Acta Medica Iranica
Volume:48 Issue: 6, Nov-Dec 2010

Iodine is a trace element in the human body, its only known function is the synthesis of thyroid hormones. Effects of iodine deficiency, termed iodine deficiency disorders (IDD), include endemic goiter, hypothyroidism, cretinism, decreased fertility rate, increased infant mortality and mental retardation. 2.2 billion people worldwide are at risk for IDD. Of these, 30-70% have goiter and 1-10% have cretinism. Two decades ago the I.R. Iran was among the countries most severely affected by iodine deficiency, but during the last two decades has made much progress in the development of universal salt iodization strategies and IDD prevention, and since 1996 meets all WHO/UNICEF/ICCIDD criteria for the sustainable elimination of iodine deficiency.

Fascioliasis is a worldwide parasitic disease in human and domestic animals. The causative agents of fascioliasis are Fasciola hepatica and Fasciola gigantica. In the recent years, fasciola resistance to drugs has been reported in the many of publications. Fasciola spp has detoxification system including GST enzyme which may be responsible for its resistance. Therefore, the aim of the study was to assay of GST enzyme activity in fasciola parasites. Fasciola gigantica and Fasciola hepatica helminths were collected from abattoir as a live and cultured in buffer media for 4 h at 37 °C. Excretory-Secretory products were collected and stored in -80◦C. F. gigantica and Fasciola hepatica were homogenized with homogenizing buffer in a glass homogenizer to prepare of somatic extract. Suspension was then centrifuged and supernatant was stored at -80°C. In order to assay the enzyme activity, excretory-secretory and somatic extracts in the form of cocktails (potassium phosphate buffer, reduced glutathione and 1-chloro-2,4-dinitrobenzene substrates) were prepared and their absorbance recorded for 5 minutes at 340 nm. The total and specific GST activity of F. gigantica somatic and ES products were obtained as 2916.00, 272.01 micromole/minute and 1.33, 1.70 micromole/minute/mg protein, respectively. Fasciola hepatica also showed 2705.00, 276.86 micromole/minute and 1.33, 1.52 micromole/minute/mg protein, respectively. These results are important for analysis of parasite survival / resistance to drugs which use for treatment of fascioliasis

RA (rheumatoid arthritis) is a chronic multisystem disease with a variety of systemic manifestations. One of these manifestations, is hearing disorder, so study of the relation between RA and hearing disorders is seem important. This was a case-control study which has done from December 2004 to August 2006. This study compared 50 patients with RA, with age, sex and job-matched as control. Audiometric tests in different frequencies show that hearing threshold in high frequencies specially in 8000 Hz had a significant difference between two groups, also acoustic reflexes were absent in case groups and had significant difference between two groups too. The evaluation of sensory neural hearing loss showed that this hearing loss is sensory not neural. Based on this study, frequent evaluation of audiometric tests is recommended for controlling hearing disorders by therapeutic and rehabilitation procedures in RA patients.

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem worldwide. Increased energy and protein needs, decreased energy and protein intake are common in COPD patients. Adequate intake is essential to improve pulmonary function and immune system, prevention of weight loss and maintaining muscle mass and strength. Assessment of energy and protein intake and its relationship with pulmonary function in COPD patients was performed in this study. The study group included 63 COPD patients. For all subjects, evaluation of energy and protein intake by Food Frequency Questionnaire (FFQ) and 24-hour recall, spirometry for measuring pulmonary function and determining disease severity were performed. The subjects were divided into three groups based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. Relationship between energy and protein intake with pulmonary function was assessed. Energy and protein intake were lower than the calculated energy and protein demand for all groups. Significant relationship was found between the amount of protein intake extrapolated from food frequency questionnaire with Forced Vital Capacity (FVC) (r=0.2, P=0.02) and Vital Capacity (VC) (r=0.3, P=0.008). The results of the study suggest that accurate evaluation of protein and energy intake and requirements should be included in the goals of medical treatment of COPD patients.

The quality of subarachnoid block can be improved by adding opioids to the local anesthetics. We compared the analgesic effects of different doses of intrathecal sufentanil added to lidocaine %5 for elective cesarean section. This study was a prospective, randomized, double-blind, controlled trial. 90 pregnant women with ASA class I-II, scheduled for elective cesarean section under spinal anesthesia were enrolled in this study. Three groups were made of them by random; Group 1 (control group) was given lidocaine 5% (75 mg) and 2 ml of normal saline. Patients in Group 2 received lidocaine 5% (75 mg) and 5 micrograms sufentanil plus 1ml normal saline. Group 3 patients received lidocaine 5% (75 mg) and 10 micrograms sufentanil. Duration of sensory block and effective analgesia (need to analgesic) were measured. Opioid related side effects were recorded. Duration of sensory block and effective analgesia were prolonged in sufentanil groups in comparison of control group(50.3±4) that was significantly more in group3 (128 ± 4) versus group 2 (58.3 ± 10)(P < 0.001). There was mild to moderate respiratory depression in sufentanil groups which was more noted in group 3 (p < 0.001). No differences were detected in other side effects such as hypotension, nausea & vomiting. The addition of sufentanil 10 versus 5 micrograms to lidocaine 5% provided more duration of analgesia for cesarean delivery. So, the adding of 10 micrograms sufentanil to lidocaine 5% for cesarean section has more effective analgesia with minimum side effects.

The latest American Heart Association (AHA) statement for preventing infectious endocarditis, has not recommended prophylactic antibiotic therapy prior to fiberoptic bronchoscopy (FB) except for patients with preexisting predisposing cardiac conditions. Our aim was to determine the incidence of bacteriemia and fever following FB in our experience and compare with those which have been mentioned in AHA guideline as well as other studies. Venous blood of 85 consecutive patients was evaluated for both aerobic and anaerobic cultures before (for detecting possible previous bacteriemia) and after FB. None of the patients were treated with antibiotics prior to the procedure. All the patients were examined during the first 24 hours after FB for detecting fever defined as temperature more than 38 °C. Positive hemocultures were noted in 7 (8.2 %) patients after FB examination. Coagulase negative Staphylococcus, coagulase positive Staphylococcus, beta haemolytic Streptococcus, Citrobacter freundii and Streptococcus viridans were found in 4, 1, 1 and 1 cultures of patients, respectively. By excluding 6 contaminated samples, the rate of bacteriemia reduced to 1 (1.1%) patient in whom the identical pathogen (Streptococcus viridans) was found both in bronchial lavage and venous blood culture. We also found fever in 9 (10.5 %) cases in the first 24 hours following the bronchoscopy. Our results were in consistent with AHA recommendations regarding prevention of infectious endocarditis as a practical gridline in patients who schedule for FB. Besides, transient fever following bronchoscopy is a common self-limited event which does not need medical intervention.

Hemorrhoid is one of the most common surgical diseases and different methods are available for its treatment. This study is a comparison between two methods of treatment of internal hemorrhoid, Monopolar low voltage instrument (Ultroid) and Rubber Band Ligation. This method has been carried out prospectively in which 50 patients who were treated with rubber band ligation and 50 patients with Ultroid were compared according to the incidence of complications, post-operative pain and treatment response. According to this study complete success rate with Ultroid was 82% and partial success rate was 10% and no response to treatment was seen in 8%. In Rubber Band method the complete response rate was 94% (P=0.2). With Ultroid, 74% of patient reported no postoperative pain, 24% reported mild and moderate pain and 2% of patients complained of severe pain. With Rubber band ligation, 72% of patients reported no post-operative pain, 26% reported mild and moderate pain and 1% complained of severe pain (P=0.00). Rubber Band ligation and Ultroid are both considered as outpatient procedures for treatment of hemorrhoids. Both methods are mostly used for grade 1, 2 and sometime grade 3 hemorrhoids. In Ultroid method the operator is required to hold the probe for a period of time, and in most cases, the surgeon should spend between 20-25 minutes for the coagulation of three piles. Some surgeons do not have patience for this modality of internal hemorrhoid treatment. In this study we achieved acceptable results comparable with those of other techniques.

An estimated 150-200 million people worldwide are infected with hepatitis C. Prevalence is higher in some countries in Asia and Africa. Only limited information about the epidemiology of Hepatitis C Virus (HCV) infection especially in females is available. The aim of this study is to determine the prevalence of anti-HCV antibodies and the possible factors for transmission in the female population of a largely urban city Islamabad. A cross sectional study was conducted from May 2006 to August 2006 in Islamabad. We select 252 female households (n=252) following the selection criteria. The primary outcome variables were HCV seropositivity and factors like history of major surgical procedure, blood transfusion, Intravenous drug use etc. The results showed mean age of the sample was 33.21 (±9.95) years and HCV seropositivity was present in 62 (24.6%) females. Final Forward Stepwise multiple logistic regression showed blood transfusion [OR, 10.094 95% CI 1.950-52.257], dental procedure [OR, 5.381 95% CI 2.315-12.507] and dilation and curettage [OR, 3.869 95% 1.867-8.015] were significantly associated with HCV seropositivity in females. The study highlights poor quality of care provided and a massive need to educate general population including patients as well as health professionals and allied health workers.

Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6%) were male, and 43 patients (36.4%) were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%). In order of frequency, unknown etiology (25.4%), Rh incompatibility (16.1%) with no immune hydrops, Sepsis(8.5%), urinary tract infection (5.1%) and others (3.4%) (Including Crigler-Najjar and cephalohematoma) were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2) ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.

Inflammation plays a major role in coronary artery disease (CAD). Currently, it is unclear, whether Cytomegalovirus (CMV) infection is associated with the risk of the atherosclerosis. The aim of this study was to determine the prevalence of anti- CMV antibodies in CAD and non CAD patients undergoing artery bypass surgery. Sera from 157 patients who underwent coronary angiography were tested for CMV by enzyme linked immunosorbent assay (ELISA) at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran. Our study population was 58.6% male and 41.4% female, with an age range of 38 to 86 years. The prevalence of CMV positivity tended to be higher in coronary artery diseases patients than in those without non coronary artery diseases (83.2% versus 63.6%) (P= 0.01). This analysis demonstrated that CMV seropositivity may be a risk factor for CAD in the present study population.

Medication errors and adverse drug events can bring about hospitalization, permanent injury, or death. Patients due to lack of adequate understanding of instruction may unintentionally misuse a prescribed medicine. The aims of the study were to examine whether patients with low back pain were correctly able to understand physician's instructions regarding drug use and also to identify influencing factors in patient's misunderstanding. The sample of the study included patients with low back pain who had been referred to five clinics in order to follow their treatment procedure. The patients completed a questionnaire to assess understanding of physician's instructions by the patients. Afterwards, physician provided them oral instructions on how they must use medications. Once the physician finished the oral instruction, he was asked patients to repeat whatever he said about the instructions. This procedure repeated frequently until the patients described correctly Instructions of the medications use. One hundred and five patients participated in the study. The mean age of the participants was 57.5 (± 13.9) years. Thirty three patients were female (31.4%) and 75.2 percent were married. Almost 80% of the patients misunderstood the oral prescription instructions at first time of presentation instruction. Gender, educational level, back pain history and drug use history were risk factors for misunderstanding prescription medication oral instructions for patients. The study affirmed that patients with low back pain suffered from a poor understanding of oral instruction.

Myofibroma is a neoplasia of myofibroblasts that can be solitary or multiple and it is found most commonly in the head & neck region including scalp, forehead, parotid region and oral cavity. In the eyelid it is rarely reported. It has a benign course in the solitary form and fatal in its multiple form. A 4 month male infant referred to Farabi hospital -the referral center for eye diseases- with a 2 month history of a mass in his eyelid with gradual enlargement with no other complaints. The only abnormal physical finding was a 2.5 cm mass in the eyelid. This mass was excised and sent to the hospital pathology laboratory. When confronting a spindle cell lesion with a nodular or multinodular growth pattern which appears biphasic due to alteration of light and dark staining areas, the surgical pathologist should think to the possibility of myofibroma. Its pattern of growth and architecture rules out the other differential diagnoses like nodular fasciitis, fibrous histiocytoma, infantile fibromatosis, and peripheral primitive neuroectodermal tumor, mesenchymal chondrosarcoma, malignant hemangiopericytoma, juvenile fibrosarcoma and poorly differentiated synovial sarcoma. In difficult cases immunohistochemical staining is helpful that is Vimentin & Actin positivity & Desmin, CK, EMA & S100 negativity.

Varicella-zoster viruses complications involving the CNS are estimated to occur rarely, transverse myelitis after Varicella-zoster virus in most patients is characterized by an abrupt onset of progressive weakness and sensory disturbance in the lower extremities, like other viruses. We describe the case of 17 year-old boy who experienced cervical transverse myelitis after chickenpox with inability to walk and with urinary retention. He was not treated with any medication but complete revovery has been occured.

Hemangiomas are the most common benign liver masses with a frequency of 0.4-7.3% at autopsy. They are usually discovered incidentally and a few require surgery. Spontaneous or traumatic ruptures are among indications of surgery for hemangiomas. We report a case of giant hepatic hemangioma presenting as hemoperitoneum following use of the slimming belt that underwent an emergent laparotomy. Abdominal exploration revealed that both right and left lobes of the liver were involved with giant hemangiomas. The liver was compressed by tightly packing laparotomy pads. After the operation, the patient was admitted to the surgical intensive care unit. Two days later, a second surgery was performed to remove the laparotomy pads. On the 6th day, the patient was discharged. One month later, to shrink the tumor, percutaneous transarterial embolization of the hepatic artery was performed.