مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال شانزدهم شماره 4 (پیاپی 65، زمستان 1387)

There are controversies regarding treatment of peritonsillar abscess as a common infection of head and neck, especially for prescription of corticosteroids. According to review of articles, use of corticosteroids in management of this abscess is increasing, but more controlled and comparative studies are needed. In this clinical trial study, we evaluated corticosteroid as an adjutant therapy for peritonsillar abscess. This clinical trial study was done on 50 hospitalized patients divided into 2 groups steroid and placebo. Antibiotic therapy and method of abscess drainage was the same in both groups. A special questionnaire included characteristics, symptoms, clinical course and complications of patients. Data was filled and analyzed by SPSS software using chi square, repeated measurement and t tests. Normalization of body temperature within 12 hours after treatment and mean time of painless swallowing was 100% and 9 hours in the steroid group as compared to 84% and 15 hours in placebo group (p value=0.04). Trismus recovery was faster in steroid group. Hospitalization period was 3 and 4 days in steroid and placebo groups, respectively (P value>0.05). Fewer complications were reported in steroid receiving patients. There was one case of relapse in the steroid group and 5 cases in the placebo group (P value=0.09). According to our findings, it seems that corticosteroid adjuvant therapy of peritonsillar abscess is effective and doesn’t lead to any important complication.

Chlamydia trachomatis infection is a common pathogen in sexual transmitted disease, but most of female patients with this infection are asymptomatic. Sequealae include pelvic inflammatory disease, infertility and ectopic pregnancy. The aim of the study was to determine the association between Chlamydia trachomatis and tubal factor infertility, if significant. This prospective, case -control study was done in April 2005-April2006. The study group consisted of 125 patients with tubal factor infertility and the control group included 125 fertile women. The level of antibodies to Chlamydia trachomatis was determined in both groups by ELIZA method. Antibody to Chlamydia trachomatis was present in 29 women in the study group (23.2%) and in15 women in the control group (12%), respectively, (P< 0.005). The mean level of antibody in both groups was 0.76 and 0.49, respectively (P<0.0005). The study showed that the level of antibody against Chlamydia is significantly more in tubal factor infertile women. We therefore suggest the screening of Chlamydia antibody testing is necessary for tubal factor infertility workup.

Kawasaki syndrome is an acute febrile vasculitis with multiorgan involvment in children. The objective of this study was assessment of demographic, clinical and laboratory data of Kawasaki patients in Yazd. In a descriptive-analytic study, the hospital records of patients treated for Kawasaki disease in all hospitals with pediatric wards between March 1996 and March 2006 at Yazd were reviewed and demographic, clinical and laboratory data recorded in a questionnaire and analyzed by SPSS, version 13. Chi-square test was used to assess statistical differences. 60.4% of patients were male and male /female ratio was 1.52. Seven percent of them were less than 5 years old. Duration of fever before treatment was in range of 1-20 days with mean of 9.1±5.07 days. Fever less than 5 days, 6-10 days, 11-15 days and more than 15 days was seen in 45.8%, 25 %, 22.9% and 6.2%, respectively. The most common symptoms were non purulent conjunctivitis (83.3%), strawberry tongue (79%), dry-cracked lips(77%), skin rash(66.6%) and cervical lymphadenopathy(47.9%). Leukocytosis, anemia and thrombocytosis were seen in 64%, 80% and 45%, respectively. Cardiac involvement was seen in 39.5% of the patients. The Kawasaki disease is predominantly seen in children less than 5 years old and most common symptoms include non purulent conjunctivitis, strawberry tongue, dry-cracked lips, skin rash and cervical lymphadenopathy.

Air pollution is one of the problems of the recent century caused by vehicles, industries and other urban activities. The City of Yazd faces air pollution due to its high population, vehicular traffic and industrial places around the city. One of the important parameters of air pollution is suspended air particles that have harmful effects on the health of people, plants and objects. This research has been carried out by first determining a station in the central area of the city (Shahid Beheshti Square of Yazd). The suspended particles were measured during a five-month period from March to July, 2006. A high volume sampler was used for measuring Total Suspended Particles (TSP). The amount of lead content of TSP was measured in samples by using atomic absorption method. In the next stage, the percentage of organic and inorganic particles in the TSP of all samples was measured by using gravimetric methods and by burning in the oven. The results of this study showed that amount of suspended particles in the city of Yazd is higher than national standard and the general mean average of the suspended particles of air in five months was 233 micrograms per cubic meter. The average concentration of suspended air particles from end of March to August during the five month period was 118, 193, 231, 267and 333, respectively. The average concentration of lead was 0.04 microgram per cubic meter and amount of organic and inorganic particles in TSP was 25.31% and 74.68%, respectively. With respect to the results, the minimum amount of TSP concentration was in March. This could be due to reduction in trading and industrial activities and New Year vacations. In addition, the average monthly TSP increased from March to July the cause of which could be relative decrease in humidity and increase in temperature. The amount of lead in samples was much less than standard, which could be due to omission of lead from petrol used in the city.

Glycemia and blood glucose levels are under the effect of Hb A1c and therefore they could be considered as a valid index for the follow-up and control of diabetes. There are different and controversial reports on the effects of iron deficiency anemia on Hb A1c. Effects of IDA in non diabetic patients are also unknown. The aim of the study was the comparison of Hb A1C levels in healthy patients and non diabetic Iron deficiency anemia (IDA) patients before and after intervention in Rafsanjan. This research was a semi– experimental intervention study. The population under study consisted of 30 non diabetic IDA patients and 30 healthy patients in Rafsanjan that were matched for age and sex and other characteristics. Ferritin, Hb, HCT, MCV, MCH, MCHC, FBS, BS 2HPP and Hb A1c, were measured to confirm IDA. These parameters were also measured in the healthy subjects (control group) to confirm their health and them being non diabetic and iron sufficient and all parameters were compared after the intervention. Then all patients with IDA were treated with iron 6mg/ kg for 3 months. The tests was repeated again and results compared with the results of both the groups before the intervention. The mean Hb A1c level before iron treatment was (7.64±2.08) in patients with IDA that was higher than the control group (5.97± 1.01)(p<0.05). Hb A1c decreased after iron therapy in patients with IDA. It is recommended that before any diagnostic or therapeutic decisions are made with regards to Hb A1c, iron deficiency should be corrected.

Radiography is one of the most important diagnostic methods for evaluation of dental caries. On the other hand, the least amount of radiation along with high quality is a main gold standard. The purpose of this study was to compare the diagnostic accuracy of Primax, Insight Radiographic films, and direct digital images (Schick CMOS-APS), in detection of interproximal natural Caries. In this experimental invitro study, 208 extracted permanent molars and premolars were selected for study on the basis of varying caries depth. Exposure factors considered for conventional films and digital images were 70 Kvp and 8 mA, and exposure times for each of the three modalities were in the following order 0.20 s for Primax, 0.16 s for Insight and 0.08 s for digital images. All film types were subsequently automatically processed. The conventional radiographs and digital images were examined by five observers. They were asked to detect caries in the approximal surfaces. They had to indicate their certainty of decision separately for each interproximal side of each tooth on a 5-point confidence scale. Following acquisition of the image modalities, the teeth were sectioned mesiodistally along the long axis of the crowns. Sectioned teeth were evaluated for the absence or presence of approximal carious lesions as Gold Standard. Inter-observer agreement in detecting approximal caries, for each image using Kappa Value, was evaluated. Then sensitivity value, specificity value and the areas (Az) beneath Receiver operating characteristic (ROC) curves were calculated. A slight (k=0.01) inter-observer agreement was observed in comparison of Gold Standard. The sensitivity value of Primax was higher as compared to both Insight and digital images. Although the Az value indicated an overall better performance of Primax(0.64) as compared to both Insight(0.63) and digital images(0.61), all three modalities showed a trend of increasing sensitivity for deeper lesions. Results indicated no significant difference between the diagnostic accuracies of three imaging modalities in the detection of approximal carious lesions (p= 0.18). However, analysis of the diagnostic accuracy of three imaging modalities in the detection of degree of carious lesion was significant. (p=0.02).which indicated the superior performance of dental films as compared to digital images. All three performed modalities are poorl in the detection of enamel lesions. Considering limitations of this study, it is proposed that insight film and digital images should be endorsed for clinical use, especially since radiation exposure is reduced.

Insertion or deletion of a guanine in -1607 at promoter region of matrix metalloproteinase-1 enzyme creates two allelic types for this gene in the population: 2G and 1G, respectively. 2G allele contains an extra binding site for ETS transcription factors that this may increase the level of gene expression. Therefore, aim of this study was investigation of the single Guanine insertion in the promoter gene and its association with colorectal cancer patient survival rate and tumor progression. Blood samples from 150 colorectal patients and 100 cases were extracted. The mean follow-up was 25 months (12-36 months). Cases and patients were genotyped using genomic DNA extraction and PCR-RFLP. Colorectal cancer patients were divided in two groups with activity of metastasis (M+) and without activity of metastasis (M-). 2G allele in metastasis group (55%) showed more frequency rather than controls (23%). Survival analyses showed that 3 years survival patients rate in the patients without metastasis activity carrying 1G allele (homo and heterozygote) was 81% and for 2G homozygote is 66% (p=0.04). The survival rate dependent to cancer was 90% and 71%, respectively (P=0.01). According to the results, it seems that patients carrying 1G allele show a better survival rate dependent on cancer as compared to patients who do not carry this allele.

Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury) are associated with higher mortality rates of 40 to 60 %. This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005). A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal) were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. The population under study included 11 patients (9 male, 2 female) with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF). Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation) is the key to success.

Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital), based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.

Osteoporosis is a multifactorial disease and several factors are involved in development and progression of the disease. The aim of this study was to increase our understanding of the relation between age, weight, BMI, postmenopausal age and bone mineral density in post menopause women. 240 Azarbaijani women aged 50-70 years having inclusion criteria were recruited. Bone mineral density (BMD) of lumbar spine (LS), femur neck (FN) and total hip were measured. Based on BMD, all subjects were divided into 3 groups osteoporotic, osteopenic and normal. Personal characteristics of the individuals were obtained and weights and heights were measured. There were significant differences between age, postmenopausal age (PMA), weight and BMI of the 3 study groups (for age, PMA and weight, p<0.001 and for BMI, p=0.018). There were negative correlations between age and PMA and BMD of different skeletal regions. After controlling the confounding variables, the association between age and BMD of hip and FN as well as PMA and BMD of LS remained significant (p=0.003, p<0.001 and p=0.025). There was also a significant correlation between weight and BMI and BMD of the measured skeletal sites. This study confirmed the positive and protective effect of weight and BMI on BMD. It also revealed the negative effect of age and PMA on BMD of different skeletal regions.

Free radicals are molecules or atoms with single electron that results in reactions thus causing severe damages to the body’s macromolecules. By preventing the formation of free radicals, repairing damages caused by radical’s activities, increasing the excretion of the damaged molecules and minimizing the cellular mutation, the antioxidant defense system contrasts the damages caused by free radicals. Different lifestyles and nutrition, environmental and genetic factors can lead to the unusual increase in free radicals formation or weakening the antioxidant defense system and can cause the imbalance between the production and excretion of free radicals. They have not only a significant role in aging but also in causing and aggravating many diseases. Accordingly, some factors related to total antioxidant capacity of saliva were studied. This study was descriptive and the sampling was performed in multi stages. The subjects consisted of 720 students (male: 325, female: 395) in Arak. Individuals filled a questionnaire approved by experts and included the demographic factors and dietary habits. Then the total antioxidant capacity in saliva of these students were measured by FRAP method. The results were analyzed with descriptive analysis (such as Mean, Deviation standard) and also analytical analysis (such as T-test and Spirman Correlation Coefficient). The mean and standard deviation (mean  SD) of total antioxidant capacity of saliva in males was higher than the females and so there was a positive and meaningful correlation between total capacity antioxidant of saliva and milk consumption, father’s education and mother’s education. P and R in this manner were (0.02, 0.04, 0.045-0087, 0.11, 0.076) while there was no significant correlation between social and economic status, consumption of fats, red and white meat and the antioxidant capacity. Parents level of education and dietary habits have a significant and positive correlation with the antioxidant capacity. It seems that giving necessary information and nutrition instruction can help decrease oxidative stress and prevent different diseases.

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by high grade fever, skin rash, arthritis, leukocytosis, increased ESR, CRP and liver enzyme levels and high levels of ferritin. The treatment of AOSD includes NSAIDs, steroids, and disease-modifying antirheumatic drugs (DMARDs). Recently biologic agents have been used for treatment of some rheumatologic disorders. Rituximab(MabThera), an anti-CD20 monoclonal antibody is one of the biologic agents which is used by only a few researchers for treatment of refractory AOSD. Herein, we describe a 23 year old woman, who was treated with Rituximab, three years after diagnosis of AOSD. She did not respond to Metotroxate and Cellcept. After administration of Rituximab, clinical and laboratory remission was achieved.

Pheochromocytoma is an adrenal tumor characterized by symptoms of hypertension, headache, increased sweating, and tachycardia. In one third of patients, the tumor is discovered incidentally during radiological evaluation of the abdomen. In this article a case of bilateral pheochromocytoma is reported. The patient, a twelve years old boy, referred with complaints of headache, flushing, palpitation and blurring of vision. He had a blood pressure of 200/120 mmHg and after investigation, coarctation of aorta was excluded. On abdominal ultrasound, bilateral adrenal mass was diagnosed, followed by serial measurements of urinary vanillyl mandellic acid (VMA) which was found to be elevated. Meta- Iodio benzyl glunidin (MIBG) scan showed increased uptake in both adrenals. Patient underwent laparotomy and bilateral adrenalectomy with the diagnosis of pheochromocytoma. Pathologic report confirmed the diagnosis.