فهرست مطالب

Archives of Iranian Medicine
Volume:7 Issue: 2, Apr 2004

  • تاریخ انتشار: 1383/02/11
  • تعداد عناوین: 25
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  • M. Ayatollahi, M. Haghshenas Pages 84-88
    Background – Sickle cell anemia is one of the most common heritable hematologic diseases affecting humans. Detection of the single base pair mutations at codon 6 of the beta-globin gene is important for the prenatal diagnosis of sickle cell anemia and sickle cell disease. We applied the polymerase chain reaction technology to detect sickle cell patients and heterozygous carriers in a group of patients suspected of sickle cell disease.Methods – The sample was composed of 45 normal individuals and 45 unrelated sickle cell disease out-patients from Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. All patients were interviewed. Results of their medical histories, physical examination, and the hematologic analysis were recorded. The blood samples were collected in EDTA and genomic DNA was extracted from leucocytes. An amplified 110 base pair fragment of beta-globin gene containing codon 6 was digested with the restriction enzyme MS II, and electrophoresed in 3% agarose. Results – We have established the technical condition for detection of sickle cell disease using a PCR assay. Thirteen patients having hemoglobin SS (Hb SS) and 32 patients in the heterozygous state (Hb AS) were identified. We confirmed that the normal controls had the Hb AA genotype. Conclusion – This amplification method is rapid, sensitive, and simple, and has the application which is important for the prenatal diagnosis of sickle cell disease.
  • H. Dahifar Pages 89-92
    Background – To determine the response of Iranian children to Cuban hepatitis B vaccine.Methods – A total of 538 children who had received three doses of Cuban hepatitis B vaccine were classified into 4 groups of 6, 12, 24, and 36 months after the third dose of vaccination. Every group was subdivided into nonresponders, hyporesponders, and good-responders.Results – Of 538 vaccinees, 240 (44.6%) were females. In Group I, of 230 (42.75%) vaccinees, 25 (10.9%) were nonresponders, 51 (22.1%) hyporesponders, and 154 (67%) good-responders. In Group II, consisting of 98 (18.2%), 18 (18.4%) were nonresponders, 38 (38.8%) hyporesponders, and 42 (42.6%) good-responders. In Group III, of 100 (18.58%) vaccinees, 8(8%) were non-responders, 32 (32%) hyporesponders, and 60 (60%) good-responders. In Group IV, with 110 (20.4%) vaccinees, 31 (28.1%) were nonresponders, 30 (27.3%) hyporesponders, and 49 (44.5%) good-responders. Conclusion – Of the total 538 vaccinees, 305 (56.7%) were good-responders, 149 (27.7%) hyporesponders, and 84 (15.6%) nonresponders. Both rates of vaccinees and concentration of anti-HBs in the good-responders were low and the number of hyporesponders and nonresponders were high.
  • D. Kouznetsov, S. Arkhangelsky, A. Markarian, M. Orlova Pages 93-97
    Background – The aim of present study was to investigate a possible link between the creatine kinase (CK) content in the V. xanthia raddei venom and its acute toxicity values. Methods – Creatine kinase, the ATP-generating enzyme belonging to a phosphotransferases family, has been completely purified from the venom of Vipera xanthia raddei using a novel method of affinity chromatography on ADP-Sepharose. Results – This enzyme is proven to be a compound for determining an acute toxicity degree provided by the intramuscular (IM) venom injection to mice. Not being a toxic agent itself, this 40 kDa monomer protein, however, increases the toxicity level when added to a natural total or creatine kinase-depleted venom composition. Conclusion – A possible significance of the data presented for research on a snake bite-promoted coagulopathies is under discussion.
  • H. Hashemi, A. Fotouhi, N. Sadeghi, H. Foudazi, S. Payvar Pages 98-103
    Background – We aimed to evaluate the effectiveness, safety, and patient satisfaction of laser epithelial keratomileusis (LASEK) for myopia in patients with thin cornea.Methods – Seventy-one eyes of 56 patients with myopia of –1.50 to –8.75 diopters (D) and corneal thickness of 451 – 499 microns were enrolled in this prospective clinical study. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and videokeratography were done before surgery. Patients were visited in the first 7 days, and also at 1st and 3rd months after the surgery. Results – All patients were examined in the first 7 days and at 1st month, while 48 eyes (71%) were examined 3 months after the surgery. At 3rd month, 46 eyes (95.8%) had an uncorrected visual acuity of 20/40 or better, 37 eyes (77.1%) had an uncorrected visual acuity of 20/20 or better, 36 eyes (75%) had a spherical equivalent (SE) within ± 0.50 D, and 46 eyes (96%) had a SE within ± 1.00 D. The mean corneal thickness was 409 ± 23 microns (SD) with a minimum of 372 microns. The epithelial healing time was 3.37 ± 1.05 days (SD). The mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.14 ± 0.75 (SD). One eye lost 2 lines of spectacle-corrected visual acuity, and no eye lost more than 2 lines. Thirty-four patients (82.9%) were very satisfied or satisfied with their operated eyes.Conclusion – LASEK was shown to be effective and safe in correction of myopia in patients with thin cornea in a short period of time. LASEK can be considered as an alternative for treatment of myopic patients whose corneal thickness is inadequate for laser in situ keratomileusis (LASIK)
  • S. H. Mirkhani, M. Salehi Pages 104-107
    Background – The Ross operation, originally introduced as a scalloped subcoronary implant with an 80% survival and 85% freedom from reoperation, has recently been modified to a root replacement which is now the most commonly utilized implant technique. A review of our experience in assessing the mid-term results with the Ross operation is presented.Methods – The records of 60 patients who had a Ross operation at the Imam Khomeini Hospital of Tehran University of Medical Sciences (June 2001 to October 2002) were reviewed to assess the operative technique and patient-related factors on survival, autograft valve function, homograft valve function, valve-related complications, and need for reoperation.Results – Two patients were expired (one case in the operating room and the other one in hospital, 20 days after the operation with neurological disorder). The 2-year actuarial survival rate was 96.6%. At 2 years, 53 (91.3%) surviving patients were in New York Heart Association (NYHA) functional class I and 5 (8.7%) were in NYHA functional class II. No significant aortic valve gradients were noted, and no pulmonary insufficiency, in all cases, was found. At 2 years, freedom from significant aortic regurgitation (grade 2 or more) was 98.3%. Freedom from significant pulmonary homograft stenosis (defined as a pulmonary gradient > 20 mmHg) was 100% at 2 years. Conclusion – The pulmonary autograft gives excellent mid-term results with low mortality and no morbidity. It completely relieves the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function in most patients.
  • A. Farajzadeh, Sheikh, N. Mosavy, H. Tavacol Pages 108-112
    Background – Haemophilus influenzae is the second most important causative agent of pneumonia in outpatients. The aim of this survey was to perform isolation, to identify biotype, serotype, and antimicrobial sensitivity pattern of Haemophilus influenzae in patients undergoing bronchoscopy.Methods – In this study 170 bronchial washing specimens were taken from patients 1 – 70 years old, and were cultured on blood agar, chocolate agar, cefsulodin chocolate agar, and Fildes media. The presence of encapsulated bacteria was identified by Fildes medium neqrosin and Congo red staining. Biotyping and serotyping were performed by serological methods.Results – The results showed that 14 (8.23%) cases were positive for H. influenzae, of which 78.5% were unencapsulated. The cases were identified as I, II, III, and V biotypes. A statistically significant relationship was found between unencapsulated H. influenzae and the age of the subjects (p = 0.0345), and their occupation, e.g., cotton-beater and mine workers (p = 0.0196). From isolated bacteria, 85.7% were sensitive to chloramphenicol and 71.42% to ampicillin and cefotaxime.Conclusion – Age and occupation are two risk factors for this bacterial respiratory, and the prevalent biotypes in the region were I, II, III and V. Fortunately, some antibiotics are too high degrees, effective on this agent.
  • H. Kaviani, P. Rahimi, H. R. Naghavi Pages 113-117
    Background – It has been longly well-known that depressed patients attempting suicide tend to retrieve overgeneral autobiographical memories and create less effective problem-solving strategies with a considerable slowness. Methods – Two cognitive measures, autobiographical memory test and means-ends problem-solving task, Persian versions, were used to assess 20 parasuicide patients who met diagnostic and statistical manual of mental disorders criteria for major depression disorder (MDD), and were compared with a matched control group. The healthy subjects also met the criteria for subjects recruitment (no psychopathological background). Beck depression inventory (BDI) and Beck hopelessness scale (BHS) were performed to assess, respectively depression and hopelessness. Results – It was found that the suicide attempters were more depressed and more hopeless than the matched healthy subjects. The results showed that the parasuicides produced more overgeneral memories and responded more slowly to positive than negative cue-word, compared to the control subjects. In the problem-solving task, the patients provided less effective strategies, fewer means, and more irrelevant means; also they took longer to respond to the matched healthy subjects. Moreover, there were significant correlations between autobiographical memory and problem-solving variables.Conclusion – There were significant correlations between autobiographical memory and problem-solving variables. Clinical implications will be discussed.
  • A. Aleyasin, S. Mohammad, Ganji, M. Ghazanfari, F. Jahanshad Pages 118-121
    Background – Down syndrome is the most common cause of mental retardation observed in approximately 1/230 pregnancies. This is the first epidemiological studies to categorize cases of Down syndrome by parent of origin of extra chromosome 21 meiotic error in Iranian Down syndromes. Methods – We studied 100 Down families using conventional cytogenetic and chromosome 21-specific markers. Five specific DNA markers, related to chromosome 21, were used to determine the origin of meiotic error to each case.Results – Chromosomal analysis revealed free trisomy 21 karyotype in 95%, mosaic trisomy karyotype in 5%, and none with chromosome translocation. The parent of origin of chromosome 21 trisomy was determined in 85% of the cases. Nondisjunctional error was determined as maternal in 86% and paternal in 14% of the cases.Conclusion – Although the exact mechanism behind chromosome nondisjunction has not been very well described, but in the case of free chromosome 21 trisomy the exact reasons behind the nondisjunction may vary between female and male who passed this extra chromosome to their child. The knowledge of Down syndrome of parental origin is one of the basic steps to evaluate accurately the risk factors and etiology of meiotic nondisjunction.
  • S. B. Jameie, M. H. Noyan, Ashraf, G. Behzadi Pages 122-127
    Background – The sex steroid hormones play a significant role in modulating postnatal neuronal maturation, synaptology, and neural circuit formation. Female gonadal steroids are known to influence serotonergic system physiology in adulthood. We aimed at finding out if gonadal steroids influence the morphology of dorsal raphe neurons in the intact adult rat brain. Methods – Golgi impregnation was performed on brainstems of ovariectomized (OVX) rats to determine whether female sex hormones influence dorsal raphe neuronal morphology in the intact adult rat brain. Results – Removal of circulating gonadal sex steroids by ovariectomy resulted in significant decrease in primary and secondary dendritic spine density of the dorsal raphe neurons in adult female rats. These findings demonstrate that gonadal steroids are necessary for the maintenance of normal adult cell structure and plasticity of dorsal raphe nucleus. Conclusion – It is suggested that the gonadal steroids are able to affect the synaptic organization, connectivity, and plasticity, and also exert a generalized action on the serotonergic system, thereby influencing a number of brain functions and behaviors.
  • Wound myiasis caused by Lucilia sericata
    S. A. Talari, F. Sadr, A. Doroodgar, M. R. Talari, A. S. Gharabagh Pages 128-129
    Lucilia sericata is one of the facultative parasites which causes myiasis in animals, and rarely in humans as an ectoparasite. Infestation in humans and domestic herbivorous animals occurs in wounds, mouth, eyes, and nose. It causes itching, pain, inflammation, secondary bacterial infections, eosinophilia, and erythema. We report on a 26-year-old man from Kashan, with a 12-year history of opium and a 3-year history of heroin injections was taken to Iran, following a heroine injection, and with signs of hypoxic encephalopathy, decreasing mental clearness, and coma. He was HBsAg and HIV negative, and HCV positive. From the wounds of his left hand, which were caused by repeated injections, 38 live larvae were removed. The larvae proved to be Lucilia sericata.
  • Lycanthropy in depression: a case report
    A. R. Moghaddas, M. Nasseri Pages 130-132
    Lycanthropy, by definition, is a belief of delusion in which patient considers himself or ors as a wolf or some or animals. Knowledge of lycanthropy dates back to about two thousand years ago, and several sources have made references to this phenomenon. A young and single male, stuttering since age 12, recently developed lycanthropic syndrome; he had symptoms of depression since adolescence. He was given psychiatric management and was treated with 12 mg of perphenazine per day as antipsychotic drug and 20 mg of fluoxetine per day as antidepressant. Within two years, symptoms of lycanthropy gradually disappeared and patient recovered from depression to a large extent
  • R. Vakili, H. Etemad, Rezaei, M. Tafazoli, S. Jalali, Mazlouman Pages 133-135
    The diencephalic syndrome (DS) is one of the rare causes of failure to thrive (FTT) in pediatric age group It is manifested by progressive emaciation in an apparently alert and cheerful young child This syndrome is almost exclusively seen in infants and young children and most patients have a space-occupying lesion of the hypothalamic region We present a case of DS, a 3-year-old boy who was initially admitted to our hospital because of severe FTT that began at the age of 4 months Computerized tomography scan and magnetic resonance imaging demonstrated a large tumor occupying the hypothalamic region After surgical removal of the tumor, radiotherapy with 5,000 rads of linear accelerator (LINAC) was directed at the tumor site He was readmitted at the age of 5 with signs of precocious puberty The interesting point with this case was that central precocious puberty was associated with diencephalic syndrome
  • M. Masoodi, K. Hosseini Pages 136-139
    Myiasis is the infestation of tissues and organs of animals or man by fly larvae Ophthalmic myiasis has been reported of various world regions In this study we present the clinical manifestations with ophthalmomyiasis caused by Oestrus ovis larvae in 8 patients from Fars Province in southern Iran All of the patients were farmers, in close contact with sheep and goat All patients presented with severe conjunctivitis The larvae were observed in the bulbar conjunctiva, and following their removal, the symptoms of eye inflammation improved in a few hours
  • M. J. Ghabouli Pages 140-141
    Anthrax has been developed as a biologic warfare agent. One millionth of a gram of anthrax spores constitutes a lethal inhalation dose, and a kilogram of it, has the potential to kill hundreds of thousands of people.Anthrax is a relatively common zoonosis in developing countries. The etiologic agent is Bacillus anthracis. Transmission to human is usually by contamination of skin abrasions with the bacilli or spores. The most common presentation is a black necrotic skin wound (95%). Fulminant sepsis, acute abdominal pain, and ascites are among rare forms of the disease, and it is especially very rare if all of them occur in one patient. Extracutaneous forms of anthrax are generally very dangerous and life-threatening. Therefore, early recognition and prompt treatment are the most crucial steps to save the life of patients
  • H. Sanaei, Zadeh, M. Kiani, A. Amiri Pages 142-144
    All cases of fireman-related suicides from 21 March 2002 through 21 March 2003 were identified by reviewing all medico-legal files at the Legal Medicine Organization (LMO) of Iran. These data led us to make an assessment of fireman-related suicide in Tehran, the capital of Iran to establish its pattern and compare this with other studies. During the 1-year study period, 27 fireman-related suicides were identified. Twenty-two (81.5%) cases had one entrance wound. Multiple entrance wounds were seen in 18.5% of the cases. The typical sites of entrance wound were the submentum (37%), chest (25.9%), center of the face (14.8%), and forehead (11.1%). All but four wounds were caused by contact or near-contact range shots. Interestingly, 96.3% of suicides occurred at the garrisons or police station. We concluded that attention should be given to the identification of those military personnel who are at risk for suicide, i.e., the detection and treatment of their psychologic disorders.
  • M.H. Esmaili, K. Kardan Pages 145-148
    Pain, nausea, and vomiting are among common complications seen after different types of surgeries which need medical attention. In this study we tried to evaluate the effects of short-acting betamethasone on postoperative pain, nausea, and vomiting. In a period of 4 months, from February until May 2000, 60 females with American Society of Anesthesiologists (ASA) class I or II undergoing elective gynecologic surgeries were enrolled into this prospective study. These patients were randomly assigned into 2 equal groups of 30 each. The procedures of induction [diazepam (0.1 mg/kg), morphine (0.1 mg/kg), thiopental (5mg/kg), and atracurium (0.5 mg/kg)], and maintenance [1 % halothane and oxygen (3 L/min) together with N2O (3 L/min)] of anesthesia were the same for both groups. The study group received 8 mg of betamethasone IM just 10 min prior to the induction of anesthesia. We evaluated the frequency of postoperative pain of different intensities at 1st, 2nd, 3rd, 12th and 24th hr after the operation using verbal scores of 1 to 4 as follows: 1= no pain, 2= mild pain, 3= moderate pain, and 4= severe pain. At the same time, the frequencies of postoperative nausea and vomiting were determined in a similar fashion, scoring them from 1 to 3 as follows: 1= no nausea, 2= nausea, and 3= vomiting. Data were interpreted by Chi-square, Pearson''s, and Mantel-Haenszel tests, using SPSS software. P-values < 0.05 were considered as statistically significant. Patients of the study group experienced significantly less pain, nausea, and vomiting at the 1st, 2nd, and 3rd postoperative hours when compared to the control group. On the other hand, there was no significant difference between both groups at 12th and 24th hr after the surgery. We found that a single dose of betamethasone, administered intramuscular IM 10 min prior to the induction of anesthesia, had an acceptable analgesic and antiemetic effect, lasting for at least 3 hr after surgery. Due to its effectiveness in reducing the frequency of postoperative pain, nausea, and vomiting, we recommend the preinduction use of betamethasone.
  • M. H. Baradaranfar, P. Dabirmoghaddam Pages 149-153
    Graves'' ophthalmopathy can cause proptosis, cosmetic problems, and visual impairment. The aim of this study was to assess the validity and limitation of transnasal endoscopic orbital decompression in Graves'' ophthalmopathy. Between 1997 and 2003, 20 female and one male patients with Graves'' ophthalmopathy underwent simultaneous bilateral transnasal endoscopic orbital decompression. All patients were nonresponders to medical management (including steroid therapy) but none of them received orbital irradiation. Preoperative and postoperative ophthalmologic examinations were recorded for all patients. In addition, photographs and CT scans of orbit and sinuses were done. After operation, visual acuity improved following orbital decompression with this technique. Diplopia in lateral gaze developed in 15 patients but only one of them required corrective surgery. The mean retrodisplacement was 4.1 mm that compares favorably with other series. After an average follow-up of 49 months, none of the patients developed sinusitis or mucocele. Endoscopic decompression provides excellent visualization without external incisions, and facilitates maximal decompression without the increased risk of hemorrhage, visual impairment, or infections.
  • M. Khajavi, M. Ardeshirzadeh, Y. Shafeghati, G. A. Shahidi Page 154
  • Commented Summary from Current Medical Literature
    S. Nasseri, Moghaddam, R. Malekzadeh Page 157
  • K. Basmenji Page 158
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