فهرست مطالب

Iranian Journal of Medical Sciences
Volume:27 Issue: 1, Mar 2002

  • تاریخ انتشار: 1381/03/11
  • تعداد عناوین: 9
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  • A.R. Emami Naeini, M.A. Davarpanah, R. Sherkat, I. Karimi, J. Hashemi Page 1
    Background
    To date, 36 years has passed since the beginning of measles vaccination; the disease is still circulating around the world, threatening lives of human beings especially in developing countries. In recent years, we have confronted measles in previously vaccinated adults from all over the country.
    Objective
    To find out if there is a need for changing our routine measles vaccination schedule.
    Methods
    In a cross-sectional study, 241 medical students (127 males and 114 females) were randomly selected. We measured the titer of antibody against measles in their blood using ELISA.
    Results
    Ninety-eight (40.7%) out of 241 had positive, 39 (16.2%) borderline, and 104 (43.1%) negative antibody titers.
    Conclusion
    In this study, only 40.7% of the previously vaccinated students had positive antibody titers, while the rest remained susceptible to contract wild measles virus.
  • K. Bagheri Lankarani, A. Mowla, F. Asadian, S.Z. Tabei, M.R. Panjeshahin Page 4
    Background
    Esophageal carcinoma is one of the most lethal gastrointestinal (GI) malignant tumors worldwide. The disease is known to have a high incidence in northern Iran; however, its condition in the South is not much clear.
    Objective
    In this retrospective study we investigated the epidemiology and time trends of esophageal carcinoma in Fars Province, South of Iran.
    Methods
    In a retrospective study, we reviewed pathologic reports of all laboratories in Fars Province, South of Iran, from March 1997 to March 1999 to find cases of esophageal carcinoma. Annual and average incidence in different age groups were calculated for both sexes, based on four censuses results.
    Results
    Esophageal carcinoma was the third most common GI cancer in Fars, with an average incidence of 2.95 per 100,000 in the population older than 15 years. The incidence of esophageal carcinoma was found to drop by 64% during the study period. This was mainly due to the decreased incidence of squamous cell carcinoma. Females developed squamous cell carcinoma in relatively younger age as compared to males.
    Conclusion
    Our region in the South of Iran is one of the low incidence areas of esophageal carcinoma as compared to that of northern borders of the country and other parts of the world with some special features.
  • S. Kashef, Z. Karamizadeh Page 11
    Background
    Previous studies have demonstrated that patients with insulin-dependent diabetes mellitus (IDDM) have a high prevalence of osteopenia. Hypercalciuria has also been well documented in human diabetes and many children with insulin-dependent diabetes mellitus have short stature.
    Objective
    To investigate the relationship of hypercalciuria and hyperphosphaturia with growth retardation in patients with IDDM.
    Methods
    Forty patients with IDDM aged between 6 and 12 years whose mean heights were less than their 32 non-diabetic siblings of similar age group were enrolled in this study. Urinary and plasma calcium, phosphorus and creatinine levels were measured in both groups. Meanwhile, the height and body weight were determined.
    Results
    Both, the mean height and weight percentiles of subjects with IDDM were significantly less than those of non-diabetic siblings (p<0.001). The height percentile of children with IDDM had negative correlation (r=-0.75, p<0.001) with the disease duration. The mean urinary calcium to creatinine (Ca/Cr) and phosphorus to creatinine (P/Cr) ratios were significantly higher in IDDM patients compared to their normal siblings (p<0.001).The growth in the group of diabetic children correlated inversely and significantly (p<0.001) with hypercalciuria and hyperphosphaturia, duration of diabetes and HbA1C level.
    Conclusion
    It is concluded that hypercalciuria and hyperphosphaturia may play a role in growth retardation of diabetic children.
  • A. Khosravi, M.T. Moinvaziri, M.H. Esmaili, A.R. Farbood, H. Nik, Khoo, H. Yarmohammadi Page 15
    Background
    Postoperative shivering is an important and troublesome condition during recovery from general anesthesia. Corticosteroids have been recommended to facilitate recovery and diminish shivering after cardiac surgery. Previous studies recommended 0.6 mg/kg dexamethasone for reducing postoperative shivering in patients undergoing cardiac surgery.
    Objective
    To test this assertion, we administered 0.15 mg/kg dexamethasone to patients undergoing routine surgeries, e.g., laparotomy, thoracotomy, and orthopedic, urologic and gynecological operations.
    Methods
    A total of 200 patients undergoing elective operations were randomly selected and divided into two groups. To the first group 0.15 mg/kg dexamethasone and to the control group, a placebo was injected right after the induction of anesthesia and before making any skin incision. Patients did not have any coexisting diseases, e.g., diabetes, hypertension, ischemic heart disease, etc., nor were they on any specific medication. All patients received the same doses of diazepam, morphine, sodium thiopental, 50% O2, 50% N2O, and 0.5% halothane for the induction and maintenance of general anesthesia.
    Results
    Patients who had received dexamethasone had a significantly (p<0.001) lower incidence of postoperative shivering (12%) compared to the control group receiving placebo (31%).
    Conclusion
    Small doses of dexamethasone (0.15 mg/kg) could effectively decrease the incidence of postoperative shivering.
  • S.A. Banani, H.R. Foroutan, M.R. Panjehshahin Page 18
    Background
    The bioavailability of metronidazole after oral ingestion, in ordinary conditions, is quite similar to intravenous administration of the drug. However, the degree of its absorption is not known in the early periods after laparotomy.
    Objective
    To determine plasma levels of metronidazole in pediatric patients following elective abdominal surgery.
    Methods
    The study group was comprised of 25 pediatric patients with mean age of 8.25 years. They took 10 mg/kg metronidazole (ingested or taken via nasogastric tube) a few hours after operation, followed by every eight hours for a total of three successive doses. We obtained blood samples 1-2 hours after each drug intake.
    Results
    The mean±SD of plasma drug concentrations after the first, second and third doses were 1.43±0.81, 6.26±3.86 and 10.21±4.28 mg/ml, respectively, showing a significant rise after each dose (p<0.001). The majority of patients (84%) obtained a level equal to, or above the minimal bactericidal concentration (MBC) after the third dose. Ninety-two and 96% of patients achieved the plasma minimal inhibitory concentration or higher following the second and third doses, respectively, as compared to 4% after the first dose (p<0.00001).
    Conclusion
    Absorption of oral metronidazole after elective laparotomy is disturbed only temporarily, as in the majority of patients the drug attains an acceptable level before the second post-operative day. Therefore, parenteral metronidazole therapy, if necessary, is recommended only during the first 24 hours, and it may be replaced by oral preparation afterward.
  • H. Najafipour, A. Vakili, M. Yeganeh Hadj Ahmadi, F. Esmaieli Page 22
    Background
    The mechanisms underlying cerebral hypercapnic vasodilatation are not fully understood.
    Objective
    To investigate the role of nitric oxide (NO) and ATP-sensitive potassium (KATP) channels in basal blood flow regulation and hypercapnia-induced vasodilatation in rabbit cerebral blood vessels.
    Methods
    The change in cerebral blood flow was measured by a laser Doppler flowmeter in 18 New Zealand white rabbits, in two groups, under general anesthesia with sodium pentobarbital. N-omega-nitro-L-arginine methyl ester (L-NAME) and glibenclamide were administered locally and systemically before and during induction of hypercapnia.
    Results
    The change in cerebral blood flow was not significant following local and systemic L-NAME administration, showing a non-significant role of local and systemic NO in regulation of rabbit basal cerebral blood flow. Hypercapnia increased cerebral blood flow by 17.3±4.4% before and 17.3±5.8% after local, and 5.8±3.2% (p<0.05) after systemic L-NAME administration. The change in cerebral blood flow was not significant after local and systemic administration of glibenclamide indicating a lack of KATP channel role in basal blood flow regulation. Hypercapnia increased cerebral blood flow by 27.2±8.7% before and 24.7±6.4% after local, and 49.3±9.7% after systemic administration of glibenclamide (p: NS in both cases).
    Conclusion
    Regional NO production had no role in basal cortical blood flow regulation and systemic NO contributed to 66% increment in cerebral blood flow during hypercapnia. Also, the KATP channels did not mediate the effect of NO or other vasodilators responsible for increasing cerebral blood flow during hypercapnia.
  • F. Okhovatian Page 30
    Background
    Energy expenditure is of paramount importance in the assessment of usefulness of wheelchair for paraplegics. Despite widespread recognition of problems associated with currently available mobility systems for persons with spinal cord injuries, development of more efficient systems has been slow. Lack of a suitable and simple technique for the assessment of energy expenditure in paraplegics has perhaps contributed to this slowness.
    Objective
    To assess the energy expenditure with a simple technique, i.e. rating of perceived exertion during arm crank ergometry and crutch walking in paraplegics.
    Methods
    The experiments can be divided into three phases; firstly, assessment of energy expenditure during seated arm crank ergometry in 10 paraplegics and 20 able-bodied subjects; secondly, upright arm crank ergometry in seven paraplegics and 20 able-bodied subjects. Arm crank ergometry was carried out with an incremental series protocol at three work rates (16, 28 and 40 watts) and at a cranking rate of 50 rpm. The third part was to assess the energy expenditure during crutch walking in five paraplegics and in 10 able-bodied subjects whilst walking with axillary crutches and knee-ankle-foot orthoses. All subjects walked at their preferred speed on a figure of eight track. We measured the oxygen consumption, using the Douglas bag technique or the face mask method, and evaluated the rating of perceived exertion by the standard 6-20 Borg scale.
    Results
    The non-significant difference of two measured variables (oxygen consumption and rating of perceived exertion) between paraplegic and able-bodied subjects showed the consistency of measured variables for the assessment of energy expenditure during seated arm activities (e.g., wheelchair propulsion) in paraplegics. However, during upright arm crank ergometry, paraplegics found work at any given rate harder upright than seated. The results indicated a greater load on the cardiorespiratory system in paraplegics during crutch walking. The different responses to these types of arm exercises in thoracic paraplegics could be partly or wholly explained by impaired mechanisms of venous return in paraplegics, problems that would be particularly severe in upright posture. In addition, dividing by speed standardizes, both the energy cost and the physiological cost index; this has not been done for perceived exertion.
    Conclusion
    Though more high lesion patients should obviously be studied, this strongly suggests that perceived exertion is not a suitable indicator for comparison among subjects whose preferred walking speeds are different. However, for comparison between individuals, crutch walking at a given speed on treadmill could be of value.
  • A. Omidi, N. Sharifi, A. Fazel, A. Niazi, M. Gharavian Page 36
    Bilateral femoral agenesis is a rare anomaly. To the best of our knowledge, only three cases of simple congenital anomaly and three cases associated with femoral facial syndrome have been reported. Here, we describe a simple form of bilateral femoral agenesis observed in one of the 2 dead fetuses delivered after termination of a 24-week twin pregnancy of a normal mother. Post-mortem x-ray examination confirmed the agenesis of both femurs and also left fibula.
  • G.H. Sadri Page 39
    Bus accident is a major health problem for bus drivers. To identify the risk factors involved in bus accidents and to design a model showing the relation between the risk factors and bus driver’s health status, 219 bus drivers who worked for travel agencies in two areas of west and central Iran were enrolled into this study. We used a questionnaire to gather information regarding both the bus drivers’ health status and bus accident. The most prevalent health problems among bus drivers were musculoskeletal disorders, ulcer, hyperacidity, obesity, hypertension and diabetes. There was a significant (p<0.05) correlation between the chance of bus accidents and occurrence of low back pain, leg pain, neck pain, hypertension and migraine. Based on the results of this study we suggest a model that can be used to design a prevention plan in making bus transportation safer. In light of this study, more comprehensive studies can be planned for the safety of traveling by bus, in Iran. Bus driver’s health status is a determinant factor in the incidence of accidents.