Tehran University Medical Journal

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325 female students of Zahedan at the average age of 16.2 years old (16-22) were randomly selected to study the prevalence of iron deficiency anemia. Hb, hematocrit, MCV, MCHC, iron, TIBC and ferritin were measured. Results showed that in the population studied 3.4%, 27.7%, 4.3%, 11.7%, 25.5%, 11.4% had their Hb, MCV, serum iron, tranferrin saturation, ferritin respectively below the WHO standards. The correlation coefficient between Hb, MCV and hematocrit, serum iron was r=0.54, P<0.00001, r=0.38, P<0.00001 respectively. Also the correlation coefficient between transferring saturation, serum iron and ferrin was r=0.94, P<0.00001, r=0.31, P<0.00001 respectively. Our study shows that hematological and biochemical markers of iron status of the young Zahedan girls at puberty are lower than WHO standards and these girls might be at risk of iron deficiency anemia.

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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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Tuberculoma is one of the Causes of the space occupying lesions in brain. Its manifestations can mimic many diseases such as tumor, vasculitis, and multiple sclerosis.
A Patient with brain tuberculoma secondary to epidymitis is reported. His symptoms and signs were very
similar to the patients with multiple sclerosis. The physicians must keep in mind this disease in the differential
diagnosis with many disorders especially multiple sclerosis

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Migraine as one of the most common types of headaches with high intensity and prevalence, affects life significantly. This study was devised to determine the effects of migraine on economic status and life quality of Iranian surffcres.
"Pain database questionnaire", prepared by the International Association for the Study of Pain (IASP) in the year 1995, was translated to Farsi. Then we modified it regaiding cultural, geographical and social characteristics of Iran. 65 patients (55 women and 10 men) were recruited form neurology clinic consultants. Those patients who met the International Headache Society. (IHS) criteria for migraine, were interviewed using IASP questionnaire. Pain effects on sleep, marital life, social, recreational and sexual activities, quality and quantity of drug consumption as well as using paraclinic procedures were considered.
Significant decrease in sleep duration was seen during pain (7.4 ± 1.9 h) compared to pain-free conditions (6 ± 3.7 h) (P < 0.001). The effects of pain on marital life, social, recrealtional and sexual activities during pain were compared with pain-free conditions based on a zero to ten ranking schedule,. Wilcoxone test showed statistically significant (P < 0.02) differences.
We concluded that the economic effect of migraine and its impact on patients' quality of life are significant and should be considered in health planning and disease management

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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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Hysteroscopy is a new and precise method for evaluating of uterus, so it is valuable in evaluating infertile women. In 18 months, 363 hysteroscopies were done on patients who were visited in IVF center of Shariati Hospital for treatment of infertility. Incidence of abnormal hysteroscopy was 18%. 32% of these abnormal hysteroscopies was endometrial hyperplasia. In evaluating of laparoscopy and other factors of these patients there was a statistically significant relation between diagnosis of PCOD (polycystic ovary disease) and endometrial hyperplasia (P<0.008), but there is no significant relation between other diagnoses like endometriosis and endometrial hyperplasia (P<0.4).

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Improper drug prescription by physicians due to wrong diagnosis, wrong drug choise or other causes will waste national funds. The annual drug costs in Iran is 900 billions Rials. With approvement of prescription, it can be reduced to 500 billions Rials. Effective factors in costs reduction are: 1) Increasing medical knowledge and persistent education of physicians. 2) Spending more time for each visit. 3) Giving more information to physicians about pharmacological compounds. 4) Teaching symptoms and signs of the common diseases and proper diagnosis of them. 5) Checking the prescriptions of physicians.

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The poll was designed to let the management system of the university know about the opinions, criticisms and suggestions of the faculty members and create a sense of cooperation and promote the level of relationships. In November and December 1997, short after the new Chancellor of the University was selected, the poll was conducted by the new board to reach the above goals. In this survey, all the faculty members of the University were questioned about the problems they faced in the University. A questionnaire of 23 questions in two pages was given to them and was returned by mail. About 47.5% of the questionnaire were returned. Analysis of the results showed that a significant majority (93%) of the respondents believed that Tehran University should be the best University of Medical Sciences in Iran, and that it dose have the capability to be so, however, a majority (66%) of them claimed that it is not so at the present. A significant majority of the respondents believed that education and research are the two most important duties of the University, and the health, treatment, and cultural duties rank next. Except for the Medicine and Health Faculties others were not satisfied with their status at the University. The satisfaction of the faculty members with educational and research performance of the faculties was questioned the results varied in different faculties. Dissatisfaction with research status was most obvious. Forty-six and 25 percent of the staff in the faculty of medicine were satisfied with educational and research performance of their faculty, respectively. The teaching staff were also questioned about their problems the most important of which was shown to be that of convenience. More than 90% of respondents stated that opinion poll is an appropriate way to relate the management of the University to the faculty members and emphasized on holding periodic sessions with the Chancellor of the University and personal visits to him.

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Intrauterine insemination (IUI) has been practiced since the late 1800's primarily for idiopathic infertility, and in men with deficient semen parameters. The procedure is done by placing washed sperm in uterus a few hours before ovulation. The records of 427 couples receiving IUI for treatment of infertility at Shariati hospital in 1370-74 were reviewed retrospectively. These patients had IUI in 574 cycles. Eighty patients became pregnant and delivery rate was 14% per cycle. Pregnancy rate is impressive when ovulation induction is combined with insemination timed just before ovulation. The success rate in Shariati hospital is comparable to other infertility centers in the world and cost of a cycle of IUI with HMG superovulation is approximately one third the cost of IVF-ET or GIFT cycle and avoids invasive oocyte retrieval and extracorporeal fertilization. So we suggest that women with refractory infertility without anatomic distortion of pelvis can have at least 3-6 cycles of IUI before IVF or GIFT.

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A retrospective study was conducted to investigate about breast cancer in Tehran from 1985 to 1995. All breast pathological records at five General District and Teaching Hospitals (18 general surgical wards) were reviewed and data were extracted. Overall, 3085 records were found (7291 female and 294 male). The final diagnosis was made for 2436 female records including 903 breast cancer (37.1%), 1430 benign breast disease (58.7%), 45 breast skin disease (1.8%) and 58 normal pathological report (2.4%). The dominant group age for breast cancer in women was age group of 40-49 years. The most frequent pathological stage was stage III. Breast cancer was also seen in 2.3 percent of women of 25 year old or younger. The diagnosis was also made for 278 men showing 32 breast cancer (11.5%), 23 benign breast disease (86%), 3 breast skin disease (1.1%) and 4 normal pathological report (1.4%). The results suggest that 3.5 percent of the overall breast cancer were men's, all having over 40 years of age with 60 years or older as the most frequent age. The most frequent pathological stage was stage III. The findings have some implications for public health professionals in terms of breast cancer screening in Iran.

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Our purpose was demographic clinical and pathological aspect of BCE in patients seen in Razi Hospital, during a six-month period (75.8.12 to 76.2.12). Results: From the total 20000 patients, 103 cases of BCE were detected. (0.5%). The male female ratio was 1.71 BCE was more frequent in sixth decade. 40.8% of patients were fair skin (Type II), 54.4% tawny (Type III) and 4.9% brown (Type IV, V). 15.5% of patients had a past history of freckles and history of radiotherapy in childhood was present in 41.7% 89.3% had no history of acne and seborrhea. The scalp was the most common site of BCE. The most common clinical type was nodular BCE and solid BCE was the dominant histological feature. Conclusion: BCE was more common in male and fair skin patients with dry skin. In those having history of radiotherapy of the scalp, lesions were seen mostly on the scalp, forehead and neck: pigmented BCE was predominant in this group.

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Introduction: Hand eczema is one of the most common causes of disabiliting dermatoses. Objective: Our purpose was to determine the frequency of hand eczema in out patients seen in Razi hospital (university medical center). Design: Of 3754 patients with skin problems, 206 were investigated for hand eczema and the study was carried out with regard to age, sex, occupation, exposure to chemical and physical irritants and predispositional factors. Results: The prevalence of hand eczema was 5.48%. The mean age was 30.8 years. The female: male ratio was 1.6. The highest number of patients were in the occupational group with exposure to reegents and water (we couldn't do patch test because it was not available). The most common complaint was itching (85.5%) and the fingers were the predominant affected sites. Conclusion: The major cause of hand eczema in contact dermatitis (Irritant and Allergic) and patch testing in necessary to determine the allergic agent, that can be helpful in allergic contact dermatitis (ACD) but are sometimes discouraged because of high false-positive rate and also in many instances, simultaneous exposure to irritant factors plays an essential role in the development of ACD.

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Nowadays, trauma is a major complex of industrial and developed countries. Integrated trauma systems have been used for many years to evaluate and minimize the severity of trauma outcomes (mortality and morbidity). We haven't had any trauma system or any comprehensive study, giving us proper information about our country trauma state. This article is based on comprehensive information of a descriptive prospective cohort study, performed in one year period in 3 major trauma centers in Tehran, evaluating 58005 Traumatic patients, referred to emergency rooms of these hospitals. In this article we have tried to represent a complete report of our patients' epidemiologic and demographic factors and trauma inducing mechanisms including traffic accidents, falls, gunshots, cutting objects ..., and their effect on the severity of injury and patients' outcome. Based on our study, traumatic patients are mainly young (age mode between 20-29) males (80%). The majority of patients were illiterate or had a low level of education. The most common mechanism of trauma was hitting of blunt objects (44.9%), however, it was car accidents in hospitalized and severely injured patients (39.9% and 53.7% respectively). The mechanism of trauma correlates significantly to the severity of injury, the need to hospitalization and the patients' outcome. In our study gunshots, car accidents and falls are the most important trauma inducing factors.

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In a cross-sectional epidemiological study of headache disorders in neurology clinic of Fatemieh hospital of Semnan (August 22-November 20.1996), information on types of headaches, quality, severity, location, duration, frequency, precipitating factors, age of onset, influence of menstruation and pregnancy, positive familial history, use of oral contraceptive pills and other epidemiological factors including socioeconomic and age/sex composition was collected. The presence of any types of headaches was ascertained by a clinical interview and examination using the operational diagnostic criteria of the International Headaches Society. The prevalence of migraine and tension type headache was also analysed in relation to variables of life style (physical activity and sleep pattern) and associated signs and symptoms (nausea, vomiting, photophobia and phonophobia). In this study migraine and tension headache were also compared in variable aspects with each other. 1) Headache was more prevalent in women than men (F/M=3/1). 2) The most common types of headache included: tension type headache (41.4%), migraine (31.2%) and unclassified headaches (17.2%). 3) Migraine and T.T.H were more prevalent in early adult life and middle ages. 4) In both migraine and tension type headache the time profiles (duration, frequency, age of onset), quality and location were like that noted in textbook and previous studies. 5) In both migraine and tension type headache the most conspicuous precipitating factor was stress and mental tension and frequent headaches were accompanied with psychiatric problems (e.g depression and or anxiety). 6) Nausea, vomiting, phonophobia and photophobia were the most common associated symptoms in both of them. 7) Positive familial history and aggravation of headache in perimenstual period were more commonly seen in patients with migraine than tension type headache. In conclusion using the operational diagnostic criteria of International Headache Society in clinical practice, treating, teaching, clinical and epidemiological research is very useful and must also be applied for Iranian patients.

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Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm) and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular) and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

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This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373). In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

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Introduction: The regulation of neuroendocrine axis is one of the most important goals in the treatment of Rheumatoid Arthritis. Disease modifying drugs such as chloroquine with low dose steroid is the first choice in clinical practice by some physicians. This combination therapy is evaluated by this study. Methods: This survey is a prospective study on furty patients. Variables for determining the activity index of disease were joint tenderness, joint swelling, morning stiffness and erythrocytes sedimentation rate in two years follow up. Results: Decrementation of disease activity index was statistically significant before and after treatment, joint tenderness (X²=7.205, P=0.007), morning stiffness (X²=19.253, P=0.00001), joint swelling (X²=14.107, P=0.0001), ESR (T=2.428, P=0.02). Conclusion: The combination of chloroquine with low dose steroid is beneficial in the treatment of Rheumatoid arthritis

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To evaluate the effectiveness of conjugated estrogen (Premarin) and progesterone in twenty-one postmenopausal women who had been menopause one year, we tested during a 6-month period the serum lipoprotein levels in subjects who offered by premarin in dosage of 0.625 milligram for days 1 to 25 and oral medroxy progestrone acetste for days 15 to 25 of a 30-day cycle. Twenty-one subjects completed at least 6-month follow-up serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerid (TG) measurements by calorimetric method. The results, six months after treatment, is compared to before treatment. The median change in biochemical studies showed significant decrease in serum total cholesterol (248.85 compared with 229.4, P<0.001) serum LDL-cholesterol (155.7 compared with 130.6, P<0.05), but significant increase in serum HDL-cholesterol (53.46 compared with 61.46, P<0.05) TG and VLDL levels did not occur. We concluded that conjugated estrogen is effective on serum total cholesterol, LDL and HLDL cholesterol in postmenopausal women

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This is a prospective descriptive research which was carried out in Imam Khomeini Hospital related to Tehran University during two years (1375-1377) in order to study the incidence of internal carotid stenosis in patients who suffered from TIA ot minor stroke. It was evaluated by duplex sonography. Risk factors of carotid stenosis were studied. 1052 patients who had cerebrovascular accident admitted to Imam Khomeini Hospital and 100 of them who suffered from TIA or minor stroke were selected. The data was gathered by questionnaire and analysed. According to the results of the research, the incidence of internal carotid stenosis was 81%. The incidence of severe stenosis (>70%) was 20%, moderate stenosis (30-69%) was 36%, and mild stenosis (<29%) was 44%. There was a significant relationship between hyperlipidemia, diabetes mellitus and alcohol consumption, with internal carotid stenosis. There was no significant relationship between hypertension and cigarette smoking with internal carotid stenosis. There was a significant relationship between history of angina pectoris or myocardial infarection with severity of internal carotid stenosis. We suggest to consider duplex sonography as a part of evaluation of patients who suffer from TIA or minor stroke for screening of severe internal carotid stenosis. Control and treatment of risk factors are useful preventive measures that can reduce the incidence of carotid artery stenosis and cerebrovascular accidents