Acta Medica Iranica
Volume:50 Issue: 6, Jun 2012

The present treatment goals for inflammatory bowel diseases (IBD) especially ulcerative colitis (UC) include rapid induction of clinical remission, steroid-free maintenance of clinical remission, mucosal healing and improvement of quality of life in UC patients. Immunomodulators have been reserved for steroid- dependent or steroid- refractory UC patients. Among these agents, azathioprine/6-mercaptopurine should be used for maintenance of remission in quiescent UC. Calcineurin inhibitors can be prescribed as a short-term rescue therapy in steroid- refractory UC patients, but the long term efficacy of these agents remains unclear. According to retrospective studies, methotraxate is not recommended for inducing and maintaining remission in UC. Novel biological therapies targeting different specific immunological pathways continue to be developed and introduced for a variety of clinical scenarios in IBD. Infliximab is currently used for induction and maintenance therapy in patients who have moderately to severely active UC with an inadequate response to conventional agents such as aminosalicylates, corticosteroids, or immunomodulators. Other anti-TNF agents and biologic therapies are undergoing evaluation in clinical trials for their efficacy in IBD. Most patients who start biologics should continue treatment for the foreseeable future and potential consequences of discontinuation should be discussed with individual patients. Currently, data do not exist to administer biologics as first-line therapy in UC. Emerging data suggest that biologics may have the potential to prevent complications and limit disease progression. If such benefits are proven, biologics may be used in the future to modulate subclinical inflammation and to prevent the development of clinical disease.

Vincristine (VCR) as a frequently used antimitotic agent which is commonly prescribed for wide spectrum of neoplasm, causes mixed sensorimotor neuropathy. Several evidences show lithium could be a neuroprotective agent, therefore to assess whether a pretreatment and at subtherapeutic dose it could prevent the peripheral neuropathy produced by VCR, rats were treated with VCR 0.1mg/kg i.p. for 3 alternative doses and / or lithium chloride (20mg/kg or 40 mg/kg i.p. daily from the first day to the day of sacrifice). Erythrocyte lithium concentration (ELC) and plasma lithium concentration (PLC) were measured at the seventh day of study and the day of scarification. After seventh day of lithium administration, PLC and ELC reached to a steady state at subtheraputic dose and they did not significantly change at normal housing situation. Hot plate, open field test and nerve conduction velocity were used to evaluate the sensory and motor neuropathy. Only VCR treated rats showed behavioral, electrophysiological and histological evidences of a mixed sensorimotor neuropathy by significant increase in hot plate latencies and a marked decrease in total distance moved and conduction velocities in both sensory and motor nerves. Lithium at the dose of 20mg/kg and specially 40mg/kg robustly reduced the rate of mortality, general toxicity and was able to ameliorate mixed sensorimotor neuropathy induced by VCR. These results suggest that lithium at dose of 20mg/kg and 40 mg/kg, potentially by its effects on cell survival pathways such as inhibition of glycogen synthase kinase-3 (GSK3β), can prevent both motor and sensory components of VCR neuropathy.

Wound healing has always been among important and crucial subjects in medicine. Morphine dependency has also been a social and health problem in the Middle East. This study was aimed to investigate the effects of morphine dependency on pro-inflammatory and fibroblast cell recruitment, as well as re-epithelialization and the revascularization processes involved in secondary intention wound healing in rats. A full-thickness wound (2×2 cm in diameters) was created on the dorsum of two groups of rats, a control group and a second group consisted of morphine dependent rats. During the first 14 days of post wounding the wound was excised consecutively at priorly planned days with peripheral margins of normal skin. The specimens were evaluated by two pathologists, who were blind to the study design, and the cellular population, re-epithelialization and revascularization were reported by them. Histological examination of the wound tissue showed evidence of increased population of fibroblasts and a plateau or decreased recruitment of macrophage and neutrophile cells. In the dependent group re-epithelialization was observed to be enhanced significantly in comparison to the control group while having an inhibitory effect on revascularization. The present study demonstrates that morphine dependency enhances re-epithelialization as well as tissue recruitment of fibroblasts; thereby probably enhancing secondary intention wound healing.

The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been failed. From 1999 to 2006, seven consecutive children (male/female ratio 0.4) with giant omphalocele (n=6) and Gastroschesis (n=2) were underwent this new operation in our center. In this technique, there were two operations. The mean of hospital stay was 38 days (range, 23-42 days), and full enteral feeding was achieved on the 8 to 25 postoperative day (Mean, 14 day). The final closure, in all patients was achieved between the 14 to 32 days after the first operation (Mean, 21 day). Mechanical ventilation was necessary for the mean of 5 days (range, 2-8 days). All patients are alive and have no complication due to the operation (1 month-7 years). Giant omphalocele and Gastroschesis can be safely repaired. The placement of an intraperitoneal tissue expander and traction of abdominal muscles can create the needed space for closure in several weeks in patients with giant omphalocele/ Gastroschesis. The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been failed. From 1999 to 2006, seven consecutive children (male/female ratio 0.4) with giant omphalocele (n=6) and Gastroschesis (n=2) were underwent this new operation in our center. In this technique, there were two operations. The mean of hospital stay was 38 days (range, 23-42 days), and full enteral feeding was achieved on the 8 to 25 postoperative day (Mean, 14 day). The final closure, in all patients was achieved between the 14 to 32 days after the first operation (Mean, 21 day). Mechanical ventilation was necessary for the mean of 5 days (range, 2-8 days). All patients are alive and have no complication due to the operation (1 month-7 years). Giant omphalocele and Gastroschesis can be safely repaired. The placement of an intraperitoneal tissue expander and traction of abdominal muscles can create the needed space for closure in several weeks in patients with giant omphalocele/ Gastroschesis.

One of the most common complications of operation and anesthesia is shivering. The purpose of this study was to compare the effectiveness of Ondanseton and Meperedine in preventing shivering after off-pump coronary artery bypass graft (OPCAB). In this double-blind randomized clinical trial, the sample consisted of 90 patients, who were candidates of CABG under general anesthesia. These patients were assigned to three groups, each containing 30 subjects: meperedine group (A), ondansetron group (B) and control group (C). Group (A) received 0.4 mg/Kg/IV of meperedine, group (B) received 8mg/IV of ondansetron and group (C) received Normal Saline. All these drugs were injected 15 minutes before the end of surgery. After the end of surgery, the intubated patients were transferred to the ICU and their body temperature was assessed through eardrum by a specialist who was blind to the research. The incidence of shivering in groups A, B, and C was 46.48%, 31.18%, and 60.83%, respectively (P=<0.01). The incidence of shivering was 64.4% in males and 35.6% in females (P=0.222). Also, the amount of incidence of shivering up to 3 hours after surgery was 75.87 % (P=0.064). Bradycardia was 3.3% in group (A) and 0.0 % in group (B). Other variables (myoclonus, seizure and rash) showed no statistically significant difference (P=0.353). According to the findings, it was demonstrated that ondansetron is more effective in preventing shivering after Off-pump CABG than meperedine.

The pathophysiology of primary benign exertional headache (EH) is not still clearly defined. Some researchers have suggested an impaired vascular response as the etiology of this disorder. In this study we investigated whether there are any differences in blood pressure (BP) and heart rate (HR) of the subjects in course of the static and dynamic exercises and the treadmill stress test between those with and without EH. From university students, 22 patients with EH (mean age: 19.8 ± 2.10, Female to Male: 7:15) and 20 normal subjects (mean age: 19.3 ± 1.97, Female: Male: 8:12) were recruited. All the subjects performed the static and dynamic exercises at 30 and 20 percent of the maximal voluntary contraction (MVC) and Bruce treadmill stress test according to the standard protocols. HR and BP of all the cases at the baseline and during and immediately after each test were measured. No significant difference was found between the mean rise of HR, systolic and diastolic BP of the subjects with and without EH in static and dynamic exercises and also treadmill stress test. It seems that between those with and without EH, there is no significant difference in rise of HR and BP response to static and dynamic exercises and treadmill stress test. Further studies are required to find the pathophysiology and risk factors of EH.

Sepsis is a significant health problem with an estimated 750,000 new cases in the USA annually. It is also the third leading cause of death in developed countries, equaling the number of fatalities from acute myocardial infarction. The high sepsis-related mortalities mean there is an urgent need to improve the diagnosis and management of sepsis patients. The aim of this study was the evaluation of fibronectin and C-reactive protein (CRP) plasma levels in patients with sepsis and other infectious diseases without sepsis. In a case-control study, 90 patients with sepsis and 90 patients with other infectious diseases without sepsis were studied. Serum levels of fibronectin and CRP were measured. The data were analyzed by SPSS version 15. The mean levels of fibronectin in the cases and controls were 288.97±89.10 mg/l and 341.24±110.53 mg/l respectively (P=0.001). The mean levels of CRP in the cases and controls were 89.42±54.05 µg/ml and 27.42±25.89 µg/ml respectively (P<0.001). Concerning the source of infection, the mean CRP levels were significantly higher in septic patients with urinary tract infection, pneumonia, and soft tissue infection (P<0.001). Decreased levels of fibronectin and increased levels of CRP may be considered as reliable diagnostic markers for sepsis. Also, CRP could be a better predictive factor for sepsis than fibronectin.

There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals (Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals). Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack (a mix of heroin and amphetamines). The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital.

To compare the study motives and career choices of senior undergraduate medical and dental students in Iran. A cross-sectional questionnaire-based survey study involving final year medical and dental students from 4 dental and medical schools was conducted in 2010. The questionnaire was designed in three sections (Demographic details, motivational items and career choice items) and after confirming the validity and reliability of the questions, it was distributed among the students. Data were entered into SPSS; statistical analysis included logistic regression and multiple linear regression. The response rate was 62% (n=219) for medical and 64% (n=300) for dental students. The factor analysis identified six motivational items: "Social and professional status", "Health care and people", "Other's recommendation", "personal interest and nature of occupation", "Occupational experience" and "Personal life". Medical students were more influenced by "Playing a role in community health" and "Personal interest". "Work independence" and "Social factors" however were two major influential factors among dental students. There were significant differences in important influences by age (Social and professional status, Other's recommendation), Parent's education (Social and professional status, Health care and people, Personal life) and marital status (single >married: Occupational experience, married > single: Personal life). Engaging in postgraduate studies was the first career preference among 90.9% and 89.8% of dental and medical students respectively. Medical and dental students report a wide range of motivational factors in studying medicine/dentistry and future career plans which is affected by age, parent's education and marital status.

Medication errors account for about 78% of serious medical errors in intensive care unit (ICU). So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6%) occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

The aim of the study was to determine the resistance patterns of Pseudomonas aeruginosa isolates recovered from patients with surgical wounds in hospitals and also to investigate their epidemiological relatedness using molecular typing techniques. Twenty Pseudomonas sp. isolated from surgical wounds were subjected to antibiotic susceptibility testing by disk diffusion, plasmid profile, SDS-PAGE and PCR using the parC, gyr A gene and RAPD using the 1254 primer. The isolates showed resistance to 12 different antibiotics with six being 100% resistant. Plasmids were detected in 16 (80%) of the isolates. The RAPD-PCR using the primer 1254, SDS-PAGE classified the 20 Pseudomonas spp. into 5 and 6 types respectively. Pseudomona aeruginosa strains isolated from surgical wounds were generally resistant to a broad range of antibiotics and this is rather worrisome. The typing techniques classified the 20 isolates into 5 and 6 groups.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature ageing disorder that is characterized by accelerated degenerative changes of the cutaneous, musculoskeletal and cardiovascular systems. Mean age at diagnosis is 2.9 years and generally leading to death at approximately 13 years of age due to myocardial infarction or stroke. Orthopedic manifestations of HGPS are multiple and shoulder dislocation is a rare skeletal trauma in progeria syndrome. Our patient had simultaneous shoulder and hip dislocation associated with a low energy trauma. This subject has not been reported. Treatment accomplished as close reduction under general anesthesia and immobilization.

Cerebral sinovenous thrombosis (CSVT) is increasingly diagnosed in neonates. Despite many studies which have addressed diagnosis and management of pediatric CSVT, diagnosis of CVSD in neonates is difficult. A female neonate born by natural vaginal delivery was diagnosed with CSVT after initiation of seizure. The seizure was stabilized and after performing diagnostic tests, the diagnosis of CSVT was made. This report describes diagnosis of this rare condition in a newborn baby in order to make awareness about this serious condition in neonates.