Medical Journal Of the Islamic Republic of Iran
Volume:27 Issue: 1, Spring 2013

Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient. After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (P < 0.001) The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.

Recto-vaginal colonization of Group B streptococcus (GBS) has been known as an important issue in mother and newborn’s health, which is getting frequent in developing countries. Screening test have been introduced and utilized in many countries and is recommended by many researchers. However, due to lack of information in prevalence of GBS, especially in Iran, there are doubts and controversies regarding whether it is necessary to execute any effort to run screening tests. The aim of this study is to determine the prevalence of positive recto-vaginal culture for GBS in pregnant women between 35-37 weeks of pregnancy in Tehran. In this cross-sectional study, pregnant women in 35th-37th week of pregnancy were included. All hospitals in Tehran, Iran, were stratified and clustered, and the sampling was done randomly. All recto-vaginal samples were referred to Firoozgar Hospital’s pathology laboratory in less than an hour and the results were reported afterwards. Other demographic information and pregnancy and neonatal-related complications such as previous pre-term delivery, PROM (Premature rupture of membrane) and neonatal sepsis and maternal infection were evaluated. The prevalence of positive GBS cultures was 22.76% (234 Out of 1028). No significant difference was found in positive cultures with mother’s age, educational level, and history of pregnancy, maternal omplications, and previous neonatal sepsis. Due to similar results with other countries, recto-vaginal GBS culture screening is recommended in Iranian urban pregnant women regarding high prevalence and higher neonatal complication.

An accurate and prompt diagnosis of bacterial arthritis is essential for earlier treatment and a good outcome. Superantigens produced by Staph. Aureus are among the most lethal toxins. The paper objective was Identification of common bacterial antigens and S.aureus superantigens in synovial fluid (SF) of children with negative culture and direct smear for other bacteria except for S.aureus. In this cross-sectional study a total of 62 patients with a mean age of 11 ± 3.8 years (range: 5 months-16 years) with acute arthritis in pediatric and orthopedic wards of Rasoul Hospital (2008-2010) were studied. Three common bacterial antigens (e.g. S.pneumonia, H.influenza, N. meningitis) using LPA (latex particle antigen) and Staphylococcal superantigens (TSST1; Enterotoxin A; B; C) using ELISA method (ABcam; USA) were identified in 60 adequate SF samples with negative culture and negative direct smears) for other bacteria except for S.aureus. Staphylococcal superantigens were compared with S.aureus infection (positive culture or direct smear). Positive bacterial antigens (LPA test) were found in 4 cases including two S. Pneumonia, one N.meningitis, and one H.influenza. S.aureus was diagnosed in 7 cases including 4 positive cultures and 3 positive smears. Staphylococcal superantigens (toxins) were found in 73% of SF samples. Some cases had 2 or 3 types of toxins. S.aureus toxins were reported in 47% of culture negative SF samples. Positive TSST1, Enterotoxin B, Enterotoxin A, and Enterotoxin C were found in 47% (n= 28), 18% (n= 10), 39% (n= 22), and 39% (n= 21) of cases respectively. The most common type of superantigens was TSST1; and Enterotoxin A was the less common type. Except for Enterotoxin A, no relation between positive S.aureus culture and positive tests for superantigens in SF was found. S.aureus has a prominent role in septic arthritis. S.aureus toxins might have a prominent role in arthritis with negative SF culture. Rapid identification of bacterial antigens (LPA) or S.aureus superantigens (toxins) are valuable for diagnosis in cases with negative cultures. We recommend usage of complementary methods (e.g. antigen detection tests) in children. Those tests are cheaper and easier in comparison with PCR as a complex and time-taking method. Identification of S.aureus superantigens in SF of all cases with negative culture, or treatment with antagonist drugs needs further clinical trial studies.

G6PD deficiency is the most common enzymopathy of red blood cells. The clinical symptoms of favism are jaundice, hematuria and haemolytic anaemia that seem to affect liver and kidney in long term. Thus we evaluate kidney and liver function of favism patients in an endemic area of the disease with a high rate of fava beans cultivation. This study was performed on favism patients and healthy controls referring to Iranshahr central hospital. Liver and kidney function tests were performed. The results showed a statistically significant difference between these two groups (p <0.05) for liver function tests, (AST, ALT and ALP), but not for renal tests (BUN and creatinine) (p >0.05). Due to abnormalities were seen in the liver function tests of these patients, we suggest that these tests be regularly performed for favism patients who are constantly exposed to oxidant agents.

Prevalence of fall-related mortality is rising in the elderly population. Falling is one of the causes of the murderous and non-murderous injuries in the elderly population which can lead to disability, dependence and decline of quality of life. Fractures constitute a major part of the fall-related injuries. The present study is designed to investigate the prevalence of fall-related risk factors of fractures in the Iranian elderly population This descriptive study was performed on 240 elderly adults (aged 72.24±8.81 years) referred to Tehran hospitals in 2011 with wrist, femoral and proximal humeral fractures, using a questionnaire designed for this purpose. Ninety four (39.2%) cases were males and 146 (60.8%) were females. Slipping was the most prevalent mechanism of falling with the rate of 26.9% followed by falling from height and falling outdoors. Femur was the most frequently injured site (57.5%) while wrist and humerus were the next sites to be injured. Only 7.5% of the cases lived in a safe environment while in 37.2% and 55.2% cases, home environment was partly safe and non-safe, respectively. Fall-related fractures in the studied population is related to cardiovascular and musculoskeletal disorders, low level of physical activity and ignorance of safety principles but, the prevalence of neurologic diseases and drug and alcohol abuse, which have been mentioned as relevant risk factors in some studies, was very low in this population.

Increased heart rate is a normal physiological adaptation occurring during pregnancy. Some women have severe tachycardia requiring medical attention. Aim of this study is to determine the number of women with benign symptomatic palpitations who receive treatment. We performed a retrospective chart review of all women who were referred to our obstetric-medicine clinic for evaluation of palpitation from January 2009 to December 2009 in one major maternity hospital in Kuwait. A total number of 27 women were identified. Of these, only 7 (25.9%) were given treatment for palpitation. Two were started on digoxin, 3 given propranolol, 1 woman on both propranolol & digoxin and 1 was started on verapamil. Eighteen women had normal deliveries with healthy babies. Palpitation is a common symptom during pregnancy. However, only a small number of patients receive treatment despite safety of drugs that are used to control tachycardia.

Sheehan’s syndrome (SS) refers to the occurrence of varying degree of hypopituitarism after parturition (1). It is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care and its frequency is decreasing worldwide. However, it is still frequent in underdeveloped and developing countries. Sheehan’s syndrome is often diagnosed late as it evolves slowly (2,3). Reports of psychoses in patients with Sheehan’s syndrome are rare. Herein, a case report of psychosis in a 31 year old woman who developed Sheehan’s syndrome preceded by postpartum haemorrhage is presented. Treatment with thyroxine and glucocorticoids resulted in complete remission after attaining euthyroid and eucortisolemic state.

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed in a 15 year old boy. We treated this case successfully with surgical microscopic decompression and drainage.

Précis:This debate article highlights some charac-teristics, progresses and challenges of the Iranian health system. Integration of medical education and health service provision, con-trol of some important communicable and non-communicable disease, some health ini-tiatives and health financing system have been discussed from the viewpoint of ex-managers of the system.