Iranian Journal of Medical Sciences
Volume:29 Issue: 4, Dec 2004

The aim of this study was to validate the well-recognized outcome measure instruments (Medical Outcome Study Short Form-SF-36, Western Ontario and McMaster University Osteoarthritis Index-WOMAC, McMaster Toronto Arthritis Patient Preference Disability Questionnaire-MACTAR) for patients who had undergone total knee arthroplasty in Iran, with its cultural and ethnic differences and compare them with the reports from other parts of the world. Sixty patients, 56 women and 4 men, who had undergone total knee arthroplasty by a single surgeon, were recruited for clinical evaluation and for filling out the questionnaires on 3 outcome instrument systems, namely SF-36, WOMAC and MACTAR. Two control groups consisting of 44 cases of similar age from general population with knee discomfort and susceptible to osteoarthritis as well as 26 patients scheduled for knee arthroplasty filled out the same questionnaires. The health status measurement (SF-36), disease-specific outcome measure and patient preference arthritis scores all showed significant improvement in operated cases, in both short and long term follow-up groups. Certain aspects of function like socialization with others, attending religious ceremonies and similar activities, often requiring full knee bending and/or sitting on the carpeted floor, were the main reasons for dissatisfaction with the procedure. The knee arthroplasty increased quality of life, improved function and produced great satisfaction in the majority of cases in our society. This is, however, a viable option for people who could change their lifestyle and household and are able to make the adjustments mentally and financially.

Perfectionism appears to play an important role in the etiology, maintenance, and course of psychological disorders. However, very few clinical data exist to clarify the nature and the relationship between dimensions of perfectionism with depression and anxiety. The aim of this study was to compare dimensions of perfectionism in depressed and anxious patients. Eighty-eight consecutive referrals to the counseling centers of the University of Tehran and Iran University of Science and Technology, Tehran Iran, were included in this study in three groups: 1) depressed patients (n= 25); 2) anxious patients (n= 19); and 3) matched normal subjects (n= 44) as control. All 88 participants were asked to complete the Multidimensional Perfectionism Scale. The Beck Depression Inventory and the Beck Anxiety Inventory. It was found that depressed patients had higher levels of Self-Oriented Perfectionism than did the other two groups. It was also found that anxious patients had higher levels of Socially Prescribed Perfectionism (SPP) than did either the depressed or the normal control subjects. In addition, depressed patients reported higher levels of SPP than did normal control subjects. No significant difference was found between the three groups in terms of Other-Oriented Perfectionism. Results of the present study reinforce the need to examine and conceptualize perfectionism as a potentially multidimensional construct

Several studies have shown that administration of magnesium sulfate prolongs the bleeding time. To investigate such effects in pregnant women in Shiraz, southern Iran. This study was conducted on 30 pregnant women aged between 18 and 32 yrs, with a gestational age of 20 to 37 weeks, who presented to Hafez and Zeynabiyeh Emergency Units affiliated to Shiraz University of Medical Sciences between January and August 1999, with premature labor pain or complaining of abdominal or back pain. The patients received tocolytic treatment with magnesium sulfate (MgSO4) in absence of any contraindication. The blood pressure and bleeding time of patients were measured upon admission to the labor room and before any intravenous infusion of MgSO4. Platelet count and serum magnesium level were also determined for each case. The aforementioned measurements and samplings were repeated following administration of 10 g MgSO4. A significant difference was observed between the mean serum magnesium level and mean arterial blood pressure, before and after MgSO4 infusion. The mean bleeding time showed an increase of 27 seconds (15%) after infusion of Mg. Nevertheless, this value still remained in the normal range of 120–420 s. A direct relationship was found between the increase in serum magnesium level and the bleeding time. No change was observed in the mean platelet count. Magnesium therapy is associated with an increase in bleeding time in pregnant women, with no change in platelet count. This increase had no clinical significance and dose-independent.

Aqueous extract of winter cherry (Physalis alkekengi L; family of Solanaceae) fruits (WCF) has long been recommended for fertility control by herbalists in Iran. The effect of this extract on lowering serum progesterone levels has been reported previously. To study the effects of WCF extract on the activities of ovarian 3β-hydroxysteroid dehydrogenase (3β-HSD) responsible for the synthesis of progesterone and 20α-HSD responsible for its degradation in rats. One ml aliquots of the aqueous extract of WCF (containing 400 mg of dried extract) were intraperitoneally injected for 8 consecutive days to rats from day 8 of pregnancy. Rats were then sacrificed 21 days and 11 hours after the day of observing sperm positive vaginal smears. Blood was collected for the determination of serum progesterone and the total and the live numbers of embryos were counted. Ovaries were also used for the measurement of the activities of 3β- and 20α-HSD. The extract of WCF decreased the ovarian 3β-HSD specific activity by 47%, serum progesterone concentration by 30% and the number of live embryos by 67%, but it had no effect on the specific activity of ovarian 20α-HSD. The aqueous extract of WCF, containing steroidal compounds with known estrogen antagonistic properties, probably interferes with the function of estradiol in inducing ovarian 3β-HSD synthesis. It may also contain components which inhibit this enzyme, thus reducing progesterone synthesis that is required for maintaining pregnancy. Such natural compounds, if purified, might be beneficial for control of fertility.

Correlations between bone marrow, heart, kidney, liver, skin and lung transplant rejection or survival with human cytokine gene polymorphisms have been described. There are also reports about the role of cytokines and Tumor Necrosis Factors-Alpha (TNF-α) on corneal transplant in animal models. Further studies are needed to clarify the role of cytokines in corneal allograft rejection in humans. To study whether corneal allograft rejection is associated with TNF-α gene polymorphism. A total of 105 cases of corneal transplant were followed for a mean period of 25.9 months and the episodes of rejections recorded. We determined allele-specific PCR (ASPCR) TNF-α gene polymorphism of the patients and evaluated their association with rejection. The overall incidence of corneal graft rejection and its subsequent recovery were 21% and 63.6% respectively. Rejection was more common in the vascularized corneas (5.4 folds; P<0.001), and in eyes with anterior synechia (3.9 fold; P<0.05). There was no correlation between TNF-α gene polymorphism and the chance of allograft rejection. No association was found between human TNF-α-308 G/A promoter gene polymorphism and corneal allograft rejection in our cases of uncomplicated penetrating keratoplasty.

Infantile obesity is becoming increasingly recognized as one of the public health problems in Iran. Obesity charts of a cohort of 317 healthy infants and their parents living in Shiraz (Southern Iran) are presented and the familial pattern of infants’ obesity with that of its parents explored. An adjusted weight-for-height index was used to develop power type obesity indices, Ip=W/Hp. Polynomial modelling was used by applying the Healy-Rasbash-Yang (HRY) nonparametric method to estimate age-related smoothed centiles of obesity and dynamic obesity charts for infants and their parents are presented. Principal component analysis (PCA) was applied to the data as continuous variables to analyse familial pattern of parent-infant obesity structurally. The optimal value of p was found to be 2.5 for infants and 1 for their parents. Infants’ obesity increases from birth to six months of age and decreases thereafter until the age of 21 months when it became stable. Obesity indices and circumferences sizes were reduced to two principal components interpreting infants as well as family obesity. The first principal component evaluates infants’ obesity as a combination of obesity index as well as their arm, chest and head circumferences. Also the second principal component combines mothers’ obesity and her arm circumference, while father obesity did not influence familial obesity structure significantly. Obesity is an age related phenomenon and dynamic charts presented herein are appropriate practical tools to assess obesity in both infants less than two years of age and their parents.

Honey has been shown to accelerate wound healing, which is especially important in the management of patients with full-thickness wounds of skin in dermatologic surgeries. To evaluate the effects of honey in accelerating healing of full-thickness skin wounds in mice. Two groups of male NMRI mice (n=12) were subjected to full-thickness skin wounds under general anesthesia. They were then randomly allocated to receive either single daily applications of placebo or honey (n=6 for each group). On each of the 4th, 7th and 10th days after operation, 2 mice from each group were sacrificed using an overdose of anesthetic. Macroscopic and microscopic characteristics of wounds were studied pathologically, histologically, and for resilience, ultimate tensile strength and toughness. Honey increased the formation of granulation tissue, density and activation of fibroblasts, keratinization in surface of wound, thickness of basement membrane and epidermis, and thickness of collagen fiber. It also decreased infection, inflammation, edema and dehiscence, and increased resilience, ultimate tensile strength and toughness of wound. Honey accelerates healing of full-thickness skin wounds in mice.

The ratio of urine protein to urine osmolality has recently been suggested as an accurate method to determine proteinuria. We studied the correlation of urine protein to urine osmolality ratio with 24-hr urinary protein excretion. 150 children aged 0.11–17 years admitted to the Department of Pediatric Nephrology were included in this study. Early morning urine samples and 24-hr urine specimens were collected and analyzed for protein, creatinine, and osmolality. The patients with chronic renal failure were not excluded. Two groups were established: Children with no proteinuria (group 1) and those with proteinuria (group 2). The optimal cutoff value of abnormal proteinuria and nephrotic range proteinuria was determined to be a protein–osmolality ratio (Up/Uosm) 0.27 and 1.59 mg/l/mOsm respectively. The correlation of 24-hr urinary protein excretion with both urinary protein/creatinine ratio (Up/Ucr) and Up/Uosm was highly significant (p<0.001). According to the receiver operator characteristic (ROC) curves analysis, we found no differences between Up/Uosm and Up/Ucr ratios in detecting either abnormal proteinuria or nephrotic syndrome. Urine protein to urine osmolality ratio seems to be a simple and a valuable test for the assessment of the degree of proteinuria in children.

Phototherapy is a conventional method of lowering serum bilirubin in newborn jaundice. We evaluated the short distance in relation to conventional long distance phototherapy between the light-source and the skin surface. Healthy jaundiced neonates undergoing phototherapy were randomized into two groups. The distance between the light-source and the newborn''s skin was 20 and 40 centimeters (G20; n=381 and G40; n=393) respectively. Newborns with any history of herbal or Phenobarbital administration were excluded. Bilirubin level was checked 24 hrs after cessation of phototherapy. Both groups were compared regarding the duration of the exposure and its effect on serum bilirubin level and of G6PD deficiency. The respective mean duration of phototherapy in G20 and G40 were 66±22 and 81.6±24.6 hrs (P<0.001). Twenty-four hrs after cessation of phototherapy, 56.1% of G20 newborns had higher levels of rebound bilirubin in contrast with 38.5% of G40 cases. The type of milk had no influence on bilirubin levels. Exposure from 20 cm distance had no side effects on the neonates of various gestational ages and birth weights. This method proved to be safe, rapid and more effective in reducing bilirubin than phototherapy from a longer distance.

The present study describes clinical manifestation, histopathologic findings and differential diagnosis of a first-reported case of giant chondroid syringoma (CS) of the upper nasal orbital rim. A 35-yr-old man with cranial palsy (CP) and a tumor of 3×3×4 cm in the upper nasal orbital rim of the left eye was referred to the eye clinic. The tumor was reported to have developed gradually over the years. It was removed under general anesthesia and no recurrence was observed during the one-year follow-up without any complaint from the patient. Macroscopic examination showed a whitish, irregular and relatively soft nodule of 3×2.5× 2 cm. and with calcificated spots on its section. Microscopically, tubules of various sizes were observed which were surrounded by cellular stroma and distinct areas of chondroid proliferation with no malignant changes. CS may assume a giant size, appearing as hard, slow-developing cutaneous and subcutaneous nodules on differential diagnosis. Despite favorable prognosis, the recurrence of CS is reported only in those patients whose tumors are not completely removed.

T-Condylar fracture of the distal humerus is rare in the skeletally immature children and is very rare in young children, under 9 years of age. This fracture has been classified as: type A (minimally displaced or undisplaced), type B (displaced but not comminuted) and type C (displaced and comminuted). Herein, we report a T-Condylar fracture of the distal humerus in a 5-yr-old boy. This fracture was diagnosed by plain radiography, and was treated by open reduction and internal fixation, as a type B T-Condylar fracture of distal humerus.