Caspian Journal of Internal Medicine
Volume:2 Issue: 4, Autumn 2011

This review basically provided a conceptual framework for sample size calculation in epidemiologic studies with various designs and outcomes. The formula requirement of sample size was drawn based on statistical principles for both descriptive and comparative studies. The required sample size was estimated and presented graphically with different effect sizes and power of statistical test at 95% confidence level. This would help the clinicians to decide and ascertain a suitable sample size in research protocol in order to detect an effect of interest.

Good cytological sample is very important for the cytological diagnosis of thyroid nodules. The aim of this study was to evaluate the adequacy of prepared samples by the combination of aspiration and non- aspiration fine needle biopsy. In this descriptive – analytical study, sampling was done simultaneously for each patient in fine needle aspiration and non-aspiration biopsy. The sufficiency of samples was studied using Mair Scoring System. Wilcoxon Signed Rank test was used for the data analysis. Three hundred two cases (289 females, 13 males) with the mean age of 43.83±12.9 years were evaluated. Inadequate samples were 31 (10.3%) in fine needle aspiration, 40 (13.2%) in non-aspiration and 13 cases (4.3%) by using two methods together (p=0.0001). The average total score was 6.00±2.17 in fine needle aspiration and 5.76±2.26 in non-aspiration method (p=0.08), and 6.6±1.98 in the combination of the two methods (p<0001 comparing with one method alone). The results show that using both methods simultaneously in each nodule considerably increases the efficiency of samples for cytological diagnosis

Candida albicans may have cariogenic potential but its role in caries etiology has not been established. The aim of this study was to determine candida albicans in supragingival dental plaque and infected dentine of cervical and proximal in early childhood caries (ECC). This cross-sectional study was carried out on 6o children aged 2-5 years, which were divided into 3 groups: children with at least one cervical caries; children with at least one proximal caries and caries-free. The infected dentine was collected from cervical and proximal caries lesions and plaque samples were collected from the three groups in order to compare the frequency of candida albicans in the collected sites. All samples were cultured in Sabouraud and CHROMagar medium and the cases that were positive for candida albicans were cultured in germ tube. Data were collected and analyzed. The mean age of the children was 3.9 years. From 100 samples, candida albicans samples were isolated in 55%, mold fungi were found in 29% cases and there was no fungal growth in 16% of the samples. In plaque samples, candida albicans were found in 15% of caries-free samples, 20% of the proximal and 80% of the cervical caries. In samples extracted from the caries, candida albicans were found in 60% of the proximal and 100% of the cervical caries. Mothers with university educational level had children with more cervical decays, caries free and proximal caries, respectively. The results showed that prevalence of Candida albicans in dental plaque and caries lesions of children with early childhood caries were relatively high and the prevalence was higher in cervical caries group.

Diabetic nephropathy is considered to be the most common cause of end stage renal disease (ESRD). Proteinuria is declared as the most marked risk factor in progression towards ESRD. The aim of this study was to evaluate the efficacy of pentoxifylline for reduction of proteinuria in type II diabetic patients. From May 2007 to June 2008, this randomized clinical trial study was performed on 60 type II diabetic patients with proteinuria over 500 mg/day despite receiving angiotensin receptor or angiotensin converting enzyme inhibitors. These patients were randomly divided into group A (Placebo) and group B (Pentoxifylline 400 mg 3 times daily). A twenty-four hour urine protein and creatinine clearance were assessed before and after three months of treatment. Among the 56 patients, 38 were females and 18 were males. The mean age of patients in the placebo group was 57.6±9.3 and in the treatment group was 55.3±9.3 years. The duration of the disease in the placebo group was 14.03±5.7 and in the treated group was 11.9±6.2 years. The reduction of proteinuria in placebo group was 294±497 mg/dl and in the case group was 979±695 mg/dl (p<0.05). The mean creatinine clearance in placebo group was 79.4±19.9 and in the case group was 80.6± 22.8 mL/min (p>0.05). The results show that adding pentoxifylline to other approved angiotensin system inhibitors can significantly reduce proteinuria in diabetic nephropathy and influence progression of the disease with no effect on renal function.

The need for assessment of oral health related quality of life has been increased over the last decades. The aim of this study was to develop a Persian version of the Oral Health Impact Profile (OHIP)-14 and to evaluate its reliability and validity for its use in Persian-speaking communities. The original version of the OHIP-14 was translated into the Persian language using the back-translation technique. To establish the reliability of the translated instrument, internal consistency and test-retest reliability trials were performed on 20 subjects (at 4-week intervals); Cronbach’s alpha was used. One hundred sixty adults over 50 years of age who attended Health Care Centers in Sari and Babol were recruited to fill out the questionnaires and received a clinical examination by a single dentist. The socio-demographic and oral health information was also collected. The test-retest reliability was excellent (Cronbach’s alpha = 0.095). In the main study, Cronbach’s reliability coefficient for all 14 questions in each dimension was more than 70%. The individuals in need of dental treatment showed significantly higher OHIP scores than the individuals not requiring treatment. The individuals with hopeless teeth, negative self-perceived oral had significantly higher OHIP scores. The Persian version of the OHIP-14 is a comprehensive and accurate instrument with acceptable reliability and validity for measuring oral health–related quality of life.

Epidemiological characteristics of diabetic foot infection in our region are not clear. The purpose of this study was to determine the epidemiological features of diabetic foot infection in Babol, north of Iran. From March, 2005 to April, 2010, the epidemiological features of 450 cases of diabetic foot infection treated in two main teaching hospitals of Babol Medical University were evaluated. Epidemiological data in these cases were determined, and collected data were analyzed. The mean age of these patients was 58.8±11.2 years. Two hundred ninety seven (66%) were females and 153 (34%) were males. Three hundred sixty nine patients (82%) had family history of diabetes mellitus (DM) and maternal inheritance was the most common pattern. Three hundred seventy eight patients (84%) were aware of suffering from DM and 297 (66%) were aware of the occurrence of foot ulcer but 86% were not familiar with the main risk factors for the development of diabetic foot infection. The results show that diabetic foot infections occur more often in females and the familiarity of the risk factor in this population is relatively low. Educating these patients for prevention of diabetic foot infection is recommended.

Prediction of severe neonatal hyperbilirubinemia is very important for early treatment and prophylaxis of neurologic sequels. The aim of this study was to evaluate the predictive role of umbilical cord α-fetoprotein (UCAFP) as a marker of an increased risk for neonatal hyperbilirubinemia in full term babies. Umbilical cord blood was collected from 400 term singleton full term well newborn babies who met our inclusion criteria and stored in -20°C. Those who developed jaundice and admitted for phototherapy (34 newborns: 22 males and 12 females), considered as case group and 31 non-jaundiced infants (13 males and 18 females) gestational age–weight-matched considered as the control group. The serum level of UCAFP was checked in these 65 newborns and was compared between these two groups. Mean UCAFP in case group was 523.429±174.158 and in control group was 664.548±154.894 µg/L. In the non-jaundiced group, mean UCAFP values was higher than neonate with hyperbilirubinemia (664.548 vs. 523.429µg/L). The mean UCAFP in males was 519.023 µg/L and in females was 531.508 µg/L (p=0.066). Sixty (92.3%) babies delivered by cesarean section (CS) and 5 (7.7%) by normal vaginal delivery (p=0.566). According to our study, there was no significant positive association between UCAFP and subsequent neonatal indirect hyperbilirubinemia or serum bilirubin level.

Risk of malignancy index (RMI) is the best method for discriminating benign and malignant pelvic masses. The aim of this study was to determine the RMI for preoperative evaluation of pelvic mass. This study was performed on 182 women with adenexal mass referred to Yahyahnejiad Hospital of Babol University of Medical Sciences in Iran from 2007 to 2009.The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of menopausal status, ultrasound finding of pelvic mass and level of serum CA-125, separately or combined into the RMI were calculated and compared. The mean age of patients was 39.9±9.3 years. The RMI with the cut-off point of 265 had a sensitivity of 91.3%, specificity of 96.2 %, PPV of 77.7% and NPV of 98.7% for diagnosis of malignant masses. Risk of malignancy index should be an effective method for evaluating a patient with adnexal masses before operation and a cut-off point of 265 which has a very high sensitivity, specificity and positive and negative predictive values for discriminating malignant and benign pelvic masses.

Ingestion of foreign bodies may result in the formation of a tracheoesophageal fistula (TEF), which causes severe morbidity in children. We describe four cases of TEF, who underwent emergent surgery for repair. In this report, we present about four patients aged between 9 months to 2.5 years, who referred due to disc battery ingestion. There were two boys and two girls. The common symptoms were cough, cyanosis, and dysphagia, choking and vomiting. The diagnosis was performed through an x-ray, barium swallow and CT Scan. All batteries were impacted in the esophagus, two in upper, one in the middle, and one in lower esophagus position. All disc batteries were removed endoscopically, but had tracheoesophageal fistula (TEF). All the patients underwent TEF repaired surgically. There was no morbidity in four patients, but one patient developed moderate esophageal stenosis, which was repaired by staged dilatation. There was no mortality in our cases. Long-term impaction of foreign bodies may result in tracheoesophageal fistula. This complication may be seen earlier with alkaline disc batteries. Removal of these foreign bodies should be followed carefully for the diagnosis and treatment of these fistulas.

Congenital lobar emphysema, also called infantile lobar emphysema, is a respiratory disease that occurs in infants when air enters the lungs and cannot leave easily. It results from cartilage deficiency and bronchomalacia causing distal air trapping and respiratory distress. In this study, we present a case of endobronchial polyp mimicking congenital lobar emphysema. An 18-month old infant was admitted to the hospital due to sudden respiratory distress. Chest x- ray showed left hemithorax lucency, mediastinal shift to the right side, left hemidiaphragm flattening, and left oblique fissure bulging to the superior. A broncoscopy showed polyp in the left lower bronchus and the biopsy of the lesion confirmed to be the polyp. The findings of this case emphasize the value of bronchoscopy prior to lobectomy in cases of congenital lobar emphysema.

Familial Mediterranean fever (FMF) is the most prevalent disorder among the hereditary autoinflammatory syndromes. This disorder is characterized by fever and some painful attacks such as abdominal, chest or joint pain and potentially development of AA amyloidosis. Several vasculitis are more common in FMF than general population. There are some reports about association of FMF with Behcet Disease (BD). In this study, we describe a 27 year old patient with BD who suffered from attacks of fever, arthralgia, abdominal pain and genetic study confirmed the diagnosis of FMF. FMF should be considered in a patient with Behcet disease who is suffering from attacks of fever, arthralgia and abdominal pain.