Tehran University Medical Journal

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The effects of taking snacks on the learning ability and educational achievement of elementary school children in district 18 of Tehran educational organization were examined in the school year 1997-98. Other factors such as grade, nutritional status, breakfast eating habits and snack eating habits in the school were also studied. For this purpose 236 boys were selected by random sampling in 4 different schools. The children were randomly assigned to a group, with a low calorie snack (119 subjects), and a low-calorie control group (117 subjects), and then given 3 cognitive functions tests. The test were repeated after 4 months. The data were collected by questionnaires and included family socio-economic conditions, nutritional status and dietary habit of the children. Also, the grades of the major courses and scores of cognitive tests were collected, and the effects of treatment on the mean grades and scores differences were determined by T-test and analysis of variance (ANOVA). Our findings are presented as follow: The experimental and control groups were similar in the initial assessment. 7.1% of the students were stunted based on height-for-age classification (NCHS). The intervention led to an increase in tests scores, but the increase was only significant in the case of the short-term memory test (P<0.03). The findings of the study showed that the intervention was effective on short-term memory and since short-term memory function in memorization process and retrieval of subjects form long-term memory and congenitive functions, we can conclude that the food intervention with an energy lower than 10% of recommended dietary needs increases learning ability level of the subjects. Stunting and the habit of eating breakfast were related to educational performance of students. Therefore implementation of such programs in the community, such as food intervention and nutritional education may be effective.

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This cross-sectional descriptive study was undertaken to know the rate of intestinal parasites infestations in our school children population. A sum of 1155 fecal samples were analyzed from an equal number of children whose age were between 6-11 years old. The percentage of infestations were: Giardia lamblia (14.11%), hymenolepis nana (1.21%), ascaris lumbricoides (0.08%) and enterobius vermicularis (0.08%). We found no differences with regard to sex, age, father and mother levels of education, family size, body mass index (BMI) and the erythrocyte sedimentation rate (ER) between the stools positive and the stools negative cases. Nearly all cases of giardiasis (99.4%) were symptomatic. Eosinophilia was seen in (5.5%) of the infested children with giardiasis and in (0.5%) of the non-infested children, the difference was statistically non-significant (P=0.056). All cases of giardiasis (N=163) were treated with metronidazole 15 mg/kg/day in 3 divided doses for 7 days. Metronidazole was effective in (92.2%) of the treated children.

 

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We studied fertility indices of Iranian and non-Iranian populations which were covered by 23 Rays health houses. This cross-sectional study aimed to prove the effect of increasing number of non-Iranian immigrants on health indices of the area covered by Tehran university of medical sciences and health services, consequently giving attention to specific health programs. The data collection method was census of permanent residents of the villages by means of vital horoscopes. 8494 of 27611 persons were non-Iranian. Dependency ratio and natural growth rate was 75%, 1.14% in Iranians and 98%, 1.74% in non-Iranians, respectively. Mortality in non-Iranians was 1.24 times more than Iranians. General fertility rate in Iranians was 60 and in non-Iranians was 110 live births in 1000 women of child bearing age. Total fertility rate in Iranians was 1.73 and in non-Iranians 3.27 neonates for each woman. Age-specific fertility rates were absolutely higher in non-Iranians. Gross eproductive rate was 0.87 in Iranians and 1.59 in non-Iranians. Mean number of girls born by a non-Iranian mother will be double times of an Iranian mother (P<0.01). Modern contraceptive methods coverage was 70% in Iranian couples and less than 40% in non-Iranian couples. 96.94% of Iranian deliveries and 70.9% of non-Iranian deliveries were safe (P<0.01).

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Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

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Metabolic alkalosis is characterized by high HCO3- as it is seen in chronic respiratory acidosis, but PH differentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely. We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized Pediatric Medical Center in Tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent. 64 precent male and 36 percent female). Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height). More than 60 percent had hypokalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis should be considered in every pediatric patient presented with projectile vomitting.

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Lithium is a immunomodulator that can increase immunoglobulins to confront infectious desese. It is also able to increase the production of interleukins, interferon gamma and prostaglandins. We conducted this study to evaluate the correlation between lithium consumption and humoral immunity. Blood samples were obtained from 76 patients under lithium treatment. We classified the patients according to their serum lithium level in to five categories. Using single radial immuno diffusion technique, we measured IgG, IgA, IgM, C3 and C4 levels in the blood samples of our patients and a group of 100 controls as well. Analysis of variance method was used for comparison of groups. We found significant differences between groups in level of IgG, IgA, IgM and C3 (P<0.05). This findings show that lithium has many effects on humoral immunity.

 

 

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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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The purpose of this study was to assess the prevalence of malnutrition and related factors that may affect the nutritional status of 0 to 59 month old children in the rural areas covered by the Birjand district health network. A total of 626 children were selected by random sampling. Data were collected using a questionnaires and face-to-face interviews with the mothers and by measuring weight and height of te children. The nutritional status of the children determination was based on the z-score (cut-off poing under-2Sd from median reference population). Based on the z-score and under 2-standard deviation from median of NCHS in rural areas of Birjand, 18.5%, 40.1% and 3% of children were suffering from past-and-present, and present, malnutrition, respectively. Therefore the highest prevalence of malnutrition was related to the past-malnutrition and the stunting was the main problem. The chi2 test showed a statistically significant relationship between the children's past malnutrition and fathers litarcy (P<0.001), also between the children's past and present malnutrition and mother's literacy (P<0.021) and past malnutrition (P<0.001). There was also significant relationship between, father's main occupation, per-capita income (P<0.0001, P<0.025 respectively) and children's past malnutrition in the cases under study. In this research, relationship between sex and prevalence of malnutrition in both peresent-past and past malnutrition was meaningful, (P<0.024, P<0.017 respectively). This study did not show a significant relationship between nutritional independent variables and nutritional status of the children.

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The phenomenon of sleep is an active nervous and biologic rhythm, which is under influence of neurotransmitters of central nervous system. In this study, the influence of serotonergic system on sleeping time have been assessed by agonist-antagonist drugs using two methods of induction and non-induction behavioral and electrophysiology. The method used for measurement of total sleeing time was Angle method. For assessment of drugs impact on brain waves, after opening two holes in frontal and temporal regions, two non-polarized silvery electrodes were fixed in above regions and was connected to physiograph and computer by linkers for waves analysis. Injection intra-ventriculary is done by stereotax apparatus. Results indicate that diazepam (2.5 mg/kg) increases sleeping time in two stages of induction and non-induction (P<0.01). 5-HTP (15, 45 mg/kg) increases dose-dependence sleeping time. p-CPA (150, 300 mg/kg) shows biphasic influence on sleeping time. The 300 mg/kg dose of p-CPA reduces sleeping time while 150 mg/kg dose inverts sleeping time (P<0.05). Interferential affects of drugs with (5-HTP) 45 mg/kg and p-CPA (300 mg/kg) doses are similar to control groups. Injection of 5-HTP inverts p-CPA affect. Intra-ventriculary Injection of 5-HTP in 150 µg/kg and 300 µg/kg doses, decreases frequency of delta waves and significantly increases the frequencies of other waves but conversely, 500 µg/kg decreases it. Due to findings of this study, interferential affects of agonist-antagonist of 5-HTP, can not invert p-CPA affect. Supported by GABA affects, diazepam induces its inhibitory affect in per-synaptic and post-synaptic membrane through ascending reticular both systems and blocking stimulation of brain cortical and limbic system. Affects of two other drugs on sleeping time and brain waves are probably caused by increment of released serotonin in pre-synaptic neurons. Although their interferential affects with other neurotransmitter system should be considered as well.

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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In this study, chromosome analyses were performed on 70 infertile Azoospermic and Oligospermic (<20 million/ml) men, and also cultures of peripheral blood lymphocytes by high resolution banding method were analysed as well. It is revealed 8 (11.43 percent) men with chromosomal abnormality. There were 31.4 percent patients with azoospermia and 68.6 percent with oligospermia from several thousands to 20×10^6 million/ml and their duration of infertility was at least 2 years. All patients with numerical chromosome anomalies had azoospermia and the most frequent anomaly was 47, XXY chromosomal constitution (klinfelter's syndrome), found in 8.57 percent of patients. We found that chromosomal anomalies found in this study were sex chromosome anomalies and an increased rate of numerical chromosomal abnormalities was among men with azoospermia. As a conclusion, we suggest that all men with azoospermia be considered for cytogenetical evaluation.

 

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It is now generally recognized that anaerobic bacteria may be involved in most human bacterial infections that follow any form of surgery or are related to those body sites that have a large anaerobic population. Anaerobes must therefore be sought in a wide variety of clinical specimens. In this study, 3015 specimens of patients (1684 male and 1331 female) with periodontitis (160 cases), abcess (305), sinusitis (33) and enterocolitis (2517) wer investigated. The anaerobic isolates from patients with periodontitis were 244 cases, abscess 32, enterocolitis 42.

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Informations regarding 152 patients of cancer of tongue in cancer institute from 1978 to 1998 was collected and analyzed. From these cases, 53.3 percent were male with a mean age of 54.49 years (SD=16.23) and the mean age of female was 2.5 years more than of male. Positive lymphadenopathy in men was positive and significantly more than that of female (P<0.05). The physical appearance of the tumor was ulcerative (66.7 percent). Most of the referrals were in the range of T1 (62.8 percent) and were operated. Information from 88 patients was evaluated and it was found that 23.9 percent of the patients has died. One year survival was 92.05 percent and 3 years survival 83.3 percent and it was confirmed that advanced stage of the illness decreases the survival rate (P<0.001).

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The phenomenon of sleep is an active nervous and biologic rhythm, which is under influence of neurotransmitters of central nervous system. In this study, the influence of serotonergic system on sleeping time have been assessed by agonist-antagonist drugs using two methods of induction and non-induction behavioral and electrophysiology. The method used for measurement of total sleeing time was Angle method. For assessment of drugs impact on brain waves, after opening two holes in frontal and temporal regions, two non-polarized silvery electrodes were fixed in above regions and was connected to physiograph and computer by linkers for waves analysis. Injection intra-ventriculary is done by stereotax apparatus. Results indicate that diazepam (2.5 mg/kg) increases sleeping time in two stages of induction and non-induction (P<0.01). 5-HTP (15, 45 mg/kg) increases dose-dependence sleeping time. p-CPA (150, 300 mg/kg) shows biphasic influence on sleeping time. The 300 mg/kg dose of p-CPA reduces sleeping time while 150 mg/kg dose inverts sleeping time (P<0.05). Interferential affects of drugs with (5-HTP) 45 mg/kg and p-CPA (300 mg/kg) doses are similar to control groups. Injection of 5-HTP inverts p-CPA affect. Intra-ventriculary Injection of 5-HTP in 150 µg/kg and 300 µg/kg doses, decreases frequency of delta waves and significantly increases the frequencies of other waves but conversely, 500 µg/kg decreases it. Due to findings of this study, interferential affects of agonist-antagonist of 5-HTP, can not invert p-CPA affect. Supported by GABA affects, diazepam induces its inhibitory affect in per-synaptic and post-synaptic membrane through ascending reticular both systems and blocking stimulation of brain cortical and limbic system. Affects of two other drugs on sleeping time and brain waves are probably caused by increment of released serotonin in pre-synaptic neurons. Although their interferential affects with other neurotransmitter system should be considered as well.

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Cut out or extrusion of the lag screw from the superior aspect of head and neck of the femur is one of the most common and devastating complications of the surgery of the intertrochanteric fractures with DHS. The exact cause of this complications is unknown, but it seems to be related to osteopenia, inappropriate position of lag screw inside head of the femur and inability of DHS to slide inside the barrel, which is the most ignored risk factor. We used short barrel Dynamic Hip Screw (DHS) for fixation of the intertrochanteric fractures in Dimon and Hughston procedure in 16 patients with unstable fracture, from may to August 2000. The only patient suffered from cut out is the one with static position of DHS in the center of the head. The other complications were delayed ::::union:::: in one, disingagement of the lag screw and side plate despite using compression screw, and one case of significant limb length discrepancy 6 months after surgery, mild limbing was the rule and the average of harris scores was 76. We think that, it is possible to reduce the rate of cut out with choosing short barrel DHS instead of the standard one, while using short length lag screw.

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World health organization has introduced concentration of vitamin A in breast milk as a proper indicator for characterization of vitamin A deficiency in lactating mothers and their infants (<6 mo). A normal phase high performance liquid chromatography with spectrofluorometric detection as a specific and sensitive detector was used for characterization of all-trans retional from 13-Cis retinal. The method was sensitive (0.009 ppm) and accurate (1±0.054 µ mol/l) and had a good recovery percentage (99.36%). This method was more better than before methods and was compatible with the other useful methods. Effect of freezing and defreezing on all-trans retinol content of milk sample was investigated. The result was interesting, whatever all-trans retinol content was bigger, it’s destroying was bigger too. Because of that reseon, day today reproducibility wasn’t good. Standard of retinol was 95% all-trans and pure so we should use this method because two retinol isomers wasn’t separated from each other by reversed phase chromatography and UV detection.

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Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors.

 Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain.

Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS.

 Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.

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Introduction: Inter-hospital transport constitutes one of the important parts of the emergency system in every country.

Materials and methods: To determine the outcome of requested CCU beds from the medical emergency headquarters in year 2000 by the hospitals affiliated to Tehran university of medical sciences, we have reviewed retrospectively 2688 clinical files of patients for whom a request for an empty CCU bed in other hospitals had been sent to the medical emergency headquarters. The main measure was the success rate of being admitted to CCU in other hospitals.

Results: On the whole 68.5 percent of requests were followed by a CCU admission to other hospitals. Using logistic regression method, variables including season of the year, shift diagnosis of the patient and the original hospital were shown to be related with the success rate. Conclusion: Increasing the number of available CCU beds and providing the centers with the necessary equipment is of high priority in hospitals located in city of Tehran.

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Introduction: Clinical manifestations of primary hyper-para-thyroidism (pHPT) had been dramatically changed during last 25 years. Evaluation of changes in clinical findings was the aim of this study.

Materials and methods: In a retrospective, descriptive case series, patients' records of all 47 pHPT (44 females, 3 males) from 1988 till 1998 were studied. Patients’ clinical presentations, signs and symptoms, laboratory and radiologic findings were reviewed and the results were compared with 34 patients' studied during 1978-1987. Serum Ca>10.5 mg/dl with increased or high normal PTH were the diagnostic criteria of pHPT.

Results: Patients’ age range was 11-70 and mean ±SD was 38±16 years, with a female to male ratio of 14:1. 57 percent of the patients had bone pain and muscle weakness, 12 percent were asymptomatic, 10 percent had pathologic fractures, 8 percent had renal stones, 8 percent had symptoms of hypercalcemia, and 2 percent had giant cell lesion. The mean±SD of serum calcium was 11.48±1.16 mg/dl, phosphorus was 2.4±0.6 mg/dl and 24-h urinary Ca was 294±197 mg. Serum PTH was increased from 1.5 to 500 folds. The frequency of single adenoma in right inferior, left inferior, and left superior gland were 43 percent, 30 percent, and 13 percent respectively.

Conclusion: In the study 12 percent of patients were asymptomatic whereas there was no asymptomatic case in the previous study. Prevalence of severe bone disease and the interval between onset of symptoms and diagnosis was also reduced. According to this study detection of pHPT in asymptomatic phase remarkably increased.