Tehran University Medical Journal

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The present survey covers a number of 91 Iranian repatriated war prisoners who, six months after their freedom, approached three psychiatric clinics in Tehran during 1989 and spring 1990. Of these, 34 persons (37.4%) who showed higher symptoms of disorders were hospitalized and 57 (62.6%) who showed milder signs of disorders were carefully diagnosed mentally and psychologically as outpatients. The prevalent disorders revealed by this study were adjustment disorders (48.3%), mood disorders (22%), schizophrenia (11%), anxiety disorder (9.9%) and organic mental disorders (7.7%). The survey showed statistically the existence of a meaningful relation between the disorder severity with such factors as negative opinion of the prisoner's family on his going to the war front, and observance of martyrdom of co-fighters by the patient. However, no significant relation was observed between the severity of disorders and such factors as being involuntarily dispatched to the front, duration of captivity, type of being captive (singular or in group), having a previous record of solitary imprisonment, observing the treason of co-fighters during his captivity.

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Beta Thalassemia major patients receive repeated transfusions in order to compensate anemia and use desferal to remove iron overload. Comparing immunoglobulins and complement components in the serum of these patients with normal range shows a significant increase (P<0.001) in IgG, IgA and IgM and a decrease in C3c and C4. The regression analysis confirms a relation between the numbers of transfusions and the mentioned immunological factors that means increasing the number of transfusions, increases immunoglobulins and decreases the complement. Also, this evaluation shows that use of washed RBC and regular in take of desferal will prevent excessive increase of immunoglobulins or decrease of complement

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The effect and arrangement of cytoskeleton (microtubules, microfilaments and neurofilaments) in neurulation of chick embryo examined by immunoperoxidase method from stage 6 to stage 12. The results were as follows: 1) Microtubules aggregated in the perinuclear region from which they radiated to take longitudinal course beneath the membrane. 2) Microfilaments were aggregated in the apical ends (free-surface) of neural epithelium causing the cells to become flask-shaped. 3) Neurofilaments (Nfs) had no important role in neural tube formation

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In this study, 307 samples of the sediments of fish breeding pools of the different parts of North of Iran were tested for the survey of different environmental Mycobacteria. After the process of cultivation, 107 cases of Mycobacterium were gained which after the performance of different biochemical tests. 112 cases of Mycobacterium were identified. From among the isolated Mycobacteria, the highest rank belonged to M.fortuitum with the frequency of 13.97% and the next M.gordonae 10.66% M.xenopi, M.nonchromagenicum 8.2% and the last M.marinum with the frequency of 5.74%. M.marinum was the case of Tuberculosis of fish and had important role in the creation of granuloma. Next to that, M.fortuitum, M.kanasasii and M.gordenae had less importance. The existence of such Mycobacteria in the fish breeding pools were on one hand the cause of pollution of fish and on the other hand the fishman and other people who are somehow connected to the fish and the pools sediments are subject to disease in case of existence of injury in their hands or feet

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In this research 20 specimen from human whole milk and whey were studied with respect to lipoproteins, cholesterol and triglycerides, 2-8 months after parturition. The whey was separated by means of ultracentri fugation. Also the 24 hour diet history was recorded. The average lipoprotein components in normal human milk were, chylomicron 16.19%±11.98%, beta lipoprotein 36.71%±9.33%, pre beta-lipoprotein 8.61%±3.03% and alpha lipoprotein 38.49%±9.97%. These components were also measured in whey and the results were as follows: chylomicron 6.91%±1.55%, beta lipoprotein 47.32%±10.5%, pre beta lipoprotein 11.48%±4.4% and alpha lipoprotein 33.87%±7.84%. The percent average of the total lipoprotein content and its free forms were estimated in human milk. The average percent chylomicron content was 6.48%±1.43%, beta lipoprotein 33.85%±13.1%, pre beta lipoprotein 12.88%±2.78% and alpha lipoprotein was 47.25%±10.63%. The average ratio of alpha to beta lipoprotein (HDL/LDL) in human milk was found to be 1.10±0.51. Thus, we conclude that breast-feeding can be considered as a potential preventive factor against future cardiovascular diseases.

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Regarding the importance of cardiovascular disease in the health of societies, Hyperlipidemia is considered as an important risk factor. One of the case recently put forward in the fat profile, is high TG (triglycerides) and low HDL-C (High Density Lipoprotein). Nowadays, we believe that TG without the presence of low HDL-C is not considered as a risk factor for cardiovascular disease. So it was decided to perform a descriptive study to define the prevalence of this syndrom, like other risk factors, in urban population of Isfahan. Samples were selected by random sampling method and the sample size, to have reliability of 95%, was about 1200 from the people over 20 year old in 6 age groups and 2 sexes. After inviting the people while going fast (about 14 hours), a questionnaire including perfect identifications was filled and blood factors include total cholesterol, TG, LDL-C (LOW Density Lipoprotein), HDL-C and F.B.S (Fasting Blood Sugar) were measured. Then the statistical analyzing of data was done to define the relation between TG and HDL-C. Regarding the coefficient of correlation and P.value <0.05 in different age and sex groups (except over 70 years old group which was not significant) was defined that TG has an inverse relation to HDL-C and the prevalence in the urban population of Isfahan is 19.7%. Results got from studying the relation between TG serum level and high LDL/HDL fraction (equal or more than five) showed that the more TG gets, the more the fraction is and regarding to its prevalence (11.6%) in Isfahan. It can be a risk factor for cardiovascular disease. So regarding the high prevalence of High TG and low HDL-C syndrome, treating this syndrome can be considered as one of the primary prevention methods. To fufil the latter goal firstly the syndrome must be identified and the related patients must be treated. So the patients with high TG must be tested for HDL-C and LDL-C too. And secondly therapeutic actions to increase HDL-C and to decrease TG level must be done.

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S-J syndrome is a rare autosomal recessive disorder of short stature, blepharophimosis, puckerd mouth, myotonia, muscular weakness, pectus carinatum and stiff joints. Case report: first case: n.1. A boy aged 7 years. His main abnormalities included puckered lip, blephharophimosis, muscular hypertrophy and weakness, pectus carinatum, short stature, shoulder joint limitation and myopia. Myotonic discharges in EMG and muscular dystrophy in muscle biopsy observed. Hypoplasia of clavicle, generalized osteopenia, mild platyspondyly and delayed bone age were radiologic findings of this patient. Second case: A boy aged 8 years. His cardinal abnormalities were similar to case 1. Hip joint limitation, low set ear, anterior cortical opacity of lens, small testis and coxa valga were the other manifestations of this patient. Both patients have a normal IQ and parental consanguinity was also present. CBZ was used for both patients

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Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.

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Oxidation of low density lipoproteins (LDLs) is belived to be an important step in the pathogenesis of atherosclerosis. During oxidation, LDL particle undergoes a large number of structural changes that alters its biological properties, so it becomes atherogenic. To study atherogenic proteins, usually two forms of modified LDLs, including Cu2+-oxidized LDL (ox-LDL) and malondialdehyde (MDA) modified LDL (mal-LDL) are used. In this study, LDL was isolated from 72 ml freshly prepared plasma by sequential Floatation Ultracentrifugation (SFU), which resulted in separation of 12.5 mg LDL protein. LDL oxidation was accomplished in Phosphate Buffered Saline (PBS) with 2µM cupric sulfate, and mal-LDL was prepared by incubating LDL in PBS with 0.5 M solution of freshly prepared MDA. These modifications were evaluated by measuring optical density at 234 nm, Thiobarbitoric Acid Reactive Substances (TBARS), and electrophoretic mobility at pH 8.6. The increase of 234 nm absorption reflected initiation of LDL oxidation. TBARS of ox-LDL and mal-LDL was 80 Nm MAD/mg LDL protein and 400 nm MDA/mg LDL protein, respectively. Electrophoretic mobility of ox-LDL and mal-LDL, in respect to native LDL (n-LDL), were increased.

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This is a report of the first serological survey of influenza C virus in Iran, performed during a one year period (March 1997-May 1998). This study was accomplished in the National Influenza Center-Division of Virology in Tehran University of Medical Scinces. 1080 samples of serum (689 samples from Tehran and 391 samples from other provinces) were assayed for the presence of antibodies against influenza C virus (C/Paris/1/67) by haemagglutination inhibition (HI) test. 43.7% of people tested in Tehran and 40.7% of people tested from other provinces had protective antibodies against influenza C virus. Distribution of seropositives in various age groups had a somewhat similar pattern as what has been reported from other countries. The results of this study indicates that the lowest level of protective antibody titer is found at childhood and the level increases with age. The protective antibody titer level off for 20-30 years old age group and decreases in older age groups. These results indicates a primary contact in childhood, reinfection in adulthood. The influenza C virus is simultaneously circulating in Iran with other types of influenza viruses (types A and B).

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In this research 600 staff of an educational office (distric seven) were being studied before and after they were educated about breast self-examination. Necessary information was gathered before and after they were educated through questionnaires. The result of the study showed that the average scores of their awareness before and after they were educated was 42.3 and 44.2, respectively. Hence, there was a significant difference because of the education of self-examination women's breasts (P<0.0001). There was no difference between family members nor between those who had different marital status, concerning the awareness of breast self-examination. However, there was a large difference between the educational level of women who were studied and the educational level of their spouses, according to their knowledge concerned about monthly breast self-examination (P=0.04).

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The nervous system has an important and vital role in the human body, but unfortunately the repairment of damaged nervous tissue is very slowly. For a long time, the scientists have been involved in finding ways to speed up this process. Radiation of low power He-Ne laser has been suggested to as a way to improve this issue. In this study, 20 rats were divided randomly into control and case groups. The sciatic nerves of all these rats were damaged under general anesthesia and sterile conditions. The day of surgery was considered as the day zero. Rats of case group received every day laser radiation (?=65 mm). At 27th day rats were killed by ether and the sciatic nerve was studied histologically. Data was analysed and the difference was significant. In the case group the repairment was faster. We concluded that low power He-Ne laser radiation on crushed sciatic nerve of the rats has accelerated the nerve repairment process.

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This study was designed to determine if body mass index was predictive of mortality in a sample of seriously ill hospitalized patients in intensive care unit (ICU) of Children's Hospital Medical Center. There were 160 children from 1 month to 14 years in this prospective study for a period of 3 months in 1377. For all of the patients after calculation of BMI, the relation between age, sex, duration of illness, underlying diseases, positive family history of serious diseases, duration of admission in ICU, history of previous hospitalization, mechanical ventilation, albumin and PRISM score with mortality risk and outcome were determined. The percentile rank of BMI between 15 to 85 accepted as normal according to previous studies. In this survey the relation between BMI and outcome of the children in ICU were significant (P=0.0001). Also this relation was significant with the children in ages of 1 to 6 months, duration of hospitalization less than one or more than seven days, no surgery, mechanically ventilated patients. BMI, a simple anthropometric measurement of nutrition employed in community epidemiologic studies, has now been demonstrated to be a predictor of mortality in acutely ill children in ICU. Future studies examining variables predictive of mortality should include BMI.

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Difference aspects of multinomial statistical modelings and its classifications has been studied so far. In these type of problems Y is the qualitative random variable with T possible states which are considered as classifications. The goal is prediction of Y based on a random Vector X ? IR^m. Many methods for analyzing these problems were considered. One of the modern and general method of classification is Classification and Regression Trees (CART). Another method is recursive partitioning techniques which has a strange relationship with nonparametric regression. Classical discriminant analysis is a standard method for analyzing these type of data. Flexible discriminant analysis method which is a combination of nonparametric regression and discriminant analysis and classification using spline that includes least square regression and additive cubic splines. Neural network is an advanced statistical method for analyzing these types of data. In this paper properties of multinomial logistics regression were investigated and this method was used for modeling effective factors in selecting contraceptive methods in Ghom province for married women age 15-49. The response variable has a tetranomial distibution. The levels of this variable are: nothing, pills, traditional and a collection of other contraceptive methods. A collection of significant independent variables were: place, age of women, education, history of pregnancy and family size. Menstruation age and age at marriage were not statistically significant.

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Inflammatory bowel diseases are one of the important reasons of the referral to GI practitioners in our country and Ulcerative Colitis is the more frequent type of these disease in Iran. In this study 200 cases of Ulcerative Colitis, which has been referred to Imam Khomeini Hospital during that last 5 year, were studied. Data was collected using the patient's records and face to face interview with them and their relatives. Majority of the patients were female (55 percent). Positive family history was seen in 28 percent of patients, autoimmune disease history in 8 percent, smoking history in 11 percent and smoking cessation history in 13 percent of patients. Most prevalent symptoms in the patients were nocturnal bleeding, rectal bleeding and bloody diarrhea. The most common involved area were recto sigmoid (58 percent) and descending colon (42 percent). Pan colitis was seen in 8 percent. Most people had complications and the most common complications was fissure (14 percent). Recurrence was seen in 83.5 percent of patients. With logistic regression analysis the only variable which showed significant relation with recurrence was male sex. According to the results of this study, it seems that ulcerative colitis clinical and epidemiological pattern in Iran is similar to many other countries, but the higher rate of recurrence and extra intestinal manifestations in patients shows that there is a growing need to reconsider the treatment efficacy in patients and correct the treatment methods.

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Sepsis is one of the most critical medical emergency situations. Treatment with anti microbial drugs should be initiated as soon as samples of blood and other relevant sites have been cultured. Available information about patterns of anti microbial Susceptibility among bacterial isolates from the community, the hospital, and the patient should be taken in to account. It is important, pending culture results, to initiate empirical anti microbial therapy.
Materials and methods: In a descriptive study during 3 years (1377-1379), microbial and anti microbial susceptibility patterns evaluated in Amir alam clinical laboratory on 2000 specimen of blood culture received from 765 hospitalized patients at Amir Alam hospital wards.
Results: 113 specimens from 77 patient (10 percent) were positive for microbial growth. Enterobacter, S. aureus, S.epidermidis, Pneumococci, Ecoli, and Pseudomonas were the most common isolated etiologic agents(80 percent) . The most common organism was Entenobacter in 1377, S.aureus in 1378 and pseudomonas in 1379 There were significant change in patlern of organisms, increase resistance to some important available antibiotics and change in antibiotic susceptibility pattern during three years (disc diffusion method).
Conclusions: According to Results of this study due to change in pattern of organism and their antibiotic susceptibility, dynamic microbiological study provide important data for Ordering empirical and culture oriented treatment of patients with bacteremia, Sepsis, anti microbial Chemotherapy, anti microbial susceptibility empirical anti microbial therapy, microbial pattern.

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Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving.

Materials and Methods: In our study CPT was compared with endotracheal tube (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, Iaryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia.

Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (P<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (P<0.05).

Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 CmH2O.

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This study was conducted to evaluate effect of clonidine as a premedication on endoscopic sinus surgery bleeding.
Methods and Materials: during a randomized double blind clinical trial we compared two groups of patients who scheduled for endoscopic sinus surgery for polypectomy and etmoidectomy. 216 patients randomly assigned in two groups.In first group 2 hours befor surgery a 0.2mg tablet of clonidine orally adminestered to patients and in second group a 100 mg tablet of vit Bj(with same size and color- as
placebo)was adminestered to patients. The amount of bleeding measured in two groups.
Results: mean bleeding volume in clonidine group was 113+76 ml and in control group was 211 + 113 ml. There was a significant statistical difference between two groups (pO.0001).
Conclusion: Clonidine as premedication can reduce bleeding of endoscopic sinus surgery significantly.

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There are few studies of eyelid's neoplasm in Asia which in comparison of references are some differences.
Materials and Methods: For this reason the retrospective study in 1103 patients which are referred to Farabi Hospital in 10 years period of 1988-1998 was performed. Epidemiological and histopathologic details were sough.
Results: 44 percent of the neoplasm were benign and 56 percent were malignant. The most prevalent benign neoplasm of eyelid respectively were Nevus (37.7 percent) hamartoma (19.6 percent) and papilloma (15.9 percent) and malignant neoplasm of eyelid respectively were basal cell carcinoma (78.7 percent), squamous cell carcinoma (11.8 percent ) and melanoma (2.4 percent ). The mean age in benign neoplasm was 36 years and in malignant ones 57 years, In benign tumors the most prevalent anatomical site respectively were upper eyelid, lower eyelid and inner canthus. But in malignant tumors it was occurred most frequently in upper eyelid in comparison to lower eyelid in addition occurrence of malignant tumors was prevalent in left but in benign neoplasm right and left eyelid were involved equally.

 

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Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients.
Materials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age>12 years), neutropenic (PMN<1000) patients with fever (Temperature, oral >38.5c) in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A) and Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B). Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever) were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result).
Results: During a twelve months period of study, a total of 57 patients (17female, 40male) were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent), the treatment was effective, compared to 15 of 29 (51.7 percent) in groups B. The duration of fever after initiation of treatment was 37.9 ± 17 hours in arm A and 40. 1 ± 20 h in arm B. Blood and / or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B).
Conclusion: Cefriaxon monotherapy is at least equally effective in low risk neutropenic patients with fever compared to combination of ceftazidim plus amikacin at a decreased cost and probably (expected) less adverse side effects in our patients.