Tehran University Medical Journal

Backgroud: Measles, as one of the most contagious diseases, because of the risks of mortality, mental and physical disabilities which may afflict on the patients, has always been so important to the scientists and researchers. With respect to burden of diseases, numerous measures have been taken to control and eliminate measles. In our country, vaccination is considered as the most important strategy to control the measles, however, the surveillance on the patients is on the second place. Screening (Active & passive), prompt and appropriate control of measles in high risk areas can help to control the disease.

Materials and Methods: There are 1375283 people with a variety of demographic traits who live in southern Tehran. Southern Tehran covering 10th, 11th, 16th, 17th, 19th divisions of Tehran municipality consists of high risk areas. Because of too many immigrants, overcrowded areas, malnutrition and poverty, the south of Tehran is considered as one of high risk areas, predisposed to measles epidemics. So in 1999, a cross-sectional study was done.

Results: On 230 subjects suspected to be measles in south of Tehran, 147 subjects were diagnosed as measles by para clinic evidence, 121 subjects of which were men. Most of these were of the age 20 to 24 years old who lived in the eleventh part of Tehran municipality area. The majority of patients were found among soldiers who lived in dormitories in Horr garrison and military training college located on the above-mentioned area. Unfortunately, most of them did not have reliable history of vaccination. Most of these patients had been in close contact with the colleagues who were measled (61.2 percent). The rate of measles incidence during winter soars at most.

Conclusion: The most important factor to be researched is that, the age of these patients differs much from what is expected, due to unknown reason.

Background: To evaluate the possibility that prolactin is involved in the pathogenesis and flare-up of systemic lupus erythematosus (SLE).

Methods: In this cross-sectional study we determined serum prolactin levels in sixty (60) serum samples from sixty patients diagnosed with SLE by the criteria of the American College of Rheumatology (ACR). All patients were females between 13-64 years of age. Disease activity was defined according to lupus activity criteria count and scored by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Serum prolactin concentrations were determined by immunoradiometric assay (IRMA) [125I]. Patient blood samples were taken between 10 a.m. and 12 p.m. Serum was separated and kept frozen at -20 ^°C.

Results: Hyperprolactinemia (>21 ng/mL) was found in 7 (11.7%) patients. SLEDAI scores of <4 were considered inactive disease, >15 active disease and 4-15 moderate activity. Accordingly, 6.7% of our patients had active disease.

Normal serum prolactin levels range from 2 to 21ng/mL. Among those with active disease, prolactin levels were higher, with mean prolactin levels of 18.15, 15.11 and 11.5 ng/mL for active, moderate and nonactive groups, respectively. Increased prolactin levels correlated with activity of SLE disease (p=0.019, r=0.305). No correlation was found between tissue involvement and prolactin level (p=0.24) and no significant correlation was found between prolactin level and age (p=0.19).

Conclusion: Hyperprolactinemia, detected in patients with SLE by IRMA, was associated with disease activity. Our findings suggest that prolactin may play a role in the pathogenesis of SLE.

Background: Sleep has a major role in daily cycles and reconstruction of physical and mental abilities. Regarding the importance of this feature, we decided to determine sleep quality in medical students.

Methods: A questionnaire containing demographic data, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index was prepared. We distributed the questionnaires using a census method to every student at the Zanjan Faculty of Medicine. The completed questionnaires were collected and the data was analyzed using SPSS.

Results: A total of 224 students answered the questionnaire, with 133 (59.4%) students evaluated to have good sleep quality and 91 (40.6%) poor sleep quality. Of these 91 students, 38% were female and 44.8% were male (p=0.307). The prevalence of poor sleep quality according to the four stages of medical training was 24.6% of those in basic sciences, 42.9% of those in physiopathology, 41.7% of externs, and 53.5% of interns (p=0.008). According to residential status, the prevalence of poor sleep quality was 61.5% among students living with their spouse, 44.6% for students living in their own private homes, 37.6% among students living in the dormitory, and 20.8% for those living with their parents (p=0.024). According to marital status, 35.8% of singles and 64.9% of married students had poor sleep quality (p=0.001). According to financial status, 57.9%, 46.9%, and 33.9% of those from low, moderate and high economic classes, respectively, were sleep deprived (p=0.049). Among those with average grades of under 16 and over 16 out of 20, 47.5% and 32%, respectively, were suffering from poor sleep quality (p=0.047). There was no obvious relationship between sleep quality and BMI, sex, or history of depression or anxiety.

Conclusion: Poor sleep quality was significantly associated with lower grades, economic status, living arrangement and type of training. A large number of students quality of life and work may suffer because sleep deprivation.

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Mood disturbances, such as anxiety, depression and psychological distress, are common among women in menopausal period. Effect of long term estrogen replacement on post menopausal  mood disturbances is curative but specifical studies has not done on the effects of vaginal hormonal therapy in mood disturbances in menopause. The aim of this study was objectives to clarify the effect extended by Hormon Replacement Therapy (HRT) in improving post menopausal mood disturbances.
Methods: In a single blinded clinical trial, the effects of a four months application of vaginal esterogen (premarin) versus placebo (n=20) in each groups were evaluated on mood status and sexual satisfaction, using the Hamilton depression score (HDS score), and self assessment of sexual function and pleasure. Four months after treatment completion (half applicator of nightly vaginal premarin or lubricant vaginally) collected and analyzed with Statistical tests.
Results: Decline of the mean HDS scores (depression score) was observed in the premarin group. The mean HDS score (depression) after vaginal premarin decreased from (14.6±4.7) to (3.4±2.3). (p≤0.001) also, The HDS score in placebo group increased from (10.6±3.1) to (11±3.3), that significant difference between two groups before and after treatment is seen. (p≤0.01). Vaginal premarin induced a greater improvement of HDS score (p≤0.006). Mean anxiety score decreased after vaginal premarin (p≤0.000), but is not significant difference in placebo group. (p=0.08). Sexual Satisfaction in Vaginal premarin group is significantly higher (p≤0.001).
Conclusions: Vaginal Estrogene directly or indirectly improved menopausal related mood and sleep disturbances, increased and sexual satisfaction.

Background: Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. SLE as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups. Our SLE registry is one of the largest series in Asia-Pacific region. The aim of this study was to show the manifestations of SLE in Iranian patients.

Results: A total of 2143 SLE patients were studied. The female to the male ratio was 8.8:1 and the mean age at the presentation was 24.2± 10 Years. Prevalence of clinical manifestations included: musculoskeletal, cutaneous, renal, neuropsychiatric, pulmonary, cardiac and hematologic were 85.2%, 83.1%, 66.6%, 24%, 22.3%, 17.5% and 67.1% respectively. There were seen positive FANA in 78.3% and anti-DNA in 70% of patients. Overlap syndrome and positive family history with other autoimmune diseases were detected in 14.9% and 3.4% of patients respectively.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Sleep and sleep deprivation plays a major role in EEG abnormalities and also idiopathic and symptomatic seizures. The aims of this study were to compare baseline EEG findings with waking and sleep EEGs after sleep deprivation in patients with sleep seizure.
Methods : In this cross-sectional study, 33 patients with sleep seizure attending the Neurology Clinic of Sina Hospital in Tehran, Iran, during year 2009 were enrolled. After a baseline EEG, patients were asked to remain awake for 24 hours before taking a waking and a sleep EEG. Finally, the baseline EEGs were compared with findings from waking and sleep EEGs after sleep deprivation.
Results : From 33 patients with sleep seizure, sixteen (48.5%) patients were female and seventeen (51.5%) were male. Patients aged from 7 to 49 years and the mean age of the participants was 26.83 (SD=10.69) years. Twenty patients had no family histories of seizure contrary to 13 patients with a positive history for the disease. There was statistically significant differences between the baseline and waking EEGs after sleep deprivation (P=0.042) as there was between baseline and sleep EEGs (P=0.041). Moreover, there was significant differences between waking and sleep EEGs after sleep deprivation (P=0.048).
Conclusion: This study demonstrated the effects of sleep deprivation on EEG findings in patients with sleep seizure. In patients with sleep seizure, waking and sleep EEGs could be better demonstrated after sleep deprivation than routine waking EEGs. According to the results of this study, waking EEGs taken after a period of sleep deprivation is superior to sleep EEGs after the deprivation.

Background: Migraine is the most common cause of headache which affects 15% of female and 6% of male populations. Patients with migraine may have psychological problems, thus, association of migraine with depression, anxiety and other psychological disorders should be considered for choosing the best management approach.

Methods: In this case-control analytical study, one hundred and twenty patients with migraine were recruited among patients who attended the Psychiatry Clinic of Farshchian Hospital in Hamedan, Iran during 2008- 2009. The patients met the IHS criteria for migraine and none had disorders, such as Huntington disease, that are associated with obsessive-compulsive disorder (OCD). The people who accompanied patients attending the Internal Medicine Clinic of the Hospital and had no history of migraine headaches were recruited as the controls. Maudsley's inventory was used for the diagnosis of OCD. Finally, the data were analyzed by SPSS software.

Results: In the control group, 3 (2.5%) and in the case group 11 (9.17%) people had OCD (P=0.024). All of those with OCD in the control group and 9 out of 11 in the case group were female. There were no cases of OCD among patients with mild migraine. Among 36 patients with moderate headache 5 (13.89%) people had OCD and among 62 people with severe migraine 6 (9.68%) had OCD (P=0.510).

Conclusion: The prevalence of OCD in patients with migraine was significantly higher than the normal population. Special attention to comorbid conditions such as OCD is necessary in the management of migraine headaches.

Background: Different treatment used for resolving menopausal problems. Some studies assayed effectiveness of citalopram but it had some side effects and other studies about medicinal plants in Iran, including Melissa (combination of officinalis and foeniculum vulgare) showed improvement insomnia and anxiety. This study decided to assay effectiveness of this drug and comparison with placebo and citalopram in treatment of sleep disturbance of menopausal women.