مجله علوم پزشکی رازی
سال پانزدهم شماره 3 (پیاپی 61، پائیز و زمستان 1387)

Background and Aimi: Complication of sinusitis is a medical emergency. The purpose of this study was to determine the incidence of sinusitis in patients admitted with orbital and intracranial infections.Patient and A descriptive-retrospective study was conducted from March 2000 to Feb 2004 on 74 pediatric patients admitted with intracranial and orbital infections. Patient information was analysed by t-test. Out of 74 patients studied, 17 (22.9%) were diagnosed with sinusitis. Sinusitis was observed in 53.85% and 16.39% of children with orbital and intracranial infections, respectively. Meningitis was the most common intracranial complication (80%). The most common involved sinus was Maxillary Sinus (58.8%). The most common age group For association of sinusitis with orbital and introcranial infection was between 5-11 years. Association of sinusitis, especially with orbital infection in clidren is common. We recommend sinus imaging in any pediatric patient with orbital infection.

Colorectal cancer is the third most common cancer and the third leading cause of cancer death. Most often it is derived from an adenomatous polyp. Therefore, detection and treatment of these baseline polyps could potentially decrease the prevalence and incidence of colorectal cancers. One of these screening procedures is colonoscopy, which is more Precise than others like. Barium enema in detecting primitive and small polyps. In addition, colonoscopy has the added benefit that lesion can be removed during the same procedure. Thus, this study was performed to determine the frequency of polyps and colorectal tumors among patients who underwent colonoscopy in Shariati hospital between November 2000 and November 2002. Patients and This retrospective analytical cross-sectional study was performed on 993 patients who underwent colonoscopy in Shariati hospital from November 2000 to November 2002. Method of sampling was by census. All patients were evaluated for demographic variables, location and size of polyps and tumors by using a checklist. The data were collected, described and analyzed using SPSS V.11.5 sofware. Chi2 and Student t-test were performed in the data analysis. Among 993 patients who were studied, 529 (53.3%) were males and 464 (46.7%) were females. The frequency of polyps and tumors in this study was 15.4% (153 of 993) and 4.8% (48 of 993), respectively. There was a significant association between the frequency of polyps and its location (P<0.01). The most common location of polyps was sigmoid (76.5%). Also, a significant association was observed between the frequency of tumors and its location (P<0.01). The most common location of tumors was again recto-sigmoid colon (70.8%). Additionally, polyps and tumors were respectively 1.6 and 1.7 times more prevalent in men than women. Regarding the most prevalent location of polyps and tumors, the use of fexible sigmoidoscopy may lead to detection and even treatment of many accessible polyps and tumors which could result in prevention of many colorectal cancers. Also colonoscopy is useful to detect lesions which were not detected by sigmoidoscopy and these inaccessible polyps and tumors can be bilopsied.

Mycoplasmas are the smallest bacteria capable of independent growth in artificial media. Mycoplasma hominis is associated with pre-mature birth, rupture of amniotic membranes and post-delivery fever. Ureaplasma urealyticum is similarly associated with chorioamnionitis and low-birth weight infants. Both of these bacteria can easily get transferred into newborns during childbirth leading to pneumonia, meningitis, cerebral abscesses and other complications. This study was conducted in order to survey the prevalence of these two micro organisms in women suffering from genital infections.Patients and The study was adescriptive. Endocervical swabs were collected from a total of 205 women with genital tract infections who referred to various hospitals affiliated to Iran University of Medical Sciences in Tehran. The swabs were placed in PPLO broth transport media and immediately sent to laboratory. Following filtration through 0.45 mm pore-size disposable filters, the filtrates were cultured into Arginine broth and Urea broth. In cases of color change, the broth media were sub-cultured into PPLO agar plates. All media were incubated at 35°C under elevated Co2 atmosphere. From the total of 205 endocervical swabs, 64 samples (31.18%) were positive for Ureaplasma urealyticum and 16 samples (7.76%) were positive for Mycoplasma hominis. The highest prevalence of positive cases was among the 29-39 years of age group (34 patients) and belonged to women diagnosed with vaginitis (36 patients). The results of this survey indicate that the prevalence rate of Mycoplasma hominis and Ureaplasma urealyticum infections among symptomatic Iranian women is in the intermediate range. Due to fact that the prevalence rates of these infections are probably on the rise, more attention needs to be paid to their role as an important etiologic factor of urogenital infections. Its prompt culture in routine clinical laboratories and immediate treatment should be considered as a health care priority.

Epidural-spinal anesthesia is one of the modern methods used to establish adequate anesthesia in cesarean section. In order to reduce these adverse effects different drugs are added to the anesthetic solution. The main aim of this article is evaluation of maternal and neonatal effects of adding Midazolam to Bupivacaine under combined spinal-epidural anesthesia in elective cesarean section Ptatients and This study has been designed as a double blind randomized clinical trial. Study population included pregnant females who were admitted to Hazrat Rasool Akram hospital to undergo elective cesarean section. Sampling was simple and nonrandomized. After considering the inclusion and exclusion criteria, and obtaining an informed consent, 90 pregnant women were divided by block randomization into 3 groups. Epidural-spinal anesthesia was achieved by using 2cc of 0.5% Bupivacaine. Based on their groups, group one (A) received only 0.5% Bupivacaine group two 2.5 mg of Midazolam along with 0.5% Bupivacaine and group 3, (C) 5 mg Midazolam with 0.5% Bupivacaine. Time duration of complete motor block, time duration of the highest score of sedation, time duration of required analgesia after surgery as well as, maternal and neonatal side effects were evaluated. To compare the qualitative and quantitalive data between the two groups, Chi sqaure test was used for normal distribution and for quantization variables, One Way ANOVA analysis of variance was used. Level of significance in this study was considered as 0.05. SPSS V. 13 was used for statistical analysis. Time of sensory motor block in Midazolam group was significantly less than Bupivacaine group this time for 5 mg Midazolam group was in the minimal range. The most sedative effects belonged to the midazolam 5 mg group. Adding Midazolam decreased significantly the time of requiring additional analgesia in mothers after surgery. The most prevalent complications that was reported by the mothers was nausea and vomiting more than 70% of mothers who received Bupivacaine alone complained of it. In this study it was shown that addition of Midazolam was associated with rapid onset of motor and sensory blocks along with maximum sedation. It also decreased the incidence of nausea and vomiting due to Bupivacaine. In addition maternal and neonatal side effects are not increased.

Klebsiella pneumoniae (K. Pneumoniae) is one of the prevalent infectious bacteria, especially in hospitalized patients. Recently, it's multi drug resistance (MDR) trait has become more important and regarded as a virulant factor. In this study, we evaluated bla-ctx-m-type gene in clinical isolates of K.pneumoniae with multi drug resistance. In this descriptive cross-sectional study, a total of 280 K.pneumoniae strains were isolated from patients. Initially, we evaluated drug sensitivity with disk diffusion method. Then the minimum inhibitory concentration (MIC) of resistant isolates was determined with E-test stripes. The existence of ESBL (Extended Spectrum Beta-Lactamase) enzymes was identified by ESBL disks in Double Disk method. These resistances were evaluated with PCR. Finally, results were analyzed by SPSS software. From total 280 K.pneumoniae, 62 samples (22.14%) showed multi drug resistance trait. 40 strains of these MDR isolates were completely resistant to the experimental cephalosporins, and positive in ESBL production by Double Disk methodology. These results were proved and evaluated with PCR and Sequencing. Detection of 22.14% MDR trait, especially extended spectrum beta-lactamases in resistant clinical K.pneumoniae isolates, points to the in usage of extended spectrum cephalosporins.

Stress urinary incontinence (SUI), is one of the important health problems for women and the knowledge about its risk factors is considerably significant.The purpose of the present study is finding a relationship between the mode of delivery and SUI, one year after first delivery.Patients and A historical cohort study was performed in Akbarabadi Teaching Hospital, Tehran, Iran, between March 2006- March 2007. One thousand four hundred primiparaous women who had delivered one year ago entered the study and were compared. They were divided into three groups.Patients were diagnosed with incontinence by questionnaire. The patients with internal disorders or chronic high intra-abdominal pressure and urinary infection were excluded from the study. Statistical analysis was performed using SPSS. t and Chi2 tests were used for comparing the results. The patients were evaluated in 3 groups. Group 1 or vaginal delivery group (400 cases), group 2 or elective cesarean section group(600 cases), and third group or emergency cesarean section group(400 case)were compared. 25 women (1.9%) had SUI, 12 of which (3%) were in the vaginal delivery group, 5 (0.83%) were in the elective cesarean group and 8 cases (2%) were in the emergency cesarean group showing a statistically significant difference (p=0.037). There was no significant difference between women in the 3 groups according to age, maternal weight, doing exercise, occupation, race, reason for cesarean section and neonatal weight. Mean duration of the second stage of labor was longer in patients with SUI (34± 8.1 min vs 25±9.63 min), showing a statistically significant difference (P=0.000). Vaginal delivery in the first pregnancy is a risk factor for SUI after one year

Asthma, as the most prevalent disorder of the airways is accompanied with excessive inflammatory, oxidative and apoptotic activity. In asthmatic patients, serum and hair levels of zinc are decreased. Zinc, as an essential micronutrient for human is reported to have anti inflammatory, anti oxidant and anti apoptosis roles. This study was conducted to investigate the effect of zinc supplementation on lung function in asthmatic patients in Hazrat Rasool Akram Hospital.Patients and Materials: A cross sectional clinical trial was conducted on 29 patients with asthma who received 50 mg zinc supplementation every other day for a period of 8 weeks. 10 ml blood sample was drawn prior to initiation of supplementation period. Serum Zinc concentration was measured by Atomic Absorption spectrophotometry and compared with that of 29 non-asthmatic individuals. Respiratory factors such as Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), Vital Capacity (VC) and FEV1: FVC ratio were measured by Spirometer in asthmatic patients before and after Zinc supplementation. Dietary intake in asthmatic patients was assessed by Dietary recall questionnaire. Data were analysed by Paired t-test and Independent t-test. SPSS V. 10 was used. The serum zinc concentration of treated patients was 0.68±0.16 mg/l, which shows significant difference (P<0.05) when compared to that of normal group. The differences of FEV1, FVC, VC, FEV1:FVC were not statistically significant before and after zinc supplementation (P>0.05) and the daily food intake of zinc in patients, was 60% of the Recommended Dietary Allowance (RDA). Zinc status of serum in asthmatic patients was significantly lower than non-asthmatic subjects and supplementation with 50 mg zinc taken every other day for 8 weeks did not lead to significant effect on respiratory factors. More interventional trials are recommended.

Today, several viruses that are responsible for the development of approximately 15% of all human tumors have been characterized.Human T cell leukemia/lymphoma virus type1 (HTLV-1), one of the human retroviruses which causes Adult T cell leukemia and Tropical spastic myelopathy, is also associated with other diseases and cancers in humans. This virus is endemic in Khorasan province.Considering the association of HTLV-1 with cervicovaginal cancers and the endemic prevalence of the virus in Khorasan, this study was designed to investigate the presence of HTLV-1 genome in the tissue specimens of cervicovaginal cancers. In this cross sectional and historical prospective study, all archived tissue specimens of cervical and vaginal cancers, diagnosed in a 20 year period(1983-2003) in the Pathology Department of Imam Reza Hospital of Mashhad were elicited and restudied microscopically. Thirty two tissue specimens were tested by PCR, using Tax, Pol and LTR primers and resulted data were analysed by Z test. The results showed that most of the patients were in their fourth or fifth decades of life about one decade younger than the other worldwide reports. Squamous cell carcinoma (SCC) was the most frequent histological subtype. In all tissue specimens studied by PCR method, genome of HTLV-1 was not detected. Despite the endemic prevalence of this virus in Khorasan, no association was noted between HTLV-1 and cervicovaginal cancers in studied Iranian women.

Hemodialysis is the most common procedure which is performed for end-stage renal disease (ESRD) patients. Furthermore, vascular access is an important aspect of hemodialysis treatment, provided for patients with ESRD. There are different reports on the prevalence and survival of vascular access. In this study we report the prevalence and survival probability of vascular accesses in hemodialysis patients in Iran.Patients and This cross-sectional retrospective study was conducted in ESRD patients who underwent hemodialysis in Hemodialysis centers of Tehran, Iran in December 2004. In order to determine the prevalence and survival of different vascular access types, 700 hemodialysis patients and 198 accesses (from 100 patients) were studied, respectively. Data were collected by using recall method, interview and check lists. Life tables, Kaplan Meier procedure, Cox Regression and Log Rank tests were used in survival analysis. Statistical analysis was done with SPSS V. 13. From 700 patients, Arteriovenous Fistula (AVF), Arteriovenous Graft (AVG)and Catheter were used by 93.4%, 3% and 3.6% of Iranian hemodialysis patients, respectively. The mean survival time of AVF was 144.52(95%CI 118.67 to 170.36) months compared with 32.43(95%CI 18.83 to 46.03) months for AVG. The results of Log Rank test demonstrated that this difference is significant (p=0.000). In addition, the estimated one, three and five year survival probability for AVF was 76.42%, 61.54% and 56.86%, respectively. Moreover, AVF survival time was significantly associated with the sites of access (p=0.0038). Our findings showed greater survival of AVF compared with AVG and catheters. However we suggest that applying highly skilled surgical technique may improve access survival, patient's satisfaction and cost implications.

Molecular basis of Acute Myeloid Leukemia (AML) involves mutations in regulatory genes of cellular proliferation and differentiation.Mutation in tyrosine kinase receptor gene of FLT3 occurs in high frequency in AML, resulting in proliferation and abnormal survival of leukemia cells. Mutations in Internal Tandem Duplication (ITD) and D835 of FLT3 gene are associated with poor prognosis. The aim of this study was to diagnose and determine the frequency of this mutation in AML. This descriptive - observational study was performed on 101 AML patients for mutations in exon 11,12 and interon 11 of ITD and D835 mutation in exon 20 of FLT3 receptor gene using PCR. Mutation in ITD was observed using PCR products run on acrylamid gel 8% and compared to marker. PCR products of D835 mutation on genomic DNA were studied using ECORV restriction enzyme and RFLP technique. ITD mutation was observed in 18% of AML studied patients with differences in subgroups of FAB. Also 6% of the patients showed D835 mutation with difference in subgroups of FAB.This study revealed that mutations in FLT3 gene occurr in substantial number of AML patients. Therefore, molecular diagnosis of these mutations prior to treatment leads to a better decision making for the therapeutic protocol.

Several agents have been used for labor pain relief. Clinical trials have shown pethidine – promethazine combination as an effective mean. Transcutaneous electrical nerve stimulation (TENS) is a new method for pain relief which uses mild electrical stimulation for inhibition of pain signals in nerves. This method has been used successfully for chronic pains such as low back pain, rheumatic pains, acute surgical and traumatic pains. In this study we compared these two methods for reducing labor pain.The aim of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and pethidine-promethazine in reducing labor pain in the active phase of labor.Patients and In this clinical trial study, 100 pregnant women admitted in Shaheed Akbarabadi hospital for labor were included in the study and alternatively were allocated into one of two the groups: TENS group (A) or combined pethidine (50mg, IM) and promethazine (25mg, IM) group (B). Pain intensity during maximum uterus contractions was evaluated with Visual Analogue Scale (VAS) in all of the cases. Four hours after delivery, pain relief and efficacy of the method was asked from the mothers. Demographic data were recorded in all cases. Data analysis was accomplished with SPSS V. 15 software. For statistical analysis t-test, regression and Chi2 were used. P value under 0.05 was assumed as significant. Mean pain intensity in 3-4cm dilatation in group A was 7.65±1.05 and in group B was 8.16±1.14 and difference was significant (P=0.003). Mean pain intensity in 6-7cm dilatation was 8.55±0.76 and 8.38±0.87, respectively which was not statistically significant (P>0.05). In full dilatation this measure was 8.73±0.84 and 8.54±0.69, respectively which was not statistically significant (P>0.05). Mean number of contractions in full dilatation in group A was significantly higher than group B (6.18±7.22 vs 3.87±66 P=0.02). Mean duration of labor in group A was 3.49±2.64 hrs and in group B was 3.31±1.5hrs which was not statistically significant (P>0.05). With respect to the results of this research and the previous studies, TENS is a side-effect free, cheap and suitable method for controlling labor pain and can be used solely and as adjuvant therapy for this purpose.

Unenhanced Helical Computed Tomography (UHCT) has evolved into a well-accepted method in patients with acute flank pain and suspected ureterolithiasis. The purpose of this study was analysis of UHCT findings in patients with acute flank pain.Patients and This is a prospective descriptive cross sectional study. The results were analyzed by descriptive statistic methods. 118 consecutive patients with acute flank pain were evaluated prospectively with UHCT. The images were interpreted for detection of calculi, size and location of the calculi we also sought for the secondary signs of obstruction. In a total of 118 patients who underwent UHCT, 99 cases had evidence of urinary calculi, 1 patient had appendicitis, 1 patient had ruptured ovarian cyst and 17 had normal UHCT. 81 patients suffered from a solitary stone in the ureter with a mean diameter of 6 mm. 3 cases had two stones one in the ureter and another in the calyx. 15 cases had two stones or more in the calyces. Also secondary signs of obstruction were confirmatory in the interpretation of UHCT. The most reliable secondary signs of ureteral obstruction were respectively hydroureter (73.7%), hydronephrosis (46.6%), periureteric edema (26.3%), perinephric edema (14.1%), and nephromegaly (8%). The highly accurate diagnostic value of UHCT makes it a suitable method in the diagnosis of patient with acute flank pain.

Thrombosis of the cerebral veins and sinuses is a distinct cerebrovascular disorder that most often affects young adults and children. Failure in brain autonomic activity could be provoked because of damage to energy-dependent cellular membrane pumps resulting from cytotoxic edema and cerebral ischemia. Measurement of vasomotor reactivity (VMR) through Trans-cranial Doppler imaging may reveal the extent of brain damage in such conditions. The aim of this study was to evaluate and compare the vasomotor reactivity in patients with cerebral vein thrombosis and in normals individuals.Patient and In this cross – sectional study, cerebral vasomotor reactivity (CVR) measurement with Trans-cranial Doppler technique was performed in 25 cerebral venous sinus thrombosis patients and 25 age and sex-matched healthy controls. Cerebral Vasomotor Reactivity (VMR) was measured after inhalation of 5% CO2 for 1-2 minutes. CVR was measured as percentage of MCA changes for every mmHg increase in arterial CO2. Statistical analysis was done via student t-test. SPSS V. 11 was also used. There was a statistically significant difference between the mean VMR values in the two groups (P<0.001,4.47 in thrombotic group and 7.62 in controls). Pulsatility index (PI) was 0.77±0.12 and 0.55±0.11 in thrombotic and control groups, respectively. Mean End diastotic volume (EDV) was 56.4±12.23 cm/s and 65.48±12.07 cm/s in thrombotic and control groups, respectively showing significant statistical differences. (P<0.001). These findings are consistent with a state of vasoconstriction in cerebral venous and sinus thrombosis that is unresponsive to stimuli, that under normal circumstances results in vasodilation. Measurement of VMR in patients affected by cerebral venous sinus thrombosis could assist in early diagnosis of cerebral autonomic dysfunction and prevent its serious consequences.

Leishmania major p4 gene is normally expressed during amastigote form of the parasite and can be a good candidate for producing an effective vaccine. The aim of this study is to clone p4 gene in a suitable vector for further vaccine production studies. This is an experimental study. Leishmania promastigote was grown in N.N.N. medium and later in the form of mass culture in RPMI 1640 cell culture medium. Total leishmania genomic DNA was extracted by centrifugation of promastigote and lysed by lysis buffer followed by boiling method. PCR was carried out using p4 gene specific primers. PCR product was detected by agaros gel electrophoresis and cloned into Bluescript plasmid via T/A cloning method. After transformation, the recombinant plasmid was screened and digested by restriction enzyme. PCR reaction and cloning p4 gene in T-vector was done successfully. Recombinant plasmid was extracted and cloned gene was released by restriction enzyme and subcloned into pPQE-30 expression vector and confirmed by restriction analysis and PCR. This newly expressed combination is p4 gene invitro. Production of p4 recombinant antigen is very much useful especially in the field of vaccine production, drug target and immunological studies.

Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent inherited disease of kidney in adults. Approximately, 30-50 percent of these patients will have one or more urinary tract infections during their lifetime. Treatment is somewhat more complicated with an infected cyst and if the patient doesnt respond to antimicrobial therapy, surgical nephrectomy is the treatment of last resort.Case report: In this article, we report a 56 year old woman with ADPKD and diabetes. The patient had multiple pyocysts and didnt respond to antimicrobial therapy. The cysts were drained and washed under sonography guidance and the patient was treated. Drainage of pyocysts in ADPKD with sonographic guide and frequent rinsing can be a good replacement for nephrectomy in patients that dont respond to antimicrobial therapy and are candidates for nephrectomy.

Ulnar bone deficiency is one of rarest congenital anomalies of upper limb which is classified under longitudinal deficiencies of upper limb. Ulnar bone deficiency is classified to several subgroups and musculoskeletal deformities are very common in this abnormality. Hand always has abnormality in the involved limb. The presenting case has ulnar deficiency with humero-radial synostosis, but interestingly no abnormality in ipsilateral hand and digits.Case Report: The patient is an 8 year old boy who had referred to the clinic because of short left upper extremity. On examination of the spine, lower extremities and right upper extremity no abnormality was found. The involved left upper limb was shorter than the right upper limb, elbow was in extension and there was no motion at that joint. Left wrist was similar to the right one. In the left hand, thumb was normal and all metacarpal bones were normal. Hand had five digits with three phalanges without any syndactylism and constrictive bonds. On radiographic examination, there was humero - radial synostosis, but no abnormalities in the bones of hand. Presenting report indicates the presence of ulnar bone deficiency without the abnormality of the hand in the involved limb.

The present studies on kyphoscoliosis operation demonstrate different results on lung volume changes. Some observations show increased, some show decreased and other studies show no changes in the dynamic respiratory flows.In this study we evaluated lung volumes before and after surgery. We also evaluated the correlation of repiratory lung volume changes with mean of Cobb's angle.Patients and In this observational descriptive study, 18 non smoker patients with idiopathic scoliosis were included. Cobb's angle, lung volume and flow were measured before and after surgery with spirometer. Paired t-test was used for statistical analysis. To consider height and weight changes during the follow ups, we used percentage relative to normal instead of absolute volumes. From 30 patients included in this study we followed 18. Mean follow up duration was 34.5±19.6 months (SD=19.6) Dynamic volume changes were: VC=13.4 SD=8.6 (P<0.005), FVC=9.22 SD=14 (p<0.001) and FEV1=9.8 SD=15 (p<0.001). There was no significant correlation between lung volume changes and Cobb's angle changes. There was weak inverse correlation between mean value of dynamic volume changes and mean changes in Cobb's angle after surgery the greater the cobb's angle changes, the lesser the lung volume changes. In this study there was significant decrement of dynamic lung volumes after corrective surgery for thoracic curve scoliosis. There was no correlation between the degree of corrective angle and the amount of lung volume changes. There was a weak linear correlation between cobb's angle and lung volumes before surgery. Greater the angle changes, lesser the lung volume changes.There was a weak inverse correlation between the mean value of Cobb's angle and changes in dynamic lung volume after surgery.

Inflammation is relatively a documented pathogenic cause of chronic rhinocynositis and nasal polyps, but the definite causes are still unknown. Among the infective causes, we decided to evaluate Mycoplasma and Chlamydia, the two major pathogens in respiratory tract diseases, as a potential etiologies in nasal polys. In a descriptive-analytic cross-sectional study, 51 patients with nasal polyp and 19 healthy persons (with nasal fracture) who had referred to Hazrat-e-Rasool Akram Hospital were enrolled in the study. Blood sample for ELISA and nasal polyp tissue (in control group a specimen from inferior nasal turbinate mucosa) for PCR tests were sent to the laboratory. Descriptive measures, Chi-square and Mac Nemar tests and Kappa agreement statistics were used for statistical analysis. Positive results for IgM, IgG and PCR for Chlamydia were 9.8%, 47.1% and 7.8% in patients and 0%, 47.4% and 0% in control group, respectively. The differences between the groups were not statistically significant. Similarly for Mycoplasma, the above mentioned results were 15.7%, 68.6% and 19.6% in patients and 15.8%, 47.4% and 0% in control group, respectively. According to IgG and PCR results, the differences between two groups seems to be significant (P =0.10 and 0.05 respectively). Between the two evaluated bacteria in this study, mycoplasma may have significant correlation with nasal polyp formation. However further studies with larger sample size and considering more confounding factors are needed.

Warts are benign tumours of the skin and mucosa and are caused by Human Papilloma viruse (HPV). They are one of the common skin disorders found mainly in children and adolescents.Although most of the warts disappear spontaneously and or respond to the usual therapeutic measures, difficult to treat and persistent forms of warts exist which are a problem in dermatology.Intra lesional injection of Bleomycin has been used in the treatment of resistant warts, and is associated with variable results in different researches. This study assessed the efficacy of intralesional administration in resistant warts and compared it with other simillar studies.Patients and This was a cross sectional study. A total of 130 warts from 30 patients were injected with (1 mg/ml) intralesional injection of Bleomycin. Patients received one to three times of injection of bleomycin every 4 weeks, and were followed for six months. Response to treatment was as complete resolution, partial resolution and not treated. We used SPSS version 13 and t and Anova tests as statistical methods for analyzing the data. 126 of 130 warts (97%), showed resolution after bleomycin injections 95 warts (73%) showed complete resolution and 31(24%) showed incomplete resolution. The cure rate was better in warts with size less than 20 mm compared to those with lesions greater than 20mm (80% vs 46%). After 6 months follow up, 7 of the 30 patients had recurrence of lesions. Recurrence was more among those with greater number of warts. It is concluded that this form of treatment for resistant warts is reliable, safe and acceptable to patients, if performed undercare and with proper dose and concentration.

Hemodynamic stability during anesthesia and operation is the most important aim of anesthesiologists. Every anesthetic drug has its own hemodynamic effects. The interaction of these drugs with each other and with preoperative drugs of the patients, may cause critical changes in patient's hemodynamic status. For a perfect anesthesia induction, while using high doses of opioids, we must add an intravenous drug such as etomidat. Selection of a muscle relaxant, when etomidat-sufentanil is used in patients taking β-blocker is very important. In the present study, we evaluated the hemodynamic effects of Pancuronium and Cis-atracurium in combination with a high dose of sufentanil in β-blocker using patients that are undergoing coronary artery bypass graft surgery (CABG).Patients and A prospective double blind randomized clinical trial analysis was performed on 80 patients undergoing coronary artery bypass graft surgery in Shaheed Rajaei Heart Center. Patients were divided randomly into two groups: Cis-atracurium (n=40) and Pancuronium (n=40).The selection of the type and dose of premedication drugs and intraoperative opioid and anesthetic in the two groups were the same. The systolic and diastolic blood pressures, mean arterial pressure, heart rate, cardiac output, cardiac index, central vein pressure and systemic vascular resistance were measured before and during induction and operation up to 60 min after induction. Results were analyzed with SPSS V. 13.0 and Repeated Measurement Analysis. The multivariate analysis showed significant reduction (p>0.05) in systolic and mean arterial blood pressures in Cis-atracurium group. There was no statistically significant difference between the two comparative groups according to others indexes. Although Cis-atracurium reduced significantly the systolic and mean arterial blood pressures in comparison with pancuronium after induction in CABG surgery of patients under treatment with β-blocker agents, there were no statistically and clinically significant changes in the heart rate and cardiac indices.

One of the proposed ways for enhancement of labor induction is administration of corticosteroids. Although animal studies have shown the importance of cortisole in the initiation of labor, the role of corticosteroids in enhancement of labor process is still uncertain The aim of the present study was to determine the effects of intramuscular dexamethasone on labor duration and its complications.Patients and We conducted this randomized clinical trial on 122 nulliparous women with favorable bishope score who were candidates for labor induction. Study group(n=61)received 8 mg intramuscular dexamethasone phosphate 6 hours before induction Induction of labor(without dexamethasone) started after 6 hours for controls (n=61). Following distile water injection. Expected result was initiation of the active phase of labor and duration of labor, that were compared in both groups. Data collection was accomplished by specific forms and data analysis was done by SPSS-15 software. t-test and Chi-square test were used for annalysis.Patients in both groups did not show significant statistical differences in regard to age, Bishop Score and time of delivery. Mean of time duration between induction and the beginning of active phase of labor was significantly shorter in the case group than the controls (3.09±1.5 hrs. versus 4.21±1.8 hrs) (P<0.001). Mean duration of active phase in the case group (2.46±1.38 hrs) did not show significant difference with that of controls (3.87±5.73hr) (P>0.05). Duration of the second phase of labor was significantly shorter in the cases than that of control group (22.23±16.09 min. versus 29.01±15.32 min) (P=0.014). Duration of the third phase did not differ significantly in the two groups.Also neonatol Apgar score of 1and 5 min. along with maternal and fetal complications including chorio- amnionitis and fetal sepsis, did not show significant differences between the two groups. Dexamethasone can reduce the time interval between induction and active phase and duration of phase 2.

Tibia hemimelia is a longitudinal deficiency of tibia bone which is manifested at birth. Limb shortening, severe foot deformity, and knee flexion contracture are presented in this disease. It is usually treated during the early years of life. The goal of treatment is to achieve stable and equal length in both legs.Case report: The mentioned case is a 20 year old man with type IA Tibia hemimelia. The interesting point in this case is the tolerance of severe right lower limb deformity, shortening with an extra thumb and toe on the same side till the age of 20 years. It is best to treat this condition in the first few years of life and as minimum as possible operations should be imposed to the patient.

Chest tube has been used as a close drainage system for evacuation of pleural cavity after thoracic surgery and in traumatic patients.Today, the chest bottles are made from hard and fragile material that may be broken easily. Also chest bottle needs sterile saline solution for proper functioning. This causes heaviness with pressure effect on the chest wall, resulting in severe pleuritic pain and interfering with early ambulation and post operative ventilation. The goal of this study is to use a new drainage device that in addition to draining pleural cavity properly doesnot have the other side-effects of the conventional chest bottle.Patients and This interventional clinical-trial was designed to compare the efficacy of new drainage device (Drainage bag) and chest bottle for pleural cavity evacuation.In this study, 50 patients that were admitted in the wards of Hazrat Rasool Akram hospital and needed chest tube were selected. After explaining the proceduce and obtaining their consent, they were divided randomly into two groups of 25 each. For one group (25 patients) routine chest bottle was utilized and in the other group (25 patients) new drainge bag was used as close drainage system of pleural cavity. The two groups were compared for severity of pain (by VAS), patient satisfaction and duration of admission. All data were analyzed statistically.Independent samples test was used for quantitative variants and qualitative variants were analyzed by Chi square test. Distribution of mean pain score was 4.2 for drainage bag versus 5.5 for routine chest bottle. Similary, in regard to patients satisfaction for movability and changing of device, the rate was 81% for drainage bag and 43% for routine chest bottle.Duration of hospitalization was the other item that was evaluated in this relation data showed 5.3 days for drainage bag and 8.7 days for the chest bottle group. According to our data it seems that use of new “drainage bag” for evacuation of pleural cavity can be as effective as routine chest bottle with less pain, more patient satisfaction and shorthening of hospitalization period.

Renal replacement therapies are usually associated with changes in trace elements and metabolism of vitamins. Multivitamins are administered routinely to dialysis patients in dialysis centers. Thiamin plasma level is a good indicator of nutritional state of the patient. In this study, a sensitive high-performance liquid chromatography HPLC method for determination of the concentration of thiamin in human plasma has developed by which thiamin level is detected in plasma of hemodialysis patients. The aim of the study was determination of thiamin blood levels in chronic hemodylysis patients in order to evaluate their need for thiamin supplements. In this experimental study, the plasma of nine Iranian patients on hemodialysis were analyzed for their thiamin levels and compared to the thiamin levels in a group of healthy Iranian subjects. The procedure was based on pre-column oxidation of thiamin to thiochrome followed by fluorescence detection. Plasma (1ml) was deproteinized with trichloroacetic acid and thiamin was extracted with diethyl ether. Then, cyanogens bromide (0.3 M) was added to convert thiamin to thiochrome. Samples (25µl) were applied to a Novapak C8, 4µm (4.6 × 250 mm) column. The mobile phase consisted of methanol: phosphate buffer (30mM) in the ratio of 45:55 and 0.05% sodium lauryl sulfate. Data were analyzed using SPSS V13. Statistical analysis was done by t-test and One- way Anova test. A precise and reproducible HPLC method was developed for determination of thiamin in plasma. The minimum detection limit was 0.2 ng/ml and percentage recovery was 85%. Inter and Intra day assay variabilities were determined for 1,5 and 15 ng/ml thiamin spikes in plasma and coefficient of variations were in the range 0.2-2.94%. The average plasma thiamin level in 10 healthy Iranian subjects was 3.07±0.95 ng/ml and in Iranian patients was 4.72±1.12 ng/ml and 4.29±0.67 ng/ml before and after hemodialysis, respectively. Our study has shown that the mean plasma thiamin level in Iranian patients on hemodialysis has no significant difference with its level in healthy Iranian subjects. The thiamin level also remained unchanged before and after the hemodialysis. The HPLC method used for determination of thiamin in plasma was sensitive, accurate, reproducible and suitable for kinetic studies of thiamin. According to our findings the thiamin level in patients undergoing hemodialysis has no significant difference with healthy subjects and it seems that dietary vitamin is sufficient for the normal functions of the body, and taking viamin supplementation is not necessary for these patients.

Ascorbate (ascorbic acid) is present in high concentration in the nervous system and is released as a result of activation of glutaminergic neurons. Due to high concentration of NMDA receptors in the nervous system, this study investigated the analgesic efficacy of ascorbic acid (AA) in neuropathic pain condition and the role of NMDA receptors in this effect. In this experimental study, neuropathic pain was induced by chronic constriction injury of sciatic nerve (CCI, model) in the left hind paw. In the second week after CCI, animals received 1, 5, 10 mg/kg of ascorbic acid or normal saline and pain threshold was determined 15 and 30 minutes later. To determine the role of NMDA receptor in nociceptive effect of AA, separate groups of animals were tested. In these groups in the second week after CCI, 30 min after injection of saline or AA (1mg/kg) animals received intraperitoneal injection of Ketamin (5 mg/kg) or MK-801 (0.01 mg/kg) and were tested 20 min afterwards. Mechanical allodynia was assessed by Von Frey hairs and mechanical and thermal hyperalgesia were determined by Randall Selitto and Radiant Heat tests, respectively. Data were analyzed by ANOVA and Newman Keuls tests. Intraperitoneal injection of 5 and 10 mg/kg but not 1mg/kg ascorbic acid increased mechanical and thermal threshold in the second week after CCI. Ascorbic acid (1mg/kg, i.p.) also produced significant inhibition of MK-801 and ketamin - induced antinociception response. In these groups there was no significant difference in the pain threshold as compared to animals that received normal saline. The results indicate that ascorbic acid produced a dose dependent antinociceptive effect that seems to be mediated through its interaction with NMDA receptors.