Acta Medica Iranica
Volume:49 Issue: 7, Jul 2011

In pregnancy period, there is high risk of hepatic diseases and alcohol consumption increases such risk. Some pregnant mothers are not able to quit the habit of drinking alcohol or they are unaware of its dangers. Finding a drug which is effective and efficient in reducing ethanol misuse consequences during pregnancy can assist the decrease of harmful effects of this habit. The purpose of the current research is to investigate the effects of oral administration of silymarin in preventing consequences of ethanol consumption on the liver during pregnancy, using the rat animal model as well as biochemical findings and clinical symptoms. 45 female rats were randomly divided into 3 groups, each composed of 15 rats. After the first day of pregnancy, the study was performed as follows. The first group received distilled water. The second group was given ethanol equivalent to 35% of their total required calorie. Furthermore, the third group received the same amount of ethanol plus 200 mg/kg silymarin. In order to evaluate liver's activity, biochemical analysis was performed at days 1, 7, 14, and 21, to measure the amount of the enzymes ALT, AST, ALP, and bilirubin. The nutrition and clinical status of animal in the groups was studied and recorded 2 times daily. This study showed that silymarin's protective effects are expressed from the first day of treatment.

General concept and major emphasis on off-pump coronary artery bypass surgery (OPCAB) is maintaining quality of care and patient safety while reducing cost and resource utilization. OPCAB probably avoids the potential complications of cardiopulmonary bypass. However its acceptance depends on clinical and economic outcome. The aim of this study is to compare clinical and economic outcome of off-pump and on pump coronary artery bypass surgery. This is a report of an analytic cross-sectional study on 304 patients underwent coronary artery bypass surgery that were randomized into conventional on pump and off-pump groups. Variables and costs were obtained for each group and these data were analyzed using parametric methods. There was no difference between the two groups with respect to perioperative and intraoperative patient's variables. OPCAB reduced the need for postoperative transfusion requirement (P<0.05) which was statistically significant and showed a trend towards reduction of morbidity although didnt reach statistical significance (P>0.05). There were no statistically significant differences in surgical re exploration and length of stay between the two groups. The mean cost for an on pump surgery was 8312000 ± 2859 Rials per patient that was significantly higher than an off-pump surgery. Based on the findings of this study, clinical outcome has no statistically significant difference between on pump and off-pump CABG but the costs are significantly higher in the on pump group.

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

This study compared the effects of anesthesia with isoflurane and TIVA (total intravenous anesthesia) on the intensity of body temperature reduction during anesthesia and incidence of chills after lumbar disc surgery. The study was done as a single blinded randomized clinical trial. From 60 patients who underwent lumbar disc surgery, 30 subjects were placed in isoflurane group and 30 in the TIVA group. Maintenance of anesthesia was done with isoflurane (MAC=0.8-1) and N2O 50% in isoflurane group and in TIVA group with propofol at the dose of 100-150 mg /kg body weight /minute and remifentanil at the dose of 2.0 mg /kg body weight/minute. Chills rate was recorded in recovery room. Changes in body temperature, body surface temperature, systolic blood pressure, diastolic blood pressure and heart rate showed no significant difference between the two groups before and after induction and at different times during the operation (P<0.05). Chill rate was not significantly different between the two groups (P<0.05). It seems that TIVA (remifentanil at the dose of 2.0 µg/kg body weight/minute in combination with propofol at the dose of 100-150 µg/kg body weight/minute) and 0.81 MAC isoflurane-N2O 50% can be used as a safe method of anesthesia in patients with good tolerance lumbar back disc surgery without hypothermia, chills and considerable hemodynamic changes.

The purpose of the present study was to determine the role of medial prefrontal cortex (mPFC) dopaminergic system in fear conditioning response considering individual differences. Animals were initially counterbalanced and classified based on open field test, and then were given a single infusion of the dopamine agonist, amphetamine (AMPH) and antagonist, clozapine (CLZ) into the medial prefrontal cortex. Rats received tone-shock pairing in a classical fear conditioning test and then exposed to the tone alone. Freezing responses were measured as conditioned fear index. The results showed that both AMPH and CLZ infusion in mPFC reduced the expression of conditioned fear. This finding indicates that elevation or reduction in the dopaminergic activity is associated with the decrease of fear responses, despite preexisting individual-typological differences.

To determine the prevalence of pituitary hormone deficiencies after moderate traumatic brain injury (TBI). We conducted a prospective cohort and included 75 patients with moderate TBI with GCS between 9 and 13 who referred to emergency department of Shariati Hospital, Tehran/Iran, during 2004-2007. Pituitary hormones were assessed 3 and 6 months after injury. In 3rd month post-injury, 39 cases had not any pituitary dysfunction; however, deficiencies in one, two and three of the pituitary hormones were found in 26, 8 and 2 patients, respectively. Twenty one patients showed a deficiency in one of the pituitary hormones and only one case with deficiency of two after 6 months. The most prevalent changes occur in IGF-1 and LH/FSH after moderate TBI. However, the whole deficiencies decrease over the time.

Gestational diabetes mellitus (GDM) is one of the important problems in pregnant women. This study conducted to determine association the level of serum glucose with fetal-maternal complications of gestational diabetes with insulin therapy. This study has been conducted as an Existing Data Study, so medical records of all pregnant women with GDM that have been treated with insulin during 2 years of study has been selected using census. The information was obtained using, medical records data. Mean level of serum glucose before and after treatment in different times according to correct level of serum glucose did not show statistical significant (P>0.05). Apgar score, time of stay in NICU, weight at the birth, base on correct level of serum glucose did not show statistical significant (P>0.05). Gestational age at the delivery, stay in hospital, diagnosis and fetal-maternal complications between two groups did not show statistical significant (P>0.05). It seems we can with screening and diagnostic GDM with suitable control of level of serum glucose and insulin therapy reduce incidence of fetal-maternal complications.

Febrile convulsion (FC) is the most common seizure disorder in childhood. white blood cell (WBC) and erythrocyte sedimentation rate (ESR) are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children(163 with FC), aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC (P<0.001) in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR (P=0.113) between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who dont have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test.

We assessed the lower urinary tract symptoms (LUTS) in prostatic cancer patients and investigated the sensitivity and specificity of international prostate symptom score (IPSS) in the screening of these patients. A total number of 132 prostatic cancer patients as the case group who were confirmed by the pathologists and 101 noncancerous men as the control group, aged 50 or older, responded to a questionnaire which included seven questions regarding urination, named the International Prostate Symptom Score (IPSS). Then, two groups were assessed and compared with each other and also the sensitivity and specificity of IPSS tool for screening of prostatic cancer patients were calculated. All participants filled out the questionnaire. 60 (59.4%) noncancerous men and 29 (22.0%) cases had mild LUTS, and 41 (40.6%) noncancerous men and 103 (78.0%) cases had moderate to severe LUTS. Moreover, the sensitivity and specificity of the IPSS tool were 78% and 59.4%, respectively. Urination status and problems could be easily assessed by IPSS and it is a sensitive and specific tool for screening of prostatic cancer patients. It appears that IPSS is a cost beneficial, sensitive, specific and easily-used screening tool to diagnose the prostate cancer cases. Therefore, it can be used more extensively by the health care providers as well as by men ≥50 years old themselves.

Among patients with chronic unrelieved pain, war veterans of eight years long Iraq - Iran war deserve especial attention. They not only suffer from severe intractable pain but also should bear some intangible consequences of unrelieved pain and severe disability. This perspective study reviews the outcome of implantation of intrathecal opioid pumps in these patients. Ten war veterans (mean age 43.36) with chronic nonmalignant pain included in this perspective study. Medical records reviewed to identify pain diagnosis, medication intake prior to implantation, details of the intrathecal opioid trial and date of implantation, surgical and technical complications. Outcome measures were global pain relief, physical activity levels, intrathecal opioid side effects, medication consumption and patient satisfaction. Overall pain relief at the time of study was 60%. Mean pain relief was 53%. A majority of patients reported improvements in physical activity levels and were satisfied with this type of therapy. Impotence and constipation were two most common pharmacological side effects. No surgical complication reported. The study showed that this type of therapy in Iranian war veterans improved analgesia, increased self-report physical activity levels and in spite of high incidence of pharmacological side effects, most of the patients were satisfied with this type of therapy. These results are comparable to those of previous studies in this field.

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (naïve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive naïve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.

Dietary factors are suggested to be involved in recent increases in the prevalence of asthma. The differences in dietary intake of 23 asthmatic and 317 non-asthmatic students were investigated, who were chosen by multistage stratified cluster sampling. The dietary data were assessed by food frequency questionnaire and a 24-h recall form. Total calorie and fat intake were similar. Daily intake of Saturated and poly-unsaturated fatty acids, and calcium and sodium were significantly higher in asthmatics. There was no significant difference between dietary antioxidant intake of asthmatic and non asthmatics. It seems that in this age, the type of consumed fat may be more important than the amount of fat intake in inducing asthma. For accurate results, n-6 and n-3 fatty acid intake must be assessed. Higher sodium and calcium intake may also be associated with asthma. Randomized controlled trials with restricting diets can help to elucidate the results.

Proper differentiation between acral malignant melanoma and benign pigmented lesions like melanocytic nevi is of great value. To avoid unnecessary biopsies, dermatoscopy has been introduced as a non-invasive modality and has improved the clinical diagnostic accuracy in recent decades. We aimed to describe dermoscopic patterns of acral pigmented lesions of patients in the clinic of dermatology in Razi Hospital, Tehran, Iran. This study was conducted as a descriptional study among a total of 62 pigmented lesions located on volar skin of palms and soles. After initial clinical evaluation, lesions were examined entirely by dermoscopy. All the patterns within a lesion were described, and lesions suspicious of malignancy (clinically or dermatoscopically) were selected for histopathological evaluation. Of our 62 lesions, three lesions were not melanocytic. According to our final clinicopathological diagnosis, 47 lesions were benign melanocytic nevi and 12 lesions were malignant melanoma. Parallel furrow pattern was the most frequent among our benign lesions (51.1%) followed by lattice-like pattern (23.4%) and acral reticular pattern (21.3%). Diffuse multi-component pattern, parallel ridge pattern and abrupt edge were respectively most common patterns among malignant melanomas. Acral benign melanocytic nevi and malignant melanomas respectively have well distinctive characteristics in dermatoscopy among our patients.

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% (95% CI 0.005-1.2) with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future.

A 28-year-old man with neurofibromatosis type 1(NF1) presented with a tumor in the sciatic nerve and femoral nerve. The differential diagnosis of malignant peripheral nerve sheath tumor was based on clinical, radiological, and histological evidence. The tumor apparently originated in sciatic nerve at the posterior aspect of the left thigh. The lesion was resected totally without neural damage to the sciatic nerve. The tumor did not recur after 2 years.

Benign renal cystic adenoma with out malignant features is a very rare entity. A 75 year old male with obstructive Lower tract symptoms and vague flank pain was admitted and planned for nephrectomy of non functional kidney -due to long term nephrolithiasis- intra operative finding was a cystic hydronephrotic kidney filled by thick mucous secretions which turned out to be a cyst adenoma of kidney with no malignant features.