Tehran University Medical Journal

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Tuberculosis appears to be a disease as old as human history. Tuberculosis is of great public health importance in the developing countries. Its clinical profile is different in developing countries in comparison to countries of Europe and North America. The recent epidemic of HIV has slowed down the declining trend in the incidence of tuberculosis. Bacilli are transmitted from one infected person to the others as an aerosol. In some cases contaminated milk may also be responsible. However despite effective regimens and addition of new drugs and improved pharmacokinetic knowledge the chemotherapy of tuberculosis still remains a challenge. Poor drug-compliance by patients being one of the foremost reason for frequent relapses and bacterial resistance. Some important and concrete steps to meet these challenges have been judicious use of two or more bactericidal drugs and introduction of short courses regiment. Multiple drugs therapy may shorten the duration of treatment and prevent emergence of drug resistance.

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Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.

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Indacrinone is a loop diuretic which also has uricosuric, kaliuretic, saliuretic and natriuretic effects. Since it has been reported that this drug has several actions in different organs, we decided to evaluate its mechanism of action on the rat jejunum smooth muscle. After preparation of the tissues, different concentrations of indacrinone were applied. Doses of 8.2×10^-6 M, 2.7×10^-5 M, 8.2×10^-5 M and 2.7×10^-4 M were all effective in a dose dependent manner to relax the muscle. Increase in the drug concentration resulted in much faster reduction in twitch amplitude. The jejunum is innervated by adernergic, cholinergic, serotonergic and histaminergic systems. To find the mechanism of action of indacrinone in rat jejunum, experiments were conducted by appropriate receptor agonists and antagonists of the above systems. There was a marked increase in muscle contraction tone and ampliture by the use of histamine, while indacrinone prevented the increase induced by histamine. It was concluded that indacrinone may be a competitive antagonist for histamin receptors in rat jejunum muscle.

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This study was conducted to investigate the prevalence of pulmonary problems, among a group of 1600 selected textile mill workers in the Yazd province. A standard questionnaire on respiratory symptoms was administered and forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined for each worker. The results obtained were as follow: Obstructive ventilatory defect 15 cases (0.9 percent), restrictive ventilatory defect 16 cases (1 percent), combined obstructive and restrictive ventilatory defect (Mix) 53 cases (3.3 percent) and normal 1516 cases (94.8 percent).

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In the present study, we investigated total cell protein patterns of ten isolates of Epidermophyton Floccosum Var.pigmented by SDS-PAGE on 10% polyacrylamide resolving gels. Densitometric analysis of the gels allowed to detect more than 31 clearly detectable mycelial protein bands with molecular weights in the range of 12 to 98 KD proteins of 12.5, 13.5, 14.4, 16, 18.4, 19.7, 20.1, 23.5, 26, 27, 29, 30, 32.5, 34, 35.5, 37, 39.5, 40.5, 43, 47.5, 50, 63, 68, 75, 79, 82.5, 74.5, 90, 94, 96, 97-5 KD were present but their frequencies varied among the isolates. Protein bands of 18.4, 19.7, 20.1, 27, 29, 34, 37, 43, 47.5, 50, 63, 79, 94, KD were stronger and common among the isolates and could be specific to recognize genus differences. Protein analysis by SDS-PAGE could be considered an useful technique in identifying differences among the dermatophyte isolates.

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In order to understand the function of mammalians serotonin system, we have to know the anatomical structure, because physiological changes are influenced through the anatomical changes. A number of thalamic nuclei are associated with functions known to be influenced by serotonergic input in brainstem, among them mediodorsal thalamic nucleus has relationship with limbic system and prefrontal cortex. The precise topographical projections of mesencephalic raphe nuclei to the MD nucleus of thalamus were identified in the rat using horseradish peroxidase (HRP) retrograde tracing substance. Injection of HRP in MD labeled a large number of neurons in rostral to caudal part of dorsal raphe nucleus. It exhibited a strong number of neurons in ipsilateral part of DR and a few cells in its contralateral part. Numerously labeled cells were also observed ipsilateral in rostral and medial part of MnR (86%) and a few cells in it's contralateral part. The present study has provided that the MD innervation by DR is more greater in density than that observed at the MnR. Upon these results and previous study, mesencephalic raphe nuclei are involved in several specific functions of thalamus as limbic system behavioral mechanism. A much more detailed knowledge is needed to show topographic relationships between mesencephalic raphe nuclei and forebrain.

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In a cross-sectional survey depression prevalence of 130 nurses in Tehran Imam Khomeini hospital has been investigated by using long from test items (21 questions) of Beck depression questionnaire. Also necessary data for independent variables was collected by interview. The findings of this study indicated that depression rate of mild, moderate and severe type were 73.1%, 21.5% and 5.4%, respectively. In this study statistically significant association has been found between depression and marital status (P<0.0001), level of education (P<0.005), over time's hours at work (P<0.02) and parent's death at childhood (Before 11th age) (P<0.001).

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To examine the relation between oral contraceptive (OCPs) use, body mass index, parity, familial history of gallstone disease, history of diabetes, history of hyperlipidemia and gallstone disease in women, we have undertaken a case-control study. The study population comparison 80 hospital patients with diagnosed acute gallstone disease as case group and 200 controls who were patients in hospital with no history of gallstone disease. The data were analyzed by Chi-square and T-student test. The results revealed that: The use of OCPs in case group is higher than that of control group. But there is no significant difference between them. No relation was found between gallstone disease and body mass index, parity, history of diabetes, familial history of gallstone disease, use of OCPs of different types and duration of use. While there was a significant difference between the 2 groups regarding history of hyperlipidemia (P<0.05). Finally we found no correlation between the history of use, types and duration of use of OCPs and symptomatic gallstone disease. There was no indication of any interaction between oral contraceptive use and other risk factors and duration of OCP use and other risk factors in the production of disease.

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twenty-two patients were reviewed retrospectively to determine the effects of embolization on Glomus Jugulare tumors. 6 patients underwent embolization and 16 did not. All tumors were removed with a type A infratemporal foassa approach. The patients were evaluated for operative blood loss, operative time, length of hospitalization and new post-operative nerve deficits. The embolized group lost less blood and shorter operative times and less hospitalization. Embolization did not reduce the incidence of new post-operative cranial nerve deficits. The experience of the surgeon and operative team also play a significant role in the reduction of blood loss and operating time. Embolization carries a risk of significant morbidity, and its use depends on the experience of the radiologist.

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The objective of this study was to determine the reference range for Creatinine in children<8 years old among Tehran citizens on the selectra 2 analyzer and manually with Jaffee alkaline picrate method. Pediatric reference ranges are important in order to determine whether a patient's result is normal or abnormal. Reference range on the selectra 2 system over this age are currently unavailable. The study used serum obtained from children admitted in diagnostic and health centers and the SPSS program T-test and Chi-square were used to analyze data. The results are given below: Creatinine: Age (Y): 0-2, Male: N=71, 0.46 mg/dl, SD=0.1 Female: N=61, 0.47 mg/dl, SD=0.1 Total: N=92, 0.467 mg/dl. Age (Y): 3-6, Male: N=89, 0.52 mg/dl, SD=0.001 Female: N=50, 0.53 mg/dl, SD=0.1 Total: N=139, 0.529 mg/dl. Age (Y): 7-8, Male: N=50, 0.58 mg/dl, SD=0.11 Female: N=37, 0.55 mg/dl, SD=0.11 Total: N=89, 0.572 mg/dl. Total: Male: N=210, 0.52 mg/dl, SD=0.11 Female: N=108, 0.53 mg/dl, SD=0.1 Total: N=318, 0.52 mg/dl. Serum Creatinine significantly increased with increasing in age and total body surface (P<0.05, 0.0001 respectively), while there has been no significant difference by sex, diet and fasting.

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Systemic sclerosis is a generalized disorder of connective tissue, in which the pattern of disease extent, progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scleroderma, disease progression has occurred mostly in the early phase of disease, but in patients with limited cutaneous scleroderma, disease progression was slow and incidious, so disease progression has occurred mostly in the late phase of the disease, thus raynaud's phenomenon, telangiectasia, hyperpigmentation and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, early and extensive organ involvement was observed in patients with diffuse cutaneous sclerodema.

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Squamous cell carcinoma, a cancer of keratinocytes origin, mostly involves sun-exposed areas of the skin. To study the pathologic and demographic features of this disease, records of 395 patients of squamous cell carcinoma of skin and lip were reviewed. Most of the patients (83%) aged 40 years or more at the time of diagnosis. Respectively, 74.4% and 75.8% of cases with skin and lower lip carcinoma were men, but in upper lip cases frequencies of both sexes were equal. The number of patients referred from western and north-western provinces were much more than those of other provinces of the country. The most frequent histologic stage was grade I (53% and 58.8% in skin and lip carcinoma, respectively), showing that most patients visit physicians early enough, and are diagnosed in early stages of the disease.

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Invasive salmonellosis is common in tropical areas. This study examines the performance of a clinical definition for its recognition among children ages 1 to 14 years admitting to a referral pediatric hospital in Tehran. 60 children were enrolled into the study during a period of 51 months. To facilitate analysis, cases were divided into 5 categories according to the likelihood of invasive salmonellosis with category A representing microbiologically confirmed salmonella bacteremia 17 (28.3%) and 6 (10%) with positive bone marrow cultures. And category D representing those cases in which an alternative diagnosis was firmly established. Salmonella serology supported invasive salmonellosis as the diagnosis in 17 (28%) of the nonbacteremic children (category B and C). Salmonella serology suggested that invasive salmonellosis without detectable bacteremia was common. Blood culture proved and serologically diagnosed cases shows that the definition has a specificity of at least 60%.

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Accurate measurement of refractive error in uncooperative patients and young children, requires cycloplegia. The aim of the present study was to determine whethere cyclopentolate by itself or in combination with 4 times instillation of atropine can be used as a substitute for 10 times instillation of atropine. From 1994 to 1996, 39 patients aged 2-12 years were included in this study. Cycloplegia was undertaken by four different methods in subsequent visits: cyclopentolate 1%, 4 times instillation of atropine, 10 times instillation of atropine plus tropicamide and 10 times instillation of atropine. 26 patients (53% male, mean age: 6.4 years) completed the four stages of the study. Spheric refraction was significantly different between cyclopentolate and 4 times and 10 times atropine groups, but we didn't find any significant difference in cylindric refraction between groups. It seems that 10 times instillation of atropine is still the best method of cycloplegia in pediatric eye examination.

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Despite the role of oral corticosteroids in management of sever asthma, use of these drugs needs careful awareness of its many side effects. There are controversies about the role of methotrexate in lowering the need for corticosteroides in these patients. In this study an attempt has been made to determine methotrexate effects in corticosteroid dependent asthma. Six patients were entered in a double-blind placebo controlled crossover trial and randomly allocated to two groups. Each group got a 12 weeks course of treatment with 15 milligrams of methotrexate or placebo which thereafter was changed to the other regimen. In comparison with placebo, methotrexate caused a 62.5% less need for oral corticosteroid (P<0.01) and a 20% increase in FEV1 (P<0.05). We concluded that the use of low doses of oral methotrexate results in less need for oral corticosteroid in treatment of corticosteroid dependent asthma.

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Tubal ligation is one of the most effective and reliable methods of contraception and of successful program of birth control in Iran. Present study was done to evaluate factors affecting risk of complications during tubal ligation surgery. We studied 1780 women that had tubal ligation in 13 hospitals in Tehran during the years 1993-95. Data on operation were collected by questionnaire and analyzed using logistic regression method. Risk of complications was increased in women had had operation after vaginal therapy, in luteal phase, after cesarean section and in follicular phase, respectively. Modified pomery, pomery and parkland methods of operation were ascendingly related to increased risk of complications. Age, history of pelvic pain, method of anesthesia, incision size and time of operation were not significantly correlated with complications. Frequency of complications was higher in women that had other procedures during surgery. We suggest that tubal ligation be done after vaginal delivery and by modified pomery method.

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DNA typing is a new method with important applications in forensic medicine. In the present study, we evaluated application of DNA typing in Iran. Loci Hum LPL, Hum Tpox, Hum F13, Hum vw 31A, Hum TH01 and Hum FES/FPS of DNA short tandem repeats were studied. To determine sensitivity of the test, 85 mother-child couples (1020 chromosomes) that were referred to DNA section of legal medicine organization of Iran were included and for determination of it's specificity 42 brother-sister couples (1200 chromosomes) and 58 non-relative couples were examined. The results show lack of mutations in the studied loci and acceptable sensitivity of the test. Of 12 alleles of siblings, there were 2-6 differences, in contrast with 3-9 differences in non-relatives, so the test has 100% specificity in these loci. Considering polymorphism, power of exclusion of these 6 sites was 99%.

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Since its introduction in 1988, laparoscopic cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1) Recurrent biliary colic (88.4%), 2) Non-specific manifestations of gallstone (5.8%) and 3) Asymptomatic gallstone (1.7%). Contraindications for LC are: 1) Acute cholecystitis 2) CBD stone and/or dilatation, 3) Gallbladder cancer, 4) Intra-abdominal malignancies, 5) The need for other elective abdominal operation, 6) History of upper abdominal, laparatomy, 7) Sepsis, 8) Ileus, 9) Peritonitis, 10) Pancreatitis and 11) Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision making is based on patient's general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: Severe adhesions, technical and enforced. There was no death after LC.

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The most common cardiovascular surgery in the world and Iran as well, is CABG. One of the most important post-operative complication of this operation, that increase morbidity and mortality, is peri-operative MI. Incidence of peri-operative MI in CABG operations is between 2.5 to 5.5%. In this study we determined the prevalence and incremental risk factors of peri-operative MI in 300 consequative CABG operation, in the Imam Khomeini hospital. Diagnostic criteria for peri-operative MI were positive ECG finding (New and persistent Q.wave) and positive CPK-MB (Serum level>100 unit) at 3 different time: 1) Just before operation in the ward, 2) Just after operation in the ICU, 3) First post-operation day (At 8 A.M). In 300 patients positive ECG findings were seen in 7% (21 cases), positive CPK-MB was 12.7% (38 cases) and both of them were positive in 5% (15 cases). Therefore the prevalence of peri-operation MI was 5% (15 cases). Incremental risk factors in the patients with peri-operative MI were history of diabetes mellitus, hypertension, hyperlipidemia, left main disease, and endarterctomy. Therefore because of high incidence of peri-operative MI in CABG operation we should try to change the risk factors and decrease the prevalence of this complication.

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Cardiopulmonary resuscitation (CPR) is one of the most important skills that every body must know it in medical services. In educational hospitals, the (Newly-arrived residents are in first cell for management of victims, specially in emergency rooms and at nights. Their knowledge and ability for successful CPR have a direct relation with prevalence of total mortality and morbidity. This research has assessed the knowledge and attitude of the new residents about CPR, and for answering to this question: "Is the CPR workshops necessary for all of the new residents in the beginning of their courses". All of the 506 new residents were examined simultaneously in 2 separate years with a questionnaire consist of 50 questions about their CPR secence and skills and 8 questions about their attitude in CPR. These informations were analyzed by SPSS and EPI6 softwares. The mean correct answers were 55%±11.8. The best results were about arrythmias (68.6%) and airway management (63.6%) and the worst were about IV access (43.1%) and pediatric CPR (31.5%). These findings were similar in 2 sequential years. Their knowledge had significant relation with sex (P=0.002), their original university (P=0.031), their residency course (P=0.024) and their residency reception scores (P<0.001). Males and knowledge more than females. The max scores were from Kerman (62%) and Beheshti universities (60.5%) and the min score were from Hamadan (48%) and Kashan universities (37%). The orthopedic (62.5%) and urologic residents (61.6%) had the most knowledge and the gynecology residents (53.8%) had the least. The knowledge had no relation with the time of graduation. About their attitude in CPR: Their knowledge was moderate (65.8%), their abilities was moderate (58%) and their education about CPR in MD course had been low (51.5%). Their references for education had been individual studies (74.6%), CPR workshop had not been condected in the most universities (92.7%). knowledge about CPR is low (55.8%) and must be 100%. In advanced centers, continuous educations in CPR is essential. Residents with low scores have accepted in courses that have more CPR situations. Difference in knowledge of residents from different universities, show the different educations. Primary knowledge was low and after years, this is lower. Attitude of residents show the low knowledge, low ability, low education in MD, courses.