مجله فیض
سال پنجم شماره 2 (پیاپی 18، تابستان 1380)

History and Considering the high incidence of preterm labor and its known complications and reports on the effectiveness of nifedipine and magnesium sulfate in its prevention and regarding their prices and way of administration, this study was carried out to compare the effect of nifedipine and magnesium sulfate in prevention of preterm labor. In referrals of Shabihkhani obstetric clinic in Kashan during the years 1998-2000. The clinical trial strategy of this study was carried out on patients with pregnancies at 20-37 weeks and hospitalized for uterine contractions without interfering parameters. The patients were randomly divided into two groups. The case and control groups were treated with nifedipine and magnesium sulfate respectively. Fetal heart rate, maternal blood pressure and complications was recorded. On condition of a successful case of labor, the patients were discharged and followed up to the time of delivery. At this time, birth-time weight, period of hospitalization and number of hospitalized infants were recorded and analyzed statistically. Both groups were similar to each other regarding maternal age, parity and gestational age. Mean delay of labor was 31.72±24.8 days after administration of nifedipine and 42±28.9 days for magnesium sulfate was non-significant. The number of newborns that admitted in NICU was 7 (28%) for nifedipine with an average of 6.85 days and was 5 (20%) for magnesium sulfate 5 (20%) with an average of 7.6 days. In addition, mean weight at labor was 2874g and 2872g for nifedipine and magnesium sulfate groups respectively that was non-significant. Meanwhile, in none of the groups there was not any need to cease the administration of these drugs. The complaint rate was 100% and 40% for magnesium sulfate and nifedipine groups respectively (P<0.0001). Since both drugs are alike regarding their effect on birth-time weight and delay of labor and in addition, magnesium sulfate is followed by greater rate of complications and nifedipine is a less costly drug and is its easier way of administration, the latter is recommended to be used in prevention of preterm labor.

History and Considering the high incidence of gastrointestinal disorders and the involvement of Helicobacter pylori in the occurrence of gastritis, duodenal ulcers and gastric adenocarcinoma and the absence of a generally-accepted and standard method for its diagnosis, this study was carried out to compare the invasive and non-invasive methods on referrals of Shaheed Beheshti hospital in Kashan in 2000. The clinical trial and diagnostic strategy of this study was performed on 127 cases with variant symptoms of gastric disorder and with endoscopic indication. During gastroscopy, samples were collected from antrum for culture, pathological diagnosis and fast urease and 5ml of blood was obtained for evaluation of IgG against, bacterium. The golden standard in this study was on the basis of a positive result for culture, pathological evaluation and fast urease. Then, the sensitivity, specificity, PPV and NPV were determined for criteria of culture, fast urease, histology and ELIZA. The study was performed on 127 cases with an age of 46.3±18 years and 57.5% out of them were male and the remainder (42.5%) were female. The results showed that each test individually or two of the three tests (Histology, fast urease and ELIZA) can not have an appropriate diagnostic value. In this respect, a combination of urease with PPV and/or with NPV can have the greater diagnostic value of 59.3% and 92.3% respectively. Meanwhile, combination of culture and PPV and/or NPV showed the least diagnostic value, i.e. 56.7% and 50% respectively and combination of histology and PPV and/or NPV showed the highest value, i.e. 90% and 100% respectively. Furthermore, ELIZA test in comparison with golden standard had the least sensitivity, even in the presence of histologic evaluation and fast urease. It can be concluded that a combination of fast urease and histology is of high value in diagnosis of Helicobacter pylori in Iran. In addition, the serologic ELIZA test recommended not to be performed because of its low specificity. However, its negative results might be helpful in some cases.

History and Considering the incidence of ulcer infection within incision area and its complications and a similar condition in perforated and gangrenous appendicitis and the efficacy of local application of antibiotics in reduction of infection, this study was carried out to evaluate the effect of ampicillin washing in incision area. The clinical trial strategy of this study was performed on two groups for patients incised with McBorni method. All of the patients received intravenous injection of metronidazole and gentamicin one day before operation and for 7 consecutive days therefore received ciprofloxacin and were followed up for a period of 1 month. For healing, control group was washed with normal saline and experimental group washed with saline solution and ampicillin. A total of 74 patients in two groups (n=37) were studied and they were alike regarding age and gender. The incidence rate in control and experimental group was 13.5% and 10.8% respectively that was non-significant statistically. In addition, age, gender and type of complication played no role in infection. Meanwhile, a thickness greater than 2cm for subcutaneous tissue can increase the incidence rate. It is concluded that ampicillin washing in comparison to saline itself can not affect the incidence of infection. It is recommended to perform more studies on ulcers with a subcutaneous thickness greater than 2cm.

History and Considering the high incidence of Streptococcus hemolytic type B and its complications and its role in early neonatal infection and easy transmission from mother to infant and lack of information, this study was performed to determine its prevalence in pregnant women and its relationship with infection in referrals of Shabihkhani obstetric clinic in Kashan in 2000. The descriptive and analytical strategy of this study was performed on 400 pregnant women with a gestational period equal to or greater than 35 weeks. For evaluation, a special questionnaire was designed in which information on age, occupation, nationality, level of knowledge, living area, multiparous status, abortions, history of preterm labor and diabetes and background illness were recorded. Sampling was made from vagina by a swab and they were transferred to related culture medium. The bacteria were diagnosed on the basis of biochemical tests and for statistical analysis chi-square and Fischer tests were used. Out of 400 evaluated cases, 32 cases (5.8%) with Streptococcus hemolytic type B were isolated and out of 23 infants born from mothers with positive colonization, only 2 cases (8.7%) has sepsis due to streptococcus hemolytic type B (P<0.003). In addition, none of the pregnant women with positive vaginal colonization for streptococcus showed any infection after labor. Meanwhile, other factors including background illnesses, diabetes, abortions, labor procedure, nationality, occupation, level of knowledge and living area did not have any role in this respect. Since the incidence of this kind of infection is low in Iran, it is recommended to perform more studies in this field to determine the causative factors and to design health-training programs for pregnant women and to perform antibiotic prophylactic procedures in mothers with positive colonization to reduce subsequent complications.

History and Regarding the prevalence of chronic abdominal pain and its known complications and absence of knowledge on the prevalence of Helicobacter pylori and different reports on the diagnostic value of fast urease test, this research was conducted on children referred to the endoscopy section of the Shaheed Beheshti hospital in Kashan from 1999 to 2000. The descriptive method of this study was performed on 39 children with an age range of 3-18 years with symptoms of chronic abdominal pain. Endoscopy was done on all of the patients and then, the specimens was surveyed by rapid urease test and evaluated pathologically for the presence of Helicobacter. The characteristics, age, gender and family members were studied. The findings of endoscopy (Being normal and/or presence of esophagitis, nodularity, gastric ulcer, duodenitis and duodenal ulcer) were recorded. The prevalence of Helicobacter was determined in specimens and the confidence interval was calculated and the diagnostic power of rapid urease test was measured. The research was performed on 39 children at an age of 9.9±4.1 years old comprised of 17 males (43.6%) and 22 females (56.4%) and having chronic abdominal pain for at least 3 months with an average of 13 months. The prevalence of Helicobacter was 30.8% and the positive predictive value of rapid urease test was 50% and its negative value was 77.8%. Helicobacter pylori was not observed in the majority of children with chronic abdominal pain and it is a matter of concern to cure all of the afflicted patients. Although the number of specimens was few, it seems that fast urease test do not have a high diagnostic power in Iran and it is recommended to perform more studies in this field.

History and Morphogenesis is achieved by the effect of different tissue factors including mesenchymal-epithelial interaction, but its chemical basis is unknown. One of the most appropriate models is the mammalian tooth, especially its pulp. The phenomena migration, proliferation and differentiation within dental pulp are affected by the components of extracellular fluid. In this respect, tenascin is one of these components that is involved in the initial stages of development and differentiation of some fetal tissues including teeth and is important in the pathogenesis of tumors. The present study was conducted on 40 ball-c mice. Different development stages of dental pulp were evaluated within the days 12-19, using immunohistochemical methods and monoclonal antibody against tenascin. The finding showed that at the bud stage, tenascin is found in the ectomesenchymal tissue and basement membrane of enamel organ in a high quantity and there is reduction in its level in cap stage. With developmental progression, the tenascin level increases significantly in early bell stage for pulp and in late bell stage in cortex. Tenascin can play an important role in morphogenesis during development of pulp. In this respect, epithelial-mesenchymal interaction is very important. Therefore, it is recommended to conduct more studies to determine the role of tenascin in the differentiation oddentoblasts following injury.

History and Postoperative shivering is a common complication in patients under anesthesia and because of the importance of its etiology and the controversies on the relationship between core body temperature and shivering, this study was carried out on referrals of Sina hospital in Tehran in 1997. Case-control strategy of this study was performed on 60 patients divided into shivering and non-shivering groups. Postoperative tremor with tonic pattern and having a 4 to 8 cycle/min waxing-and-waning component was considered as shivering. Core body temperature was estimated by a nasopharyngeal probe in both groups and they were compared using t-test. The means were reported as Mean±SD. This research was carried out on 90 patients, i.e., 30 patients for case group (Shivering) and 30 patients for control group (Non-shivering). Both groups were similar regarding age, gender and temperature of operation room. Core body temperature in non-shivering group was 36.11±0.33 and in shivering group was 35.32±0.61 (P<0.001). Meanwhile, prevalence of shivering was 36.7 percent. There exists a relationship between core body temperature and the occurrence of shivering. Therefore, it is recommended to perform more studies in this field regarding shivering and its complications.

History and Considering the incidence of Chlamydia trachomatis and its known complications and costly diagnostic methods needing especial facilities, this study was carried out to determine its prevalence among patients with pelvic inflammatory disorders. The descriptive strategy of this study was conducted on 323 cases. After a diagnosis of PID on the basis of medical history and clinical examination, samples were collected from endocervix by a swab and tested by fluorescent antibody direct method. In addition, information on age, multiparous status, contraceptive method and so on was collected through arranging interview. At last, the prevalence was calculated for the society. A total of 323 women with PID were studied in whom only 33 cases (10.2%) showed chlamydial infection. There was an inverse relationship between prevalence and the factors increased age, age of intercourse engagement, number of intercourse/week and knowledge level. There was also a lower rate of prevalence when using condom and/or contraceptive pill and coitus interruptus increased the incidence rate. In addition, patients with PID showed a higher rate of dysmenorrhea and dyspareunia and there was no significant relationship between infection and uterine bleeding and/or dysuira. Patients with cervical hypertrophy showed a higher rate of PID. prevalence of Chlamydia trachomatis is not high in PID. Nonetheless, because of its complications, it is necessary to conduct studies on its causative factors and to lower its incidence.

History and Considering the extensive use of heparin as an anticoagulant and because of the controversial reports on the prevalence of heparin-induced thrombocytopenia (HIT) in different studies, this study was conducted in the cardiology ward of Shaheed Beheshti hospital in Kashan to determine the prevalence of HIT. The descriptive strategy of this study was carried out on 400 patients. Patients with a diagnosis of cardiovascular disorder were selected to consume heparin at an appropriate treatment dose and initially did not have thrombocytopenia and patients with such a condition were excluded from the study. Thereafter, cell count was conducted very two day. The study was performed on 400 patients with angina pectoris (65%) and myocardial infarction (35%) (67% out of them were male and the remainder (33%) was female). None of them showed signs of thrombocytopenia. It appears that in contrast to results of other studies with an incidence of 30% for thrombocytopenia, this complication is a rare one and it is not essential to conduct expensive and troublesome methods of platelet counts for related patients.

History and Sepsis is one of the most serious diseases in neonates that is as a result of hemodynamic and metabolic disturbances following infection. The major criterion for its diagnosis is to cultivate the sterile fluids of the body including blood, cerebrospinal fluid and urine. Meanwhile, its result is prepared with delay. Until now, there has not been any report on the diagnostic value of clinical signs in Iran. Therefore, this study was performed on neonates referred to Shaheed Beheshti and Shabihkhani hospital during the years 1999-2000. The clinical trial and diagnostic strategy of this study was carried out on 120 neonates. In this respect, the suspected cases for sepsis were admitted and clinical signs including convulsion, fever, vomiting, anorexia, hypothermia, cyanosis, respiratory distress and hyporeflexia were evaluated. In addition, specimens of CSF, blood and urine were analyzed. Then, the diagnostic value of each one of these signs was determined. The most common observed signs were hyporeflexia and anorexia. In 13% of them (10.8%), there was a positive result for culture of each one of the sterile fluids. In addition, the predictive value specificity was the highest for convulsion and the most sensitive sign was anorexia. All of the cases (n=111) with positive culture were treated and cured using antibiotics and complementary treatments. The results showed diagnostic value of clinical signs in neonatal sepsis is limited. Furthermore, considering a recovery of 92.5% for cases, it could be concluded that positive culture is a golden standard for definite diagnosis of neonatal sepsis.

History and Considering the incidence of arthritis and controversial reports regarding type, involved joint, gender and paraclinical findings and the absence of enough information for its prevalence in Iran, this research study was performed to determine the epidemiology of arthritis in children admitted to Shaheed Beheshti hospital in Kashan from 1991 to 1999. The research was conducted on existing data on hospitalized children with an initial diagnosis of arthritis. For this purpose, their records were collected and the cases with a definite diagnosis were carefully studied. The data regarding age, gender, involved joint, type of disease and ESR and so on were recorded in questionnaire. The study was performed on 4960 admitted children and 248 (5%) out of them had arthritis. In addition, 57.3% out of them were male and 42.7% were female. Meanwhile, 3.6% had an age less than 1 year, 42.3% with an age between 1 and 5 years and 54.1% had an age greater than 5 years. The most common form was septic arthritis (23%) and this type of arthritis was observed in children under 1 year of age and its incidence was 50% in children under 3 years of age. Other kinds of disorder were reactive, brucellosis and toxic arthritis. Furthermore, all cases with an ESR greater than 100 had septic arthritis and some of the children with septic one showed a low ESR. The septic arthritis is the most important and common form of arthritis, especially in children under 1 year of age. Therefore, it is recommended to perform similar studies in other region in Iran to have a thorough epidemiological evaluation.

History and Ascites is defined as fluid accumulation in peritoneal space and is one of the critical symptoms for background disorders. Considering its causative factors and lack of information in this respect, this study was performed on hospitalized patients admitted to Shaheed Beheshti hospital during the years 1993-2000. This study was conducted on existing data of patients with ascites. For this purpose, their medical records were extracted and studies. Then, the characteristics including age, gender, diagnosis, ascites/serum albumin gradient and protein concentration were determined and recorded. A total of 17 cases out of 117 patients excluded from the study because of death prior to diagnosis, early leave and absence of coordination for paracentesis. The studied patients had an average age of 55.8±18.4. In addition, 44% of them were female and 56% of them were male and most of them had an age greater than 60 years. The major causative factors included cirrhosis (66% in total, 80.4% for males and 47.7% for females), malignancy (20%), heart failure (9%), Tuberculosis (1%) and mixed factors (4%). Furthermore, in 36 out of cases with ascites as a result of cirrhosis (97.1%), the albumin gradient was greater than 1.1. This value was 100% in patients with ascites due to cardiac disorders and its sensitivity was 92.8%. It is concluded that the most common cause of ascites is hepatic cirrhosis and it is recommended to evaluate cirrhosis and determine albumin gradient for diagnostic goals.

History and Considering the high incidence of thyroidal nodules in mountainous and hot regions of Kashan and the importance of its rapid diagnosis and treatment and the existence of controversies in this field, this study was performed on referrals of health centers in Kashan with thyroidal nodules from 1998 to 2000. The clinical trial strategy of this study was performed on 65 patients. At first, they were tested for FNAc and operated according to indications (Lobectomy, isthmectomy, pyramidectomy, subtotal and/or total thyroidectomy). The biopsies were evaluated pathologically and diagnostic value of FNAc was determined. Out of 65 studied cases, 55 patients were female and 10 cases were male. In addition, in 5 cases (7.7%), there existed a state of malignancy according to pathological evaluation and FNAc. Meanwhile, the sensitivity and specificity was 100% for FNAc. FNAc has a high diagnostic value of thyroid nodules and it is recommended to be performed before surgical operations of the thyroid gland for all of the cases to reduce unwanted and costly operations.

History and Considering the significance of congenital heart disorders and lack of information on its prevalence among neonates in Iran and for determination of the effect of environmental and genetic factors in its etiology, this study was carried out during the years 1996-2000. The study was conducted on existing data and the related data were collected in pre-designed questionnaires and all neonates with a definitive diagnosis of congenital heart disease were evaluated. In this respect, gender, age, type of disorder, family history, history of drug consumption during pregnancy, familial marriage and accompanied anomalies were considered. The results showed that out 2840 hospitalized neonates, 46 cases (1.6%) had congenital heart disease. The most common from was VSD observed in 22 cases (47.8%). The prevalence was 28.2%, 19.5%, 10.8%, 4.3% and 13% for ASD, TGA, PDA, TOF and other congenital heart disorders respectively. In addition, out of 46 neonates, 20 cases (43.5%) were female and 26 cases (56.5%) were male. Furthermore, in 41.3% of them, there was a familial marriage. It is concluded that prevalence of CHD is higher than references, especially for TGA. Meanwhile, familial marriage can increase the incidence of CHD. Therefore, it is recommended to perform more studies in this field in Iran.