Tehran University Medical Journal

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A case-control study was performed by the Research Center of Isfahan University, to determine the predisposing factors of early atherosclerosis. Children of cases admitted to a university hospital in Isfahan with early myocardial infarction (MI) were considered for the study. The affeckted cases (n=116), had 120 children aged 2-14 years. The control group were selected from children of the neighbors of the cases. The two groups were similar in age of parents, children and socio-economic status. Mean cholesterol and triglyceride levels and the frequency of hypercholesterolemia and hypertriglyceridemia were significantly higher in the children of MI cases. The mean lipid concentration of the controls was significantly higher than standard levels. These results emphasize the importance of evaluating children of high risk cases for risk factors of MI.

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Sixty pregnant women with the gestational age of 6-14 weeks who met the following criteria were selected: 1) Presence of nausea and vomiting. 2) Absence of other medical conditions that cause nausea and vomiting. 3) Negative history of medical treatment for at last three days prior to admission. 4) Negative for threatened abortion, molar and twin pregnancy. Cases were randomly divided into two groups. Mean age of the cases was 25.16 y (range: 16-37 y) and not significantly different in the two groups. The two groups were also similar in gestational age, severity of nausea and vomiting, number of previous pregnancies and abortions, profession, working inside or outside the house, family income and education of patients and their spouses. In one group, Pe6 point of acupuncture was stimulated by TENS (once every 2 hours, 10 minutes each time, from the time of awakening). The other group received placebo. Both groups were hospitalized for 48 hours, and were evaluated for severity of nausea and vomiting, apetite, frequency of vomiting and VAS at their worst day, 24 hours prior to admission and 24 and 48 hours after admission. The two groups were similar in frequency of vomiting, VAS, appetite, and severity of nausea 24 hours prior to admission, and the worst degree of nausea and vomiting. However, a significant difference was observed in the severity of nausea and vomiting 24 and 48 hours after the adminission between TENS and placebo (P=0.000). In the group who received TENS, 24 cases (86.7%) reported improvement (compared to 23.3% in the control group). Of all the cases, 81.6% had received prior medication, only 18.3% of the latter reported improvement with medication. Level of VAS in the groups with severe and mild to moderate nausea and vomiting was not significantly different in the first and second days of admission. Fifteen percent of the cases reported a transient cutaneous rash. Five cases were hospitalized more than once. Of the cases who reported improvement with TENS, 5% had improved after two stimulations, and 47% reported a relapse of symptoms in less than 24 hours after cessation of TENS. In one of the cases who were re-admitted, TENS did not result in alleviation of nausea and vomiting, and 56.6% of all the cases suggested to use TENS at home, 45% were attracted to TENS by commercial advertisements. Disscusion: Stimulation of Pe6 (Neiguan) point alleviates the nausea and vomiting of pregnancy.

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Port wine stains are benign but cosmetically devasting congenital angiomas. The argon laser is a therapeutic device newly applied to this condition. Our program was begun 6 years ago. From the beginning, the study was conceived as a clinical investigation of both the port wine stain and its argon laser therapy. A total of 218 patients with port wine stains have been studied and many aspects of their clinical condition detailed. Employing the Argon laser, test spots have been carried out in patients and the results have been analyzed with clinical aspects of the lesions. Altogether, 501 treatments were performed in 218 patients. Good to excellent results were obtained in 81 patients. Moderate Result was obtained in 31 weak result in 65 patients. Most common complication were hyperpigmentation and depressed scar.

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In this quasi-experimental study, we have evaluated the effects of an educational program on the level of knowledge, attitude and practice methods of experimental assistant dentists in Shiraz, regarding AIDS and HIV transmission. These variables were assessed before and after an educational program, by a questionnaire and a checklist. The educational program consisted of lectures and group discussions, held in 4 sessions during one month. The second assessments of knowledge, attitude, and of practice methods were performed six weeks and three months after the completion of the educational program, respectively. The scores were significantly different before and after the educational program, which can therefore be considered effective in improving knowledge, attitude and practice methods in the cases under study.

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The function of Helicobacter pylori (H.pylori) is confirmed as one of the factors which motivates gastric and duodenal ulcer and gastritis. Various methods are used to diagnose the infection. Serological tests are the easiest and most harmless for the patients. Probably, H.pylori strains in Iran are different from the strains in other countries. Hence, it seems neccessary to design a specific serological test to recognize and identify different strains of bacterial antigenic proteins of Iranian patients.
Since the most manifest and specific to these bacterial antigens are the "Outer Membrane Protein" (OMP), therefore, the first necessary step is to separate and purify H.pylori OMP and then to identify antigenic proteins.
In this study, we received bacteria colony that belonged to 15 patients with gastric or duodenal ulcer, which had been growed in blood agar or brucella broth. After processing such as washing, freezing and defreezing, sonicating, centrifugation with high speed (10,000 g) and treatment with sarcosyl, the sarcosyl insoluble fraction was extracted. Sodium Dodecyl Sulfate - Poly Acrylamide Gel Electrophoresis (SDS-PAGE) was preformed. From all 15 OMP specimens, we isolated protein bands.
The first two bands with higher MW, were major bands and the two lighter bands were the minor bands. Approximate MW of these 4 proteins are equal to 67000, 61000, 30000 and 17000 dalton

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Sixty-nine children with phenylketonuria (PKU) under coverage of Tehran Genetic Research and
Consultation Center, fed Lofenalac and Phenylfree were studied. The 24-hour dietary recall method was used
to determine food intake and blood samples were analyzed for iron parameters. The results showed that over
7% of the children had a low intake of energy, protein and iron. In addition, hemoglobin and hematocrit were
lower than normal in 3.1% of the children, while in 24.2% of them there was decreased serum transferrin
saturation percent. There was a statistically significant relationship between lenght of diet therapy and iron
parameters. The findings show that inadequate nutrient intakes may, over time, cause appearance of anemia signs in the children with PKU dependent on special formulations

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Between 270 patients complaining of symptoms of vaginitis, bacterial vaginosis was diagnosed in 68 women (%25) based on at least three of four criteria: 1. Homogenous vaginal discharge 2. Positive amine test 3. pH more than 4.5 4. Clue cell in wet smear. The results were compared to 55 normal controls.
Clue cell with more than %20 of epithelial cells was seen in %87 of cases and %5.5 of controls. A pH more than 4.5 showed the greatest sensitivity (%100) and the smallest specificity (%47). The most frequent complaints included increased discharge, bad odor, and sensing bad odor after coitus.

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Perinatal mortality rate is an import health index. In this study, we have attempted to determine the causes and rate of perinatal mortality, in 18885 randomly selected newborns, in all the obstetrics and delivery centers of Tehran, during one year (1994-1995). The mortality rate was approximately 21/1.000. Cesarean section was performed in 42.2%, and vaginal delivery in 57.8% of cases. Prematurity was observed in 11.3% and 8.4% weighted less than 2500 gr (low birth weight : LBW). Perinatal mortality was significantly more frequent in the presence of prematurity (p = 0,000), LBW (p = 0.000), mothers who were older than 35 y (as compared to the 20-29 y age group p = 0.01), high parity (> 5 p = 0.00001), and high gravida (> 5 p = 0.04), low educational level (less than high school diploma p = 004), twin or multiple pregnancies (p = 0.000), congenital malformations (p = 0.000), low Apgar score (< 4 in 1 and 5 p = 0.000), and in the absence of perinatal care (p - 0.000 002)

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Ingestion of fish oil fatty acids (omega - 3 fatty acids ) inhibits the formation of arachidonic acid - derived cytokines and leads to production of compounds with diminished biological activity. Beneficial effects of dietary supplementation with fish oil in rheumatoid arthritis have been shown in many controlled trials.
Methods : 43 patients with active rheumatoid arthritis entered in a prospective, double-blind, placebo-controlled clinical trial to recieve either lOgr fish oil daily (treatment group) or corn oil (placebo group). Baseline drugs and usual diet were continued without any changes. Disease variables were evaluated at baseline and after completion of study period.
The changes in disease variables were compared by paired t-tesl in each group. Comparison of the two groups was done by t-test. Functional capacity was compared by Wilcoxon ranks test.
Results : 19 patients in treatment group and 20 patients in placebo group completed the study which lasted eight weeks . In the treatment group, joint pain index decreased from 30±11 at baseline, to 18±11 at the end of study period (P < 0.01). Joint swelling index decreased from 8 ± 4 to 2 ± 4, (P< 0.01), morning stiffness from 87 ± 41 to 24±16 minutes (P < 0.01). In the placebo group the above variable changes were from 19±14 to 25±14 8±8 to 7±6 and 80±71 to 76±75 minutes respectively, which were not significant . The differences between the treatment and placebo groups were significant in joint swelling index (P < 0.05), morning stiffness (P<0.01) and functioal capacity (p< 0.005), the differences in joint pain index and grip strenght did not quite achieve statstical significance. During study period there were no adverese effects with fish oil consumption.
Conclusion : Fish oil supplemention has anti-inflamatory effects in rheumatoid arthritis. Further studies are needed to recommend its long - term usage concomittant with other drugs in all patients

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This survey, evaluated the level of awareness and knowledge among the medical staff about conditions and methods of performing cardiopulmonary ressucitation. The study sampling comprised 497 subjects including 208 residents and 262 interns of ten university hospitals in Tehran. In regard to the basic principles, this has been 43.54% (SD = 13.36%), in drug and fluid therapy 31.22% (GD = 13.22%), in electroshock 43.6% (SD=21.12%), in appropriate approach to the problem 34.73% (SD=13.42%) and in complications of CPR 17.7% (SD = 15.25%). Considering the results of the project, the medical staff have insufficient knowledge of CPR md it does not improve significantly during internship and residency period. Therefore, there is a great necessity for the medical students to attend basic and advanced CPR courses during their study

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With the intention of research of various methods of epithelial tissue culture we've studied five French Albino rabbits with an average of 8 weeks. In order to evaluate and control growth and proliferation of autologus cultured tissue samples were obtained on 1st, 5th and 8th days. After fixation of these samples and passing them through various processes, histologic sections were prepared. These sections were stained with H-E and studied by light microscope, we succeeded in developing the original donor surface by 18 times.

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Infections are significant causes of mortality and long term morbidity in neonates especially in developing countries. Temporal and geographic differences in the relative frequencies of various neonatal pathogenes are well recognized. The outcome of neonatal infections can be improved if appropriate antimicrobial agents are promptly administered. In this report microorganisms of neonatal sepsis and susceptibility to various antimicrobials is determined.

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Diabetes Mellitus is one of the common diseases leading to dialysis. In a cohort study, diabetic dialysis patients were compared with non-diabetic dialysis patients for one year about age, sex, cause and times of admission and rate of mortality. The study was done on 101 patients. At the end of the study, 88 patients remained. Results were interprected by T-test and chi-square statistical analyses and signified with P value less than 5 percent. Results: Diabetes was the cause of 17.8 percent of renal failure in 101 patients. The mean age of diabetics was greater than non-diabetics (P=0.02). Mortality of diabetics in one year was 20 percent, similar to non-diabetics. Infection (chills and fever) was the most common cause of admission in diabetics (33 percent) and non-diabetics (25 percent) with no significant difference. Conclusion: Mortality and morbidity between diabetic and non-diabetic dialysis patients had no significant difference.

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Post partum haemorrhage (PPH) and retained placenta are the most common serious abnormalities encountered during the third stage of labour. PPH is one of the most common causes of mortality in childbirth, particularly in developing countries. The incidences of PPH and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction (CCT). Weather such treatment is valuable is open to question because of the lack of clinical and physiological studies. Unfortunately, oxytocic drugs are not available to about half the women of developing countries, who do not deliver under the care of a trained midwife. We know that sucking stimulates uterine contractions in lactating women. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast-feeding and again within 3 min of the start of sucking. Traditional birth attendants (TBAs) do not have the skill to administer injectable oxytoxics. It has become the practice in some TBA training programmes to teach that the risk of PPH can be reduced if the mother puts her baby to the breast immediately after delivery. Objective: To determine the effect of sucking immediately after childbirth on the length of 3rh stage and amount of bleeding in the first day. This is a semi-experimental study. It was done in Tehran'e Mirzakochak hospital. 100 women received oxytocin intramuscularly and 120 women were placed in sucking group. Then the lenghth of 3rd stage and amount of bleeding in the first day was compared between two groups. Results: The duration of the third stage and number of pads different between oxytocin group and sucking group (4.42 vs 6.08 min) and (10.58 vs 11.72 number). As for the, parity, gestational age, maternal systolic and diastolic blood pressure, infant weight and hight, the results showed no significant difference between the groups. As for the, maternal age, the results showed differed significantly between the groups. As for the gestational age, the results of the research showed that between the gestational age and the duration of the third stage, there was a reverse correlation in multipare women. So when gestational age decreases the duration of third stage will be longer. As for the maternal age, parity, systolic and diastolic blood pressure, infant weight, infant hight, infant sex, the results showed that there was no correlation between these and the duration of the third stage.

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AV-node modification by catheter RF energy delivery is treatment of choice in the symptomatic patients with AVNRT. This study included 30 patients with AVNRT (19 women, 11 men). We did slow pathway ablation in 29 cases successfully. Maximum effective energy delivery was 40 watts for 40 msec. 1:1 AV conduction increased from 290±40 msec before ablation to 340±65 msec after ablation. Also AV-node ERP increased from 235±35 msec before ablation to 280±65 msec after that. There was no recurrence of arrhythmia in the group with slow pathway ablation during 28 months follow-up. We did fast pathway ablation in one case. In this patient AH interval increased from 120 to 200 msec, maximum RF energy delivery was 20 watts for 20 msec (2 times). Recurrence of non sustained PSVT occurred in this patients 20 months after RF ablation. There was no case of permanent AV Block. We recommond slow pathway catheter RF ablation in patients with symptomatic AVNRT.

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In order to compare the new generation of oral contraceptive pills containing Norgestimate (NGM) with currently available pills containing levonorgestrel (LNG) a clinical trial was conducted. 413 women (age 18-35 years) with no contrainindication to pill use entered the study and randomly received one type of pills. Premenstrual syndrome and depression were significantly decreased in NGM group (P=0.00016, P=0.005), on the other hand, breast tenderness, mood changes and hair loss were significantly increased in LNG group (P=0.001, P=0.042, P=0.011). Comparing two groups with each other, following variables were significantly lower in NGM group: headache (P<0.05), vertigo (P<0.05), cloasma (P<0.05), acne (P<0.04), depression (P<0.05), appetite change (P<0.03). Overall patient satisfaction was similar in two groups.

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In a period of 5 years (1371-1375), 87 cases of septic abortion were analyzed in Mirza Koochak-Khan Hospital. Most cases were in 21-25 years old group (28.7%) and most of them were in 5 or more gravidity group (48.2%). Fever was the most important symptom in these patients (80.4%). In this 5 years, period patients have paid 45900000 RLS for septic abortion. Treatment for most patients was antimicrobial treatment and curettage

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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 a quasi experimental study, the effect of health education program in the students' knowledge about personal hygiene and its related factors were investigated. The subjects were 150 students that selected by stratified sampling from the Moslemebna Aghil guidance school in the rural area of Ghooch Hesar, a district of shahre Rat. It was found that: before the health education program respectively 13.3%, 68% and 18.7% and after that respectively 46.7%, 51.3% and 2% of students had high, medium and poor knowledge about personal hygiene. Knowledge about personal hygiene rose from a mean score of 12.19 to 14.15. Appropriate statistical tests showed a significant relationship between students' knowledge difference and their grade (P<0.006). The results indicated that the students' knowledge about personal hygiene significantly improved after health education program

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