Acta Medica Iranica
Volume:48 Issue: 2, Feb-Mar 2010

Noise is considered as one of the most severe sources of environmental and work place constraints. Noise effects on immune function, hormonal levels, cardiovascular and respiratory systems are well known. The aim of the study is to evaluate the effects of traffic noise on basal and stimulated gastric acid secretion. 48 healthy rats were divided into five traffic noise exposures (1, 7, 14, 21, 28 days) and a control groups. Pentagastrin was used IP for stimulation of gastric acid secretion. The gastric contents were collected by the wash-out technique and then titrated. Histological studies were performed on gastric epithelial layer. In the 1, 7, 14 and 21 days traffic noise exposure, basal and pentagastrin-stimulated gastric acid secretion increased compared to the control group (P<0.001), but a significant decrease was seen in hyperacidity in 28th days, in the both basal and stimulated states(P<0.05). Histological study showed that mucosal layer thickness of stomach increased, while the number of oxyntic glands and cell nuclei decreased. It seems that 1,7,14 and 21 days traffic noise increase gastric acid secretion, while 28 days traffic noise can induce adaptation.

We aimed to compare the therapeutic effect of Avonex (Av)، Betaferon (Be) & Rebif (Re) on the Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS). Ninety patients referring to Farshchian Hospital were entered in this study. The patients were divided into three equal groups: group 1 received Av، group 2 received Re and group 3 received Be، and after 24 months، comparison was done by calculating primary and final EDSS and the relapse rate. For comparison of the primary and final EDSS in each group، the relapse rate between the groups and side effects between the drugs، the paired samples t. test، the One-Way ANOVA test and the Pearson- chi-square were used. Average age was 31. 11 ± 8. 62 years، 80% being female. Comparison of the average primary and final EDSS using the paired samples t. test showed a significant statistical difference (P < 0. 05). Motor and visual disturbances (respectively 68. 3% and 60. 3%) were the most common signs and relapsing- remitting form was the most common form (42. 1%). The average EDSS change of groups Av، Be and Re was respectively، 1. 28 (29. 76%)، 1. 30 (24. 30%) and 1. 26 (26. 63%)، showing no significant statistical difference in reducing EDSS. Groups Av and Be، showed no significant statistical difference in the average relapse rate before and after treatment، but in group Re there was a significant difference (P < 0. 05). Treatment with these drugs reduces motor disability، with no significant difference between them. Also in comparison، Re has a greater effect in reducing the relapse rate، but again with no significant statistical difference among them.

the aim of this study was to determine the diagnostic value of a serologic test for Helicobacter pylori (H. pylori) in pediatric population presenting with abdominal pain suspected of peptic disease. We conducted a preospective cross sectional study. There were 202 children with abdominal pain. Serologic BM test using Helisual Quick test kit was performed. All patients then underwent endoscopic examination. The calculated sensitivity، specificity، positive and negative predictive values of the applied serologic BM test were 72. 4%، 64. 8%، 44. 6% and 85. 7%، respectively. We concluded that a positive result from serologic test could not be judged independently. Thus، in symptomatic patients، other diagnostic methods (e. g. endoscopy and UBT) should be applied prior to the therapeutic decisions.

Vancomycin is a a glycopeptide antibiotic with bacetiocidal effects on gram positive bacteria by interfering with cell wall synthesis. The necessity for monitoring of serum vancomycin concentrations (SVCs) has been recently noticed at many institutions because of concerns for its nephrotoxicity. We aimed to describe the SVCs monitoring in pediatric patients, in an effort to determine subtherapeutic or toxic levels. The medical records were reviewed for all patients older than 60 days of age admitted to the general or subspecialty services who received intravenous vancomycin at Children''s Medical Hospital in Tehran, Iran between July 2003 and December 2005. Because pharmacokinetic parameters for children with cancer may be different, this group was evaluated separately. During the study, 167 infants and children without cancer and 42 patients with cancer; aged between 3 months to 17.5 years were treated with vancomycin for various infections. In children without cancer, peak SVCs were in an adequate therapeutic range for 93% of patients (8-55 g/ml). For children with cancer, peak SVCs was lower than 10 g/ml (10%), and trough values were lower than 5 g/ml (21%). In conclusion, according to the results of this research, due to different pharmacokinetics of vancomycin in cancerous patients, the monitoring of vancomycin plasma concentrations is necessary for the best therapeutic antibacterial activities with a fewer occurrence of serious adverse effects.

In this study, we assessed the adverse reactions to influenza vaccination in HIV- infected individuals. From November 2006 to January 2007, a total of 203 HIV-infected persons were recruited. Demographic data were collected. Subjects were evaluated 48 h and 15 days after vaccination for symptoms and significant health events as possible side effects. Participants were instructed to measure their temperature in the morning and evening for 2 days post-immunization and to assess injection site and systemic adverse reactions. 80.3% of the subjects were male. The mean age of the subjects was 36.9±7.9 years. Local and systemic reactions were reported by 61 (30%) and 62 (30.5%) persons, respectively. The most common adverse reactions to the influenza vaccine included skin redness (37 cases), induration (32 cases), and pain (55 cases) as local reac-tions, and fever (22 cases), myalgia (46 cases), headache (12 cases) and weakness (35 cases) as general reactions. 1.4 % of the subjects had fever over 38.5 ºC. There were significant associations between myalgia and flushing with CD4 counts (P<0.05). We found no relationship between ad-verse reactions and sex, history of smoking, allergy, alcohol, and drug usage, stage of HIV infec-tion, anti-retroviral therapies, anti-TB medication and previous vaccination. We concluded that inactivated influenza vaccine administered in HIV-infected adults did not result in potential ad-verse events in this study population.

Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study، we examined the effects of MBSR upon psychological، physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study، we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3، 6، 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 ±7. 7 yrs. There was no significant difference in MSCL scores after MBSR and in 3، 6، 9 and 12 months compared to those before MBSR (P>0. 05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0. 05). Nevertheless، in 3، 6، 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0. 05). The means of CD4 count، before and after MBSR، and in 3، 6، 9 and 12 months were 549± 173. 6، 640. 2±189. 4، 655. 3±183. 4، 638±167. 4، 619. 3±163. 2، and 595. 2±165. 6، respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0. 05). In our study، MBSR had positive effects on psychological status and CD4 count. However، more studies with large sample size are necessary.

Among the therapeutic options for achalasia are pneumatic dilatation (PD)، an appropriate long-term therapy، and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty- four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late PD) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16)، PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1، 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score ≥ 50% of baseline. There were no significant differences between the two groups in gender، age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87. 5% vs. 67. 1% (P = 0. 7)، 87. 5% vs. 61. 1% (P = 0. 59) and 87. 5% vs. 55. 5% (P = 0. 53) at 1، 6 and 12 months respectively. There were no major complications in either group. The mean symptom score decreased by 62. 71% in the BT-PD group (P < 0. 002) and 50. 77% in the PD group (P < 0. 01) at the end of the first year. Despite a better response rate in BT+PD group، a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

Closure of fascia after transverse rectus abdominis musculocutaneous (TRAM) flap has usually been performed with direct closure or synthetic material. The dermal autograft was removed from zone IV of flap was an alternative to reinforce fascial closure. The dermal autograft was used in 34 patients after TRAM harvest for breast, head and neck reconstruction and Prolene mesh was used in 42 other patients for closure of fascial defect. All patients were followed by physical examinations. Average follow-up in the dermal autograft group was 27.3 versus 20.7 months in the second group. In the dermal autograft group, one patient complained of bulging of the anterior abdominal wall; one developed a wound infection. In the second group, one patients experienced true hernia. Dermal autografts are a useful alternative to mesh repair of fascial defects after TRAM flap harvest.

The purpose of this study was to evaluate the early and late outcome after total correction of tetralogy of fallot (TOF) in 101 consecutive patients with a mean age of 8.23 ± 4.90 years underwent repair of surgery at one institution between 1995 and 2006. Forty two patients had initial palliative operations. A transannular patch was inserted in 60 (58.5%) patients. Risk factors for operative mortality were analyzed. Follow-up was obtained from clinical appointments and telephone questionnaires. The operative mortality was 6.9%. Aortic cross-clamp time more than 90 minutes (P<0.01) and cardiopulmonary bypass time more than 120 minute (P<0.01), affected operative mortality, whereas previous palliative procedure, hematocrit level, and use of transannular patch did not. Mean follow-up is 34.08 ± 31.09 months (range, 1 month to 120 months). Actuarial survival is 91% alive 10 years after total correction. On Postoperative echocardiography, 22 patients had mild pulmonary regurgitation, 19 had a right ventricular outflow tract gradient more than 50 mmHg, and 10 had a small residual ventricular septal defect. There were two late deaths. Late sudden death from cardiac causes occurred in one patients. Total correction of TOF can have low operative mortality and provide excellent long-term survival. This experience suggests that the key factor in the total correction of TOF is to correct the pathology completely, to protect the myocardium, and to manage the complication properly.

Ankyloglossia (tongue-tie) is a congenital anomaly with a prevalence of 4-5% and characterized by an abnormally short lingual frenulum. For unknown reasons the abnormality seems to be more common in males. The pathogenesis of ankyloglossia is not known. The authors report a family with isolated ankyloglossia inherited as an autosomal dominant or recessive trait. The identification of the defective gene(s) in these patients might reveal novel information on the pathogenesis of this disorder.

Intrauterine device (IUD), a conventional method of contraception is rarely associated with uterine perforation and extra uterine dislocation. A 29 years old woman complaining of vaginal bleeding was referred for pelvic mass identified in ultrasound. The mass was confirmed with CT scan. In laparatomy we found an IUD in cul-de-sac and pelvic mass was apparently an organized hematoma. Transmigrated IUD can induce organized hematomas presenting as a pelvic mass.

The distal third of the tibia, ankle and heel area is difficult to reconstruct. For small to medium size defects, local flaps are often an easier alternative than free flap. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. The distally based superficial sural artery flap, first described as a distally based neuro skin flap by masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. The main disadvantage of distally based sural artery flap is sacrifice of the sural nerve because it is described the concept of neurocutaneus island flap. We describe one case of reverse sural flap without sural nerve. The aim of this paper is to establish the reliability of this flap even without sural nerve.

Aortobronchial fistula (ABF) is a rare and late complication of cardiac surgery. If untreated, mortality rate is approximately 100% secondary to exsanguinations haemoptysis. Early diagnosis and treatment are essential for successful management. Open surgical repair is associated with high morbidity and mortality rate, ranging from 25% to 41%. Endovascular treatments of ABF is a less invasive treatment modality and have become an important alternative to open surgical intervention in aortic pathologies. We present a case of ABF that successfully is managed by endovascular approach.