Tehran University Medical Journal

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Diabetic nephropathy is common in Mazandaran and a significant number of patients under chornic hemodialysis are diabetics. The present study was designed to study the prevalence and predisposing factors of diabetic nephropathy (DN) in Mazandaran. Methods: During a 20 months period from June 1993 through December 1994, 490 (350 female, 140 male) cases of non-insulin dependent diabetes mellitus (NIDDM) were diagnosed according to the criteria of National Diabetes Data Group. DN was diagnosed in 18 (11 male, 7 female) patients with proteinuria of 500 mg or more in a 24-hour urinary sample in at least two separate occasions, and excluding other causes of nephropathy. Results: 3.7 percent of all NIDDM patients had DN, 15+5 years after onset of diabetes. Male patients have higher prevalence of DN (7.8%) than female (2%). Onset of diabetes before 50 years age in male is a risk factor for DN (9.5%) as compared after 50 (4.5%) (P=0.01), in female the prevalence of DN before and after 50 is, 1 and 3.4 percent respectively (P=NS). Conclusions: In Mazandaran DN is not uncommon, it is more common in male patients than female. The age of onset, duration of diabetes and maleness are predisposing factors for DN.

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Febrile seizure is the most frequent type of seizure in childhood occurring in 2-4% of children under the age of 5. Although pathogenesis of seizure following fever is not well understood, multiple risk factors are known to contribute to its precipitation. One of the possible risk factors which had not been mentioned yet in reference texts and still is in the research phase is a serum sodium level below the normal limits which specially plays a role in the recurrence of febrile seizure. In this descriptive retrospective study records of 400 in-patients cases of primary episodes of febrile seizure in Bahrami children hospital in the years of 1996-1997 were reviewed. 214 (53.5%) cases had serum sodium levels of <135 m.mol/L. The mean serum sodium level for all the cases was 135.28±4.65 m.mol/L which is considerly less than the serum sodium level of 140±0.8 m.mol/L seen in healthy children. There was no significant difference in serum sodium levels different sex and age groups in this patient population

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In this study we review 82 infants under two months with bacterial meningitis admitted in Tehran University's hospitals during a 14 year period. Male to female ratio was 1.4 to 1. The patterns of predominance among bacterial pathogens changed during the period of study. During the first six years the most common pathogens were Salmonella-SP., but during the later years E.coli became the predominant pathogen, and also meningitis caused by GBS and Staph. epidermidis was observed. The case fatality rate was 37.8 percent. The antibiogram revealed that E.coli were hundred percent resistant to ampicillin and 50% resistant to gentamicin, 40% of all bacteria isolated were resistant to ampicillin and gentamicin. These findings provide guidelines for the selection of empiric antimicrobial agents in our country

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This is a study on 62 G6PD patients hospitalized in Bahrami hospital between 1993 to 1995. Favea was the oxidant agent causing acute hemolysis in more than 90 percent of patients. Most of acute hemolysis occurred in spring, the season of high consumption of favea. More than 60 percent of patients had moderate to severe hemolysis with Hb less than 7 gr/dL. According to WHO reports, the incidence of G6PD is 7-12% in Iran and it is favism type. It is suggestive to prevent parents of sugh patients of favea consumption, which in turn decreases the rate of acute hemolysis, its complications, complications of transfusion and hospitalization in endemic area of Iran.

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To determine the complications of gold sodium thiomalate therapy in rheumatoid arthritis (RA), 32 patients with active RA (27 female, 5 male) treated for a mean period of 28 ? 14 weeks were studied. From these patients, 62.5 (46-79) percent showed at least one drug reaction. Pruritus was the most common complication occurred in 59 (42-76) percents, and was accompanied by skin rush in 37 (15-57) percents of cases. Renal, mucosal and post-injection complication developed, each in 16 (3-29) and percents of patients. Hematologic and pulmonary reaction occurred in 12.5 (1-24) and 9 (1-19) percents of cases respectively. Drug reaction resulted to discontinuation of gold therapy in 19 (5-32) percents of patients. Majority of drug reactions occurred during the first 15 weeks of therapy. In comparison to reports coming from other studies, drug reactions in Iranian patients were more frequent but less severe.

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Schizophrenia is one of the most important and disabling mental disorders in the world. Males and females are equally affected. Diagnosis is a very difficult problem in this disorder. Because the diagnostic systems such as ICD-10 and DSM-IV are mainly subjective, they are not valid and reliable. Essentially, in the future, we will need to more objective criteria in psychiatry especially in diagnosis of schizophrenia. Neurological soft signs are an example of these objective criteria. In this study we evaluated the prevalence of neurological soft signs in schizophrenic patients and compared it with the prevalence of these signs in other psychotic patients (except mood disorders with psychotic features) and normal subjects.
Methods: We compared the neurological soft signs (sensory motor integration, motor. Coordination, consequent complex motor acts, primary reflexes, and eye movements) in 30 schizophrenic patients, 30 other psychotic patients (other than mood disorders with psychotic features) and 30 normal subjects. Diagnosis of schizophrenia and also other psychoses were based on DSM-IN criteria. Normal subjects have been selected form the staff of Roozbeh hospital randomly.
Results: The difference between the means of motor coordination subscale of neurological soft signs in schizophrenia and other psychotic disorders (other than mood disorders with psychotic features) were significant (P value < 0.04). There were no significant differences between the means of other subscales of neurological soft signs in two groups of patients.
Conclusion: There are some disturbances of motor coordination subscale of neurological soft signs in patients with schizophrenia. It seems that, these disturbances are evidence of involvements of basal ganglia, motor cerebral cortex, and cerebellum. So it may be suggested that motor coordination as a marker can be used in differentiation between the schizophrenia and other psychotic disorders.

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Background: ‏Today, coronary artery disease is a leading cause of death and morbidity in the world and recognition of all aspects of this problem appears to be necessary and important. In recent years in addition to traditional coronary risk factors, other new risk factors are presented that can affect coronary arteries and accelerate atherosclerosis process. One of the most important of these, are infections, specially with Chlamydia pneumonia. We aimed to study this possibility that is whether correlation between infection with Chlamydia pneumonia and Acute Myocardial Infarction. (AMI).

Materials and Methods: This research is a descriptive case-control study which evaluates frequency of infection with Chlamydia pneumonia in the 100 patients with AMI and 105 patients without any history or evidence of CAD admitted in sections of CCU and surgery, in Dr. SHARIATI and SINA hospitals in 2001. For this purpose we took 5ml blood sample from all of the patients, and tested for specific anti Chlamydia pneumonia antibodies (IgG & IgM) by ELISA method.

Results: Our study showed that 38 percent of control group patients and 54 percent of patients with AMI had positive titer of anti Chlamydia pneumonia antibody and so they were infected with Chlamydia pneumonia {OR= 1.9 (95% CI: 1.34 to 2.46)} (P< 0/001).

Conclusion: This study demonstrates that, there is significant correlation between infection with Chlamydia pneumonia and occurrence of AMI so treatment of this infection could be of profit.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: It is a well known fact that language functions are primarily related to the left hemisphere in right handed individuals, there is still no agreement about hemispheric language dominance in left handers. The aim of this study is to evaluate the possibility of using functional Transcranial Doppler ultra sonography (TCD), as a non-invasive method for investigation of hemispheric language dominance and also to explore possible gender influence on hemispheric language representation.
Methods: We performed functional TCD during a word generation task, in 62 healthy volunteers (30 right handers and 32 left handers, 50% male and 50% female). All subjects were medical students in the age range of 22-29 years. Right or left handedness was determined using Edinburgh questionnaire. Two subjects were excluded from the study because of poor temporal windows. Mean blood flow velocity was measured in both right and left middle cerebral arteries (MCA) at rest and during a word generation task, and changes in flow velocities were compared.

Results: Increase of MCA blood flow velocity was observed in 55% (33 subjects) of the students in the left side, and in 45% (27 subjects) of them in the right side. Right hemispheric dominance was observed in 43.3% of right handers and 46.7% of left handers. Left hemispheric dominance was observed in 56.7% of right handers and 53.3% of left handers. Our results showed no significant right hemispheric language dominance in left handed subjects.
Conclusion: This study does not show significant difference in hemispheric language dominance between right and left handers, using functional TCD

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Background: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam.

Methods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than 70 years, and the age in control group ranged 20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of 0.02 mg/kg IV midazolam the BIS value also was taken and recorded.

Results: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p< 0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p< 0.0001).

Conclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of 50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.

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Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related side- effects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management. Methods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6 hours. Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference between the two groups at other intervals. The occurrence of nausea and vomiting was similar in both groups. No respiratory depression was observed in the patients. Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects

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Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.

Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.

Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).

Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.

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Background: Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension (HTN). We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension.
Methods: In this prospective cohort study, patients who received three or more anti-hypertensive medications with 160mmHg systolic blood pressure (BP) or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects.
Results: One hundred and seventeenth patients (54%) out of 212 screened patients were included in the first group (renal denervation) and 95 patients as the second group. The mean of BP changes in the first group was 35/15 mmHg with standard deviation of 22/11mmHg. (P<0.001) in the second group, the mean changes of BP was not statistically significant. (5/0mmHg± 22/11, P=0.79 for systolic BP and P=0.96 for diastolic BP). 92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls (P=0.001). There was no observed complication after denervation in the first group.
Conclusion: It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.

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Background: Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO2 (puls-eoximetry oxygen saturation) in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation (SaO2) during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship.
Methods: In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO2 was recorded and compared with SaO2 obtained by blood gas analysis. One or serial arterial blood gas analyses (ABGs) were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO2 and SPO2 we recorded.
Results: O2 saturation as a marker of peripheral perfusion was measured by Pulseoxim-etry (SPO2). The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12%±1.6%. A total of 137 paired readings demonstrated good correlation (r=0.754 P<0.0001) between changes in SPO2 and those in SaO2 in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation (r=0.799 P<0.0001) and the mean difference between SaO2 and SPO2 was 0.05%±1.5%.
Conclusion: Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn’t alter the relation between SPO2 and SaO2 to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.