Iranian Red Crescent Medical Journal
Volume:13 Issue: 6, Jun 2011

This report describes a unique experience of Second National Medical Science Olympiad that was held in August 2010 in Shiraz, Islamic Republic of Iran. The history of medical science Olympiad in Iran and the development, process and domains in the Olympiad and the way for future will be discussed.

This article aims to provide an overview of the epidemiology, medical and rehabilitation issues and recent advances and emerging practices. We also intended to assess the validity of trials in head injury and find the generalized concepts according to their results. All randomized controlled trials on the treatment and rehabilitation of patients with head injury published before November 2010 was surveyed. Data were extracted on the number of participants, use of blinding, loss to follow up, and types of participants, interventions, and outcome measures. Until November 2010, using several search engines, 479 reports were identified. The average number of participants per trial was 92. No trials were large enough to detect reliably a 5% absolute reduction in the risk of death or disability. Of 226 trials assessing disability, 211 reported the number of patients followed up, and average loss to follow up was 19%. Of trials measuring disability, 26% reported that outcome assessors were blinded. Randomized trials in head injury are too small and poorly designed to detect or refute reliably moderate but clinically important benefits or hazards of treatment. Limited funding for injury research and unfamiliarity with issues of consent may have been important obstacles.

Renal transplantation is the best option for treatment of the end-stage renal diseases and has more advantages than dialysis. The objective of this study is to determine the ten-year graft survival rate of renal transplantation and its associated factors in patients who have been transplanted from March 1999 to March 2009 in Nemazee Hospital Transplantation Center. This is a historical cohort study of 1356 renal transplantation carried out during 1999 to 2009. Kaplan-Meier method was used to determine the survival rate, log rank test to compare survival curves, and Cox regression model to determine hazard ratios and for modeling of variables affecting survival. The 1, 3, 5, 7 and 10 years graft survival rates were 96.6, 93.7, 88.9, 87.1 and 85.5 percent, respectively. Cox regression model revealed that the donor source and creatinine level at discharge were effective factors in graft survival rate in renal transplantation. Our study showed that 10 year graft survival rate for renal transplantation in Nemazee Hospital Transplantation Center was 85.5% and graft survival rate was significantly related to recipients and donor’s age, donor source and creatinine level at discharge. Our experience in renal transplantation survival rate indicates a success rate comparable to those noted in other reports.

The causes of childhood leukemia as the most common malignancy in children are vastly unknown. The aim of this study is to evaluate the relationship between maternal birth characteristics with environmental exposures in childhood leukemia. This is a case-control study which consists of children younger than 18 years old suffering from leukemia who reside at Fars Province of Iran. Patients were individually matched with variables such as age, sex and residence region. In order to evaluate the relationships between each variable and the risk of leukemia, odds ratio(OR) and 95% confidence interval (CI) were estimated using conditional logistic regression. Statistically, the association between risk of childhood leukemia with birth order (OR=6.177, 95%CI: 2.551-14.957), pet ownership (OR=2.565, 95%CI: 1.352-4.868) and history of leukemia in first and second degree relatives (OR=2.667, 95%CI: 1.043-6.815) was significant. However, there was no significant association between daycare attendance, history of miscarriage, number of siblings and history of mother's diagnostic radiology tests with risk of childhood leukemia. Although no definite etiologic factor for acute childhood leukemia has been clearly defined, the contribution of environmental risk factors in the context of genetic predisposition are strongly elucidated.

The imaging parameters that mandate further diagnostic workup in focal asymmetric breast densities are not clearly defined. To identify indications for further workup in Focal asymmetric breast densities (FABD) by doing ultrasonography. One-hundred women underwent breast ultrasonography after incidental discovery of FABD on mammograms. Mammograms and sonograms were evaluated for lesion location, associated calcifications, architectural distortion and change from previous examination when available. Twenty three patients had abnormal sonographic findings and the site of sonographic abnormal findings was the same as the site of FABD on mammography. Sonographic findings were 7 focal increases in fibrous tissue, 5 ductal ectasias,4 simple cysts, complex cyst in one, 4 benign solid masses, one malignant solid mass and one with fibrous tissue at the site of pervious breast surgery. There was a significant relation between FABD in upper inner quadrant and normal sonography (p=0.036) and FABD in retroareolar region and ductal ectasia in sonography (p=0.002). FABD usually present a benign etiology and can safely be managed by follow up. Sonography helps the physician do tissue diagnosis by detecting mass with features of possibly malignancy, in the women with negative physical examination.

Gestational diabetes mellitus (GDM) is associated with maternal and fetal complications. Specific outcomes in previous pregnancies are considered as risk factors for GDM in the consecutive pregnancies. The aim of this study was to evaluate the pregravid risk factors of GDM in multigravid women. We conducted a retrospective cross sectional study on 114 multigravid women with GDM without previous history of diabetes and compared them with non-diabetic controls. We used modified criteria of Carpenter and Coustan for screening. Risk factors were obtained from medical records of individuals. We found that women of 26 years and older who had previous neonates with birth weight more than 3800 and those affected with hypothyroidism or chronic hypertension were at risk for GDM. The difference of the number of preterm birth in GDM women and healthy controls was statistically significant (p=0.05). There was no significant difference between the numbers of pregnancies, parity, previous fetal and neonatal death and abortion number between patients and the control group. Our results show that maternal age over 26 years, birth weight of previous neonate more than 3800 g, hypothyroidism, chronic hypertension and probably history of preterm birth were significant risk factors for GDM.

The importance of accurate diagnosis of premature rupture of membranes (PROM) is quite apparent while trying to diminish false negative or positive results as much as possible. This study compares ------ (ELISA) and three rapid human chorionic gonadothropin (HCG) dipsticks in diagnosis of premature rupture of membranes. During 2008-2009, 181 pregnant women with single pregnancy from 14 to 41 weeks of gestation who referred to Ayatollah Taleghani Hospital in Tehran, Iran were divided into two groups, 91 patients with PROM and 90 controls with matched gestational weeks. All patients underwent speculum examination for cervicovaginal washing fluid, HCG three rapid tests and ELISA. The HCG concentration of vaginal fluid was significantly different between the two groups. Using receiver operating characteristic (ROC) curve and determining the threshold as 19 mIU/mL for HCG by ELISA method, the sensitivity was 94.5%; specificity, 91%; positive predictive value, 91.5%; negative predicted value, 94.2% and accuracy was 92.2%. In rapid diagnostic test, the most sensitivity was for ----- (ACON) and the most specificity for ----- (DIMA). Comparing the four methods, DIMA strip showed the highest accuracy and the highest value in early diagnosis of ROM. The reliability of three rapid diagnostic tests in diagnosis of ROM in cervicovaginal discharge was acceptable.

This study analyzes the therapeutic effects of intravenous infusion of iloprost in wound healing, healing of the amputation stump wound, improvement in intermittent claudication and prevention of major amputation in patients with Buerger’s disease. In a prospective study, 19 patients with known Buerger’s disease, received intravenous iloprost infusion, 6 hours per day for 10 days. Iloprost with a dose of 0.5-2 ng/kg/min according to the patients’ tolerance and using cardiac monitoring during the whole infusion period was administered for 6 hours/day using saline solution. Patients with larger wounds underwent simultaneous transmetatarsal or Ray amputation of the involved toe(s). All patients were discharged after 10 days. Patients were followed to detect their healing changes. Nineteen patients, 19-55 years old received 0.5-2 ng/kg/min iloprost intravenously for 6 hours/day for 10 days. During this period, there was relative improvement in resting pain, but no significant amelioration was noticed in wound healing. In a 2 years follow-up, 14 patients showed a complete healing of the amputation stump and increased distance of walking without any pain. Some previous candidates of major amputation did not need amputation anymore. Five patients (26%) did not respond to therapy. Although Buerger’s disease patients who were under iloprost therapy, may not show significant changes in wound healing during treatment and at discharge, late results have proved that iloprost infusion is promising in improving wound healing and claudication and preventing major amputations.

HTLV-1 infection is endemic in Mashhad, Northeast of Iran. This study was designed to assess the epidemiology of HTLV-1 and potential risk factors in Neyshabour, Northeastern Iran. All those who referred to Iranian Academic Center for Education, Culture and Research (ACECR)-Mashhad Laboratory in Neyshabour for evaluation of HTLV-I by ELISA, were tested using WB if the ELISA result was positive. A questionnaire about risk factors of infection was completed for all cases. HTLV-1 infection was positive in 7.2% (35/483) of the participants according to the results of enzyme-linked immunosorbent assay (ELISA) and western blot (WB) tests. Infection was significantly associated with age, family size, income and blood transfusion. However, gender, education, birthplace, race, marital status, and history of surgery, dentistry, traditional cupping, and hospitalization showed no significant relation. It seems that HTLV-I infection is highly endemic in Neyshabour and it is seems that more effective treatment strategies are needed.

Because of the low prevalence of ------ (HTLV-I) in comparison with Khorasan Province, considering HTLV-I as an etiology of spastic paraparesia, it may be neglected in evaluation of spastic paraparesis in the other regions of Iran. Some reports of spastic paraparetic patients due to HTLV-I infection in West Azarbaijan, caused us to reconsider the importance of HTLV-I epidemiology in the other areas of the country. All spastic paraparetic patients who referred to Motahari and Imam Khomeini educational hospitals of Urmia from September 2004 to September 2007 were assessed for HTLV-I infection antibodies. In our 3 years study, 11 cases were diagnosed as ----- (HAM/TSP, 2 males and 9 females).The mean age of patients at the time of diagnosis was 45.8 years. Dorsal and cervical MRI of all patients was normal. Serum Enzyme-Linked Immuno-Sorbent Assay (ELISA) and Western blot (WB) for anti HTLV-I antibody in all patients was positive. Four patients underwent for lumbar puncture in which were normal in respect of cells and biochemistry, but positive for anti-HLTLV-I antibodies. HAM/TSP detection in West Azarbaijan in spite of its long distance from Khorasan Province shows the importance of anti-HTLV-I Ab assay in the blood and CSF of every spastic paraparetic patient all over the country.

As much of the studies on cochlear implantation (CI) have concentrated on aspects of speech perception and production, we studied the quality of life in pre-lingual deaf children in Shiraz, southern Iran. Twenty four parents were selected from those pre-lingual deaf children that their children were implanted by Fars CI Center. The quality of life questionnaire was used and after 3 months was evaluated again. Significant changes were noticed in parent's satisfaction. The parents believed that the children communicated better, but they still needed special care to do school works, etc. Also they had still difficulty in articulation. CI was significantly associated with improvement of quality of life, especially in communication, happiness and relations with their friends and family members.