity, we report 2 cases of this disorder, here.