مجله علوم پزشکی رازی
سال دهم شماره 1 (پیاپی 33، بهار 1382)

Blood hypereosinophilia is a common finding in medical practice requiring further investigation. There are a wide range of potential causes including atopic disorder, drug allergy, parasitic infection, certain forms of immundeficiency, inflamatory process and malignant diseases. If hyper eosinophilia last a long time, and will not associated with parasitic infection and other disease could be suspected in idiopatic hyper eosinophilia syndrome that is rare disorder in children. Most cases are reported in women aged between 20-50 years and unknown etiology. We have reported a 4 years old girl with compliants of anemia, continuous fever, artheralgy, hepatomegaly and hypereosinophilia for two month, was admited in Children Hospital. In the CBC had leukocytosis, increased Eos(45%), and after role out of other causes of HES, she was treated and now she is alive and well.

Infection is a common complication of diabetic foot that needs hospital admission and surgical intervention.Diabetic foot occurs in one of each ten diabetic patients. Diabetic foot complications are osteomyelitis, arthritis and abscess formation. Radiography, isotope scans, MRI and CT-scan are the procedures that help diagnosis of these complications but these are not always cost effective or available. If ESR and CRP level could help us to determine depth and width of diabetic foot ulcer and the possibility of presence of osteomyelitis, we can cost saving and begin appropriate therapy very soon. A retrospective chart review of 35 diabetic patients admitted to the Rassol Akram Hospital with diagnosis of osteomyelitis or cellulites of the foot during a 2-year periods (1999-2000) was performed. Depth and width of ulcer, presence or absence of osteomyelitis, ESR and CRP level are compared in this group. A retrospective review of 35 diabetic patients that admitted to this hospital only for control of blood glucose also was performed as control group. In this survey ESR and CRP level in diabetic foot group was higher than control group(P.value=0.00), and in diabetic foot with osteomyelitis was higher than diabetic foot without osteomyelitis(P.value=0.001 for ESR and P.value=0.00 for CRP). CRP level in large ulcers were higher than small ulcers(P.value=0.001). ESR and CRP level in patients with long duration of admission were higher than patients with short duration (P.value=0.00 for ESR and P.value=0.001 for CRP). We concluded that higher ESR and CRP level is seen in diabetic foot with osteomyelitis and higher CRP level is indicated of the presence of large ulcer and if patient with diabetic foot has a high ESR and CRP level, need a long period of treatment. We concluded that in diabetic foot only when ESR and CRP level is high investigation for presence of osteomyelitis could be necessary.

The aim of this study was test a new developed severity for individual organ system involvment in 40 patients with systemic sclerosis (SSc, scleroderma). In this study used from a new developed disease severity scale published by an international study group for determination of severity grade in 9 organ system, general, skin, peripheral vascular, joint/tendon, skeletal muscle, gasterointestinal, lung, heart and kidney in 40 patients with systemic sclerosis in firoozgar hospital. Severity scale graded from 0(no documented involvement) to 4(end stage disease). The data required for scale complation are available in data bank of systemic sclerosis (SSc) for all of our patient in firoozgar hospital. The mean age was 40±14.5 years. Female to male ratio 9/1. Mean of total skin score in all patients was 10.7(based on modified rodnan score). Mean duration of first symptoms to time of study was 3.4 years. Normal grade of severity seen different organ system. Severly ill patients contain 1:4 of patients. Sever to end stage disease seen in 2.5% patient with cardiac and 20% of patient with lung involvment. This long term (>5 years) study of disease severity show relativly 1:5 patients developed severe end stage lung disease that approprait management at this time is cardiopulmonary transplant so the center for cardiopulmonary transplanation must be informed to provide facility for these cases.

Regarding to preventive effect of HRT in many menopausal complications such as cardiovascular disease, osteoporsis and genital atrophy, and insufficient consideration to HRT in our country, in this cross sectional study the prevalence rate of use of HRT and related factors was determined in 860 menopausal women refferred to Iran university clinics during 1999-2000. Only 15% of these women use of HRT. Use was more common among those who were younger and had higher education or history of Hysterectomy and oophorectomy(31.8% vs 7.3%). The mean period of use was 26±5.24 months. In that group who didn’t use HRT during the study. 17.2% used HRT in the past and the most common reason for discontinuation was HRT side effects specially vaginal bleeding. In that group who never used HRT, the most common reason was lack of knowledge about HRT. With regard to these findings for extensive use of HRT, increasing knowledge of women and physicians and changing their attitude is important.

Chondrrosarcoma of nasal septum is a rare tumor that referd to ENT department of Hazrat Rasool Hospital. We report two cases of chondrosarcoma nasal septum that extensive to ethmoid, Sphenoid sinuses and intracranial cavity. The main symptoms is obstraction of nasal and epistasis. The choice treatment is surgery and total resection of tumors.

Carotid body tumors may present with variable clinical symptoms and endocrine dysfunction. E. N. T, vascular and Neuro surgeons are intresting to management of these tumors. Four cases that we describe had palpable neck mass and disocomfort, dysphagia and dizziness. Neuroimaging tests include CT scan, angiography that showed a medium to large size vascular tumor in neck. The mainstay of therapy for carotid body tumors is complete surgical excision. We think that biopolar coagulation technique in capsular-adventitial plane without use of a shunt and preoperative embolization are best. These are as opposed to the subadvantitial plane as advocated by some suregeons.

True diagnosis is very important. It’s the base of treatment. Misdiagnosis is practical for health policy, health education and treatment specifically in pediatrics because of patients who can’t say their problems and parents don’t know more. It is an analytic cross-sectional study on 1090 patients. First and final clinical diagnosis, age, sex, chief compliant and autopsy (if there was) were collected. T-test, chi2, ANOVA and correlation coefficients were used in analysis. The most common chief compliants were fever, vomiting,diarrhea and cough, respectively. The most common diseases were respiratory, gastrointestinal and multisystem infections and nervous system diseases. Admission and discharge clinical diagnosis were correlated significantly (P<0.001, r=0.71). Final clinical diagnosis and autopsy results were correlated significantly, too(P<0.001, r=0.72). Despite improving new technology, misdiagnosis have not considerably decreased yet. Similarity of admission and discharge clinical diagnosis was 71% and between final clinical diagnosis and autopsy was 72%, Therefore, first clinical and autopsy diagnosis are related poorly (50%). It causes more excessive and unnecessary costs for patients and society that can be cause of patients’ wandering and probably unreversible complications. Education of medical students by new practical, attractive and effective methods is emphasized.

Mesenchymal chondrosarcoma(MC) was first described in 1959. MC is a rare tumor arising in bone or soft tissue which is composed of well differentiated cartilage with in a proliferation of primitive mesenchymal cell. MC occurs most often in the second and third decades of life. The prognosis is poor, local recurrence and metastases are frequent. A 32 year old, white female consulted a physician for abdominal pain, nausea and vomiting. Computed tomographic(CT) scan of the abdomen disclosed a huge retroperitoneal mass with large area of necrosis located at the left side. With probable diagnosis of kidney tumor, left nephrectomy and splenectomy was performed for the patient. While surgery a retroperitoneal mass occupying the left side with adhesion to the adjacent viscera was detected and removed. Histologic examination revealed mesenchymal chondrosarcoma.

Hepatitis C virus infection is affecting an estimated 200 million people worldwide and 210 thousand in Iran. It is a major cause of morbidity and mortality from liver disease. Interferon-alpha is the choice of treatment but interferone (IFN) with ribavirin is known more effective recently. This study evaluated effect of IFN on Iranian patients and predict response to therapy. This is a quasi experimental study on 33 patients of chronic hepatitis C that are treated by IFN-2a, 3 Mega units, three times in week for 12 months, subcutaneously. We assessed ALT, AST, alkaline phosphatase, total and direct billirubine at first, second week and every month till 12 months. HCV-RNA and biopsy were done at first and end of study. T test, chi2, ANOVA, correlation coefficient and regression models were used for analysis. %82.7 were ejucated under diploma. AST, ALT and alkaline phosphatase were decreased under normal range during treatment significantly(P=0.00005, P=0.0005 & P=0.001). Liver enzymes and billirubine normalized 2-4 months after treatment and the first biochemical break through was during first 6 months. %86.7 of all patients response to therapy biochemically. Percent of patients with negative HCV-RNA was more in the end of study significantly. (P<0.009) Mean biopsy score decreased significantly(P=0.03). Interferone-alpha decreases progression of liver disease, hepatocellular carcinoma, transplantation need and probably death. Total dose of IFN is more important than weekly dose or duration of therapy. Selection of patients with high probability response to therapy, instead of all of patients should be done. Biochemical response was high and quite acceptable. Significant models for prediction of the first time of response and the first biochemical break through during therapy are effective, cheap, easy and available. Results of this study suggest to give information about chronic hepatitis C to patients and doctors, too.

Today, Isostation B-200 is one of the most familiar for assessing low back muscles function.This study that is a Quasi-Experimental design was done on 30 healthy men (mean age~26.4 years). The aim of this research is to determine the best and worst motor efficiency in standing and sitting position following torque measurement. In this research maximum torque of low back extensor muscles as measured in standing & sitting position & in four different degree of trunk flexion (0, 20, 40, 60). All date was analyzed by statgraphics plus software and concluded that in standing position with increasing of tunk flexion, and after extension of low back torque was increased continously and in sitting position, with increasing of trunk flexion, extension torque increased unitl 40 degree of trunk flexion, then decreased. The most prominent clinical point of this research is using of sufficient position & angle of low back spine in stabilization exercises, that in the early stage of training non specific standing position recommended and in the late & terminal stage specific standing & sitting position preferred.

To investigale the topographic changes in the cornea after scleral buckling and vitrectommy. A prospective study was conducted. Thses changes were analyzed based on the type of surgical procedures performed. Design of this study was observational prospective case series. 49 eyes from 48 patients were stratified into four groups based on the type of surgical procedures performed. 10 underwent local buckling (group A), 9 underwent vitrectomy (group B), 18 underwent vitrectomy with encircling (group C) and 12 underwent encircling with additional segmental buckling (group D). These eyes underwent keratometry and videokeratography examinations before surgery as well as at 1, 3, and 6 months after surgery. No statistical significance was observed in the amounts of the induced corneal astigmatism and the refractive cylinder among the four groups. There was statistical significance in the amount’s of the spherical equivalent among the four groups as well as based on the status of the lens(phakia and aphakia)after local buckling (group A). Statistical significance was observed in the amounts of the induced corneal astigmatism before surgery and 6 months after surgery. There was statistical significance in the amounts of the spherical equivalent before surgery and 6 months after surgery among the B, C and D groups as well as based on the status of the lens (phakia and aphakia). After local or additional segmental buckling (groups A and D), corneal steepening, which corresponded to the buckle occurred at a high incidence. After vitrectomy (group B) corneal steepening, which correspond to the scleral sutures occurred that than changed to central steepening over time. After vitrectomy with eneircling (group C) similar changes bbserved but done changed to central steepening over time such corneal changes persisted for up to 6 months in an irregular and asymmetric configuration. Corneal video keratography is a useful tool for evaluationg the post operative corneal curvature. All four types of surgery were found to produce prolonged irregular and asymmetric corneal shape changes, where as the patterns of the changes differed depending on the surgical procedures used.

This study was done for evaluation of engagement rate in nulliparous women and it’s effect on delivery rout. 1322 nulliparas with term pregnancy at the beginning of active labor were studied and followed until delivery. 1132 of them were without engagement but there were 190 cases with engagement (14.4%) (All of the pregnant patients were singletone and with cephalic presentation). Maternal age and rupture of membrane didn’t have effect on engagement occurance whereas pelvic contraction was known as an important and effective factor on engagement occurance(P<0.005). Duration of second stage of labor in two groups was not statistically different, but the duration of first stage of labor in unengagement group wes more prolonged (P<0.005). Also fetal weight was an important factor on engagement occurance(P<0.05). Form 1132 patients without engagement, cesarean section were done in 108 cases. But in only 44 cases were because of progress failure and C.P.D In all cases with engagement vaginal delivery were occured. Therefore unoccurance of engagement alone cannot be a prognostic factor on delivery rout.

Quantitation of urinary protein excretion is important for diagnostic and prognostic purposes and to achieve the best treatment. The method most commonly used to measure urinary protein in 24 hour urine samples, are time consuming and often inaccurate. This study performed on 101 persons. Urine samples were collected three times aday. The protein/creatinine ratio(mg:mg) was measured and compared to the 24 hour urine samples of 20 healthy persons and 81 patients with a wide spectrum of renal function and proteinuria. We used pesce and strand method to measure protein urine samples. In addition, we used test tape for determination of protein in urine samples. Our findings revealed a close correlation between the amount of protein in random samples and 24 hour urine excretion. The higher correlation was found in urine samples, collected at 11.00 A.M and the lowest correlation in samples obtained at 6.00 A.M. There are higher correlation in patients who 24 hour urinary protein excretion are less than 1g. By taking in to consideration the effect of different rates of creatinine excretion, we conclude that determination of the protein/creatinine ratio in single urine samples obtained during normal day light activity can replace the 24 hour urine collection in the clinical quantitation of proteinuria. However, this method is simple, fast and reliable compared to the test tape method which gave false positive and false negative results.

Cryptosporidiosis is one the reasons of diarrhea between children in the world. The prevalence of cryptosporidium in children is more than adult. This research is effective for studying of prevalence of this disease in students of elementary schools in the west of Tehran(aged 6 to 12 years) In this study 3 fecal samples preserved in 10% formalin, were collected from 500 children. Oocyst concentration was performed through Richie’s(modified) methods and staining of fecal smears for each sample (total of 2000 slides) was done by the Zyle Nelson methods infection rate was about (1%) that was observed. There was relation between literacy of fathers and infection rate and there was not any relation between sex and infection rate. Because of prevalence of cryptosporidiosis between elementary students consideration to health and preventive actions in the schools and the city is necessary to prevention of appearance of this disease.

Under-and over-reporting of energy intake is one of the well-known problems in dietary intake assessment. This study was conducted to assess the relationship of these factors to body mass index and lifestyle-related factors. Dietary data on 947 pariticipants (415 male and 532 female) of TLGS was collected using two 24-hour recalls by trained interviewers. Weight and height were measured by digital scale and tape meter according to standard protocols and recorded to the nearest 100gr and 1cm, respectively. Basal metabolic rate (BMR) was calculated. Under-normal-and over-reporting of energy intake was defined as EI: BMR<1.35, 1.35-2.39 AND >2.4, respectively. Means (±SD) of age were 37.3(±14.6) and 32.9(±13.6) for men and women, respectively. Men had higher EI: BMR than women (1.72±0.44 VS. 1.27±0.44, P<0.001). EI and EI: BMR were highest in the youngest age groups in both sexes. The prevalence of under-and over-reporting were %31 and %5, respectively. Fewer men than women underreported EI(%40 VS %19, P<0.001). The fraction of over-reporters was significantly higher in men than women (%7 VS. %3, P<0.05). EI: BMR was decreased with age. Under-reporters were older and had higher BMI than normal-reporters but their educational level did not differ significantly. Over-reporters were younger and had lower BMI than normal-reporters but their educational level did not differ significantly. Most of over-reporters had normal BMI. Smoking was more prevalent in over-reporters than normal ones (%28 VS %19 in men and %6 VS. 1% in women, P< 0.01). The results showed a high prevalence of misreporting of energy intake in our country and this phenomenon is related to age, obesity and smoking habits. These findings must be kept in mind in dietary assessments.

Malnutrition affected many of children in the world, and due to population growth, rend of that is increasing. For reaching to children health promotion must know about their nutrition and related risk factors. In this survey, frequency of malnutrition and related risk factors in under 5 year children of karaj is studied. In a cross-sectional study, 600 under-5 year children by multistage random sampling and by questionnaire, interview and house to house in karaj is studied. Demographic anthropometric, health and measles immunization variables are measured. Instruments of collecting data were scale, questionnaire and metric mesurment. data analysis performed by Epi 6 and SPSS ver 9. Anthropometric data was compared to national center for health statisite(NCHS). 13.9%, 20.3% and 4.9% of studied children were moderate to severe underweight, stunted and wasted respectively. 49.7% were girls and 50.3% were boys. Underweight girls were more than boys. Mother literacy under Diploma, birth weight under 2.5kg, under 3 years duration with previous birth, non breast feeding and housekeeper mother job were more in malnurished children than normal children. Important risk factor of malnutrition with significant statistical ralerionship were birth weight under 2.5kg, under 3 years with previous birth and under diploma of mother literacy.

The consequences of resistance include higher mortality and greater morbidity. Emergence of resistance bacterial pathogens has increased concerns about antibiotic perscribing patterns. Parents request perscribing of some of antibiotics from physicians, and this may be influences on perscribing patterns of them. To limitation of inappropriate use of antibiotics, must be determine affect of parents request and their suggested strategies for control, on perscribing patterns of physicians. This study carried out to determine frequency of antibiotic use in pediatric (physicians) basis of parents request in Tehran. The type of study was cross-sectional. Method of collecting data was self-administered questionnaire and we used non probability (convenience) sampling method with going to the offices, clinics, hospitals and others. Sub specialist pediatrician was excluded. From 198 pediatricians, about 47.5% was male and saw average of 128 patients perweek and were in practice for 12 years. 32% of pediatricians indicated that 10 or more times in the past month a parent had requested on antibiotic when the physician did not feel it was indicated. 65% reported always/most of time. Or often pressure them to perscribe antibiotics when their children are ill but antibiotics are not indicated. In follow-up questions/approximately 24.7% of physicians reported they occusionally or more frequency comply with these requests. 48.5% felt that educating parents would the single most important program for reducing inappropriate oral antibiotic use. Due to results, educating of parents about appropriate indications for antimicrobials must be part of any comprehensive plan to reduce inappropriate antibiotics indication. If parents educated correctly about oral antibiotics use, not only reduce pressure on the perscribing patterns of physicians, but also effect on their behaviour for selection of useful antibiotics.

The mammalian sino-atrial node is not a uniform tissue in histological and electrophysiological terms. The differences in ionic currents underlying the regional differences in electrial activity are only just beginning to be understood. One of the ionic currents it is thought to play a role in the center of sino-atrial node for action potential upstroke should be transient Ca+2 current (ICa,T). This prediction was tested in the present study by investigating the effects of block of this current on pacemaker activity in the periphery and center of the nine intact sino-atrial node of the heart rabbit by 40 μM Ni+2 for 30 min. In all cases Ni+2 failed to change significantly action potential configuration either in the center or in the periphery of the intact sino-atrial node. It is possible that under physiological conditions ICa,T is inactive in both the center and peripheral zones of the sino-atrial node of rabbit. Alternatively it is possible that ICa,T is important in the center and pacemaker shift in the present of Ni+2 conceals the effect.

Leishmaniasis is a protozoal disease that transfer to human by phlebotomus with leishman body. It is a chronic disease that infects skin, mucosa and viscera. Cutaneous form is common in Iran but visceral form is endemic in Kordestan, Lorestan and Khozestan. It is a case report of visceral type of leishmaniasis from Lorestan. His disease onset was fever, bloody diarrhea and cough, that sustained for a week and then relief spontaneously. In visceral Leishmaniasis, lung, lymphnodes, kidneys, liver, bone marrow (reticuloendothelial system) and GI tract will be infected but GI symptoms have been seen rarely, specially bloody diarrhea is not reported as a symptom in onset of disease.

Gliomas comprise about 50% of all primary central nervous system tumors that have defied treatment. Despite of improvement in treatment with surgery, radiotherapy and chemotherapy, the prognosis for these patients remains poor. Efforts to improve the treatment of malignant glioma have included Targeted Radiotherapy with [125I]-Iododeoxyuridine. 125IUdR, a thymidine analogue, is preferentially incorporated into the DNA of tumor cells, and the Auger electrons emitter [125I] is highly toxic to dividing cells. We have achieved comparative study of Targeted Radiotherapy and external beam therapy in treatment of glioma. Clonogenic assays formed basis of experiments to the human glioma cell line “A172” cultured as monolayers in the exponential and the plateau phase. In external beam radiation, the survival curves were exhibited a distinct shoulder, in comparison with, lack of shoulder (absence of repair) in Targeted Radiotherapy. In the treatment of cells in the plateau, the effectiveness of 125IUdR was attenuated by the presence of non-cycling cells. These finding suggest that Targeted Radiotherapy may be a useful method for treatment of glioma, in case we overcome non-cyling malignant cells.