Tehran University Medical Journal

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Acute amniotic fluid infection has emerged as a possible cause of many heretofore unexplained preterm births. Our purpose was to determine the effect of ampicillin in the prolongation of pregnancies receiving tocolysis for preterm labor. A blinded, placebo-controlled, randomized trial was conducted to study ampicillin in women hospitalized for preterm labor between 24 and 37 weeks' gestation. A total of 60 patients with intact membranes and without chorioamnionitis who were receiving magnesium sulfate were screened. Thirty women with preterm labor received ampicillin, and 30 received placebos. The primary end point was prolongation of gestation. There was no difference in age of delivery (37.6±9.7 days vs 36.08±3.9 days, P=0.085) and no difference in retardation of delivery (4.7±3.1 vs 4.1±2.1, P=0.39). The mean degree of preterm delivery were 0.62±1.93 and 1.8±3.3 weeks in ampicillin and placebo groups, respectively (not significant, P>0.1). Conclusions: Ampicillin had no effect on interval to delivery or duration of pregnancy in women treated for preterm labor. So rotine clinical use of ampicillin during tocolysis should not be recommended.

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A descriptive, analytical cross-sectional syudy was conducted in 1996 on 350 female students 11-14 years old in the center of Tehran, Iran. The general objective was determining energy and nutrient intakes and weight, height and BMI (Body Mass Index) of the girls, using anthropometric measurements, interviews (24-hour dietary recall and food consumption frequency), and the NCHS standards. The results were as follows: 1) Based on weight for age and the Z-score, 20% of the girls suffered from mild past and present malnutrition. 2) Based on height for age and BMI, 16.6%, 12.5%, and 1.3% suffered from mild past malnutrition, severe present malnutrition and overweight, respectively. 3) The height curves were normal, as compared to the respective standards. 4) The BMI curves were quite different from the respective standards. 5) On the whole, 53.7%, 49.7%, 86.0%, 59.0%, 67.7%, 76.5% and 88.0% of the girls had low intakes of energy, vitamin A, riboflavin, vitamin B12, folic acid, calcium, and iron, respectively. 6) A positive linear correlation was observed between energy intake and height, vitamin A intake and weight, zinc intake and height, and carbohydrate intake and height.

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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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To evaluate breath-holding spell (BHS) and its triggering factors, 47 children with BHS admitted to the out patients clinic of Children's hospital medical center, between Sept 1998-June 1999, were included in this prospective study. Diagnosis of BHS was made for cases by medical history, pediatric physical examination, EEG, ECG and lab findings. 4 cases were excluded from study because of paroxysmal epileptic discharges at their EEGs. Of 43 cases having BHS (M:F: 1.15:1), 74.4% were less there 24 months of age (Mean age 18.4 mo). 77% of patients had onset of BHS within 12 months of age. Family history of BHS in first degree relatives were found in 51% of patients. Parent consanguinity were found in 30% of cases. The commonest type of BHS were cyanotic (79.1%). Pallid (11.6%) and mixed (9.3%) were other types. Pain and anger were the commonest triggering factors. 78% of cases were iron deficient and 53% of cases had iron deficiency anemia.

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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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Different ossificant materials have been used for induction of bone repair in many studies, and bone matrix gelatin which contains bone morphogenic proteins is one of the best ones. In present study we evaluated the role of this material in acceleration of bone repair in rabbit tibia. A hole of 3.5 mm diameter was made on right tibia of 10 and 12 rabbits as study and control group respectively. In the experiment group, in addition to Bone Wax, we applied bone matrix gelatin in the hole. Radiographic images were taken in days 0, 20, 40 and 53 after operation. In 6 rabbits of each group, photographic pictures were also taken after exposure of entire bone. In 6 controls less degree of restoration were seen on day 53. In 4 experimental animals restoration were completed by this time and in 2 speciments repair processing were better than controls. This results shows that bone matrix gelatin can be used as a accelerator of bone repair.

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Zinc has an important role in skin health and its deficiency reduces immunity. To evaluate levels of Zinc in squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) of skin, we studied 44 BCC and 38 SCC cases together with 33 controls. Blood samples were taken and after separation of serum, levels of Zinc, albumin and total protein were measured by atomic absorption, albumin kit and reflectometer consecutively. Serum globulin levels were stimated by substracting albumin from total protein levels. Zinc levels were significantly lower in cancer cases than control (P<0.001). Mean serum albumin of BCC cases was significantly more than controls (P<0.01), but in BCC cases was not significantly different. Significant correlations were seen between levels of serum Zinc and albumin of SCC (R=0.507, P<0.01) and BCC (R=0.43, P<0.01) patients and controls (R=0.35, P<0.01). Mean globulin levels in cancer cases were significantly lower than control group (P<0.01). We concluded that serum Zinc and globulin levels decrease in BCC and SCC of skin.

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Epilepsy is a disease with high prevalence, which interferes driving and may lead to car accident This case-control study has been done on 100 epileptic patients and 100 persons as control group, who had history of driving. We gathered our patients with face to face interview and registering their information in special forms which were prepared for this study. There were three times more accidents among epileptic cases comparing with control group and this difference was more considerable in men and in patients under 35 years old. The cause of accident were not seizure attack in more than 60% of the patients and these ordinary accidents were also more in case group. Epileptic patients with history of car accidents during driving had poor drug compliance comparing with the epileptics without history of an accident so drug compliance may be valuable in predicting accident in these patients. We have also found poor drug compliance in whom seizure attacks caused accident for them. 58% of the epileptics had not consulted their physician about driving. 43.3% of seizures during driving were of generalized type and none of the patients had inform police about their disease during getting driving license.

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This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) and right internal carotid arteries (38.4%). We measured peak systolic and end-diastolic velocities (PSA and EDV) and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio). Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%), accuracy (89.5%) Severe stenosis: Sensitivity (82.1%), accuracy (92.8%) Total occlusion: Sensitivity (93.8%), accuracy (96.5%). There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5%) but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%). EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86%) have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

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Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

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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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Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

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There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon) in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.

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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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Brucellosis is an endemic disease in Iran with variety of clinical manifestation. Special characteristics of clinical diagnosis and treatment issues may cause some problems in manegement of patients. In this descriptive study 505 patients with Brucellosis retrospectively were evaluated from clinical point of view, Lab exams and therapeutic issues for 10 years (1990 to 1999). From 505 patients, 321 cases were male and 184 were female. 42.7 percent of cases were in age group of 10 to 30 years. Ingestion of un-pasteurized dairy products was detected in (66.7 percent) and 31.86 percent of cases were sheep herders. The most common symptoms and signs were fever (65 percent), sweating (61 percent), arthritis (30.09 percent), sacroilitis (21.5 percent), orchitis (8.2 percent), spondylitis (2-3 percent) and endocarditis (1.18). In this survery blood culture for Brucella melitensis became positive in 48.5 percent and bone marrow in 61 percent. Standard tube agglutination was positive in 96 percent (?1.80). Doxycyclin plus Rifampin was the most common regimen we used (37.8 percent). 4 patients died, but just one of those was directly because of Brucella Endocarditis. In this article we have discussed about some interesting cases as well.

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Helicobacter pylori (H.pylori) is the most prominent causative agent of gastroduodenal diseases all over the world. Other manifestations such as urticaria and coronary heart diseases, also are suspected to be induced by H.pylori. Non invasive methods are preferred for diagnosis and ELISA, because of its reliability, speed, sensitivity and specificity is widely preferred as diagnostic tool. Previously we have used IFA, and here, we report an indirect ELISA technique for H.pylori diagnosis. First, 9 strains, of H.pylori isolated from biopsies, were cultured, and the soluble crude antigen was used to coat ELISA plates. Antigen concentration and conjugated antiserum dilution were optimised using checker board method. In this study the gold standard was: rapid urease test, culture and direct smear. Patient serum dillution and the cut-off value was determind, using 22 negative and 30 positive confirmed samples according to ROC curve and the results were compared with a commercial kit. The sensitivity and specificity of this method were 93.2 percent and 95.4 percent respectively. A commercial ELISA Kit, was used and compared simultaneously. The sensitivity and specificity were 87.8 percent and 73 percent respectively. Therefore, regarding the acceptable sensitivity and specificity, ease of work of ELISA, being economical and non-invasive, it can be employed in diagnosis of H.pylori infection and also in epidemiological studies.

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Postoperative nausea and vomiting is a common complication that all anesthesiologist are familiar with the problems of its consequences. Although continued research on the recognition of factors affecting the incidence of PONV is being done but they are not sufficient and the need for research along with advances in anesthesiology and newer drugs are considered. In this prospective cohort study 400 children of 3 to 12 age who has been operated for general surgery (other than eye, thorax and upper abdomen) and orthopedic surgery in the Imam Khomeini and Children Medical Center Hospital has been evaluated. Of these, 200 children who had smoking parent and according to definition were passive smokers and the other 200 children had no smoking parents. Both the groups were matched for sex, age, and type of operation. With the analysis of data we noted that the incidence of PONV in both groups was 19.5 and there was no significant difference between the two groups. (Passive smoker 19 percent and non-passive smoker 20 percent). We also noted a relation between the duration and the incidence of PONV. So operation with more than 2 hours had higher incidence of PONV. There was also positive relation between PONV and controlled ventilation. However, there was no significant difference as the sex and type of operation was concerned. In conclusion, children of smoker parents suffer more PONV than children of non-smoker parents if operation takes longer than two hours or the patient is mechanically ventilated during operation.

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The healthy city is one that is designed to achieve optimal echological, social, and physical specifications for residents of the community that are developing constantly, and that a comprehensive different intrasector cooperation, resources and existing utilities are developed so that an environment of mutual cooperation and assistance for every individual civilian are provided. An environment to maximize their potential ability. One of the specific goals of healthy city, is the development of public knowledge, and cooperative involvement in social health and hygienic programs. The project of healthy city is carried in the Koyee Sizdah Aban, Rey city for the first time. This article has compared the studies carried in the Koyee Sizdah Aban and the other one that in carried in the district of Dowlat Abad, in regard to above-mentioned points. In this study the rate of knowledge, attitude, and the practice of four hundred of 15-49 years old women within the limits of healthy city, was compared with other four hundred women residing in the district of Dowlat Abad in regard to hygienic programs. According to the result of this study the mean percent of knowledge in the healthy cities women were significant in relation to other group. The rate of attitude toward the hygienic problems in the health city and the district of Dowlat Abad did not show a significant differences. The rate of practice of the women of healthy city with 95% of confidence was more than the women of Dowlat Abad. This study clarified that literacy of women and their spouse have positive effect on their knowledge and practice in regard to hygienic problems, but there is not meaningful relation between profession and age of women in regard to the knowledge and practice.

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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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Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases.

Materials and Methods: To determine the efficacy of this method in Iran in patient's with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months.

Results: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement.

Conclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.