Tehran University Medical Journal

Background: The misdiagnosis of urinary tract infection (UTI) may lead to kidney deficiency and even pyelonephritis. Since different species may cause this disease, urine culture (UC) and antibiogram of the isolated species should be performed and results compared to urine analysis (UA) parameters to obtain the best diagnosis.
Methods: The urine specimens from 1509 patients (1195 women and 314 men) were processed for UA, UC and antibiogram. First of all, the sterile urine samples were cultured using differential media, including EMB and blood agar. After 24 hr incubation, the colonies were identified and differentiated by biochemical tests. Antibiograms for all isolated species were determined using Muller Hinton agar. All results obtained from this survey were analyzed using SPSS software.
Results: Of the 1509 samples, 986 (65.3%) were positive for pathogenic bacteria, 170 (17.2%) of which were from men and 816 (82.8%) from women. E. coli was the most prevalent with 591 cases (58.7%), followed by Enterobacter 115 (11.4%) and Klebsiella 88 (8.8%). Data analysis revealed that the correlations between the WBC, RBC, nitrite, crystal, and protein were significantly higher in culture-positive samples. Of the antibiotics tested, isolated species were most sensitive to amikacin and most resistant to ampicillin.
Conclusion: The present study revealed a correlation between pyuria and bacteruria however, it should be noted that the clinical signs and the presence of WBC in urine could not be used to confirm the UTI. In addition, since different bacterial species are able to cause UTI, in order to administer proper treatment while controlling improper use of antibiotics, thorough testing, including UA and UC together with antibiogram, is strongly recommended.

Background: This study have conducted in order to determine of direct or indirect effective factors on mortality of neonates with low birth weight by path analysis.

Methods: In this cohort study 445 paired mothers and their neonates were participated in Tehran city. The data were gathered through an answer sheet contain mother age, gestational age, apgar score, pregnancy induced hypertension (PIH) and birth weight. Sampling was convenience and neonates of women were included in this study who were referred to 15 government and private hospitals in Tehran city. Live being status of neonates was determined until 24 hours after delivery.

Results: The most changes in mortality rate is related to birth weight and its negative score means that increasing in weight leads to increase chance of live being. Second score is related to apgar sore and its negative score means that increasing in apgar score leads to decrease chance of neonate death. Third score is gestational age and its negative score means that increasing in weight leads to increase chance of live being. The less changes in mortality rate is due to hypertensive disorders in pregnancy.

Conclusion: The methodology has been used could be adopted in other investigations to distinguish and measuring effect of predictive factors on the risk of an outcome.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Gastric cancer is the second most common cancer and known as the second cause of death due to cancers worldwide. Adenocarcinoma is the most fatal cancer in Iran and a patient with this kind of cancer, has a lower lifetime than others. In this research, the survival of patients with gastric carcinoma who were registered at Taleghani Hospital, were studied.
Methods:  291 patients with Gastric carcinoma who had received care, chemotherapy or chemoradiotherapy, at Taleghani Hospital in Tehran from 2002 to 2007 were studied as a historical cohort. Their survival rates and its relationship with 12 risk factors were assessed.
Results:  Of the 291 patients with Gastric carcinoma, 70.1 percent were men and others (29.9%) were women. The mean age of men was 62.26 years and of women was 59.32 years at the time of diagnosis. Most of patients (93.91%) were advanced stage and metastasis. The Cox proportional hazards model showed that age at diagnosis, tumor stage and histology type with survival time had significant relationships (p=0.039, p=0.042 and p=0.032 respectively).
Conclusion: The five-year survival rate and median lifetime of gastric cancer patients who underwent chemotherapy or chemoradiotherapy are very low and seems that one of the important reasons for this situation is delayed diagnosis. The scheme of public education about the early warning signs of the disease and diagnosis and administration of periodic examinations is unavoidable.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Although the short-term results of kidney transplantation have improved greatly during the past decades, the long-term results have not improved according. Graft loss due to chronic allograft dysfunction (CAD) is a major concern in renal transplant recipients (RTRs). There is little data about disease progression in this patient population. In this paper, we investigated history of kidney function as the pattern, waiting time and rate of pass from intermediate stages in RTR with CAD.

Methods: In a single-center retrospective study, 214 RTRs with CAD investigated at the Urmia University Hospital urmia, Iran from 1997 to 2005. Kidney function at each visit assessed with GFR. We apply NKF and K/DOQI classification of chronic kidney disease (CKD) staging system to determine pattern of disease progression per stage in this group of patients.
Results: The pure death-censored graft loss was 26% with mean waiting time 81.7 months. 100% of RTRs passed from stage I to II in mean waiting time 26.3 months. The probability of prognostic factors transition from stage II to III was 88.9% with mean waiting time 25.5 months, transition from III to IV was 55.7% with mean waiting time of 24.9 months and transition for stage 4 to IV was 53.5% with mean waiting time of 18.2 months. In overall rate of transition from stage i to j in patients with stage III at the beginning of the study (time of start CAD's process) was faster than others.
Conclusions: This study revealed, that kidney function in first years after transplantation is one of the most important II to III of survival probability per stage and death-censored graft loss. Therefore care of RTRs in first year could potentially increase long-term kidney survival.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Anthropometric facial analysis and quantitative measurements are useful methods for diagnosis, as well as planning in plastic surgery. The literature is replete with numerous related studies, few of which are about the Iranian population. This study was conducted to determine the average facial proportions of Iranians and compare it with that of Caucasians. 
Methods: This cross-sectional study was conducted on a convenient sample of 212 Iranians (male=108, female=104) aged 18-30 years who did not have any previous major facial surgery or trauma and their past two generations were Iranian. Measurements between facial landmarks were determined and compared with Caucasians with Student and one sample t-tests (P<0.05, 95% CI). 
Results: The intercanthal (en-en) and eye widths (ex-en/R), forehead height 2 (tr-n), trichion-endocanthion (tr-en) and nasofacial and nasofrontal angles were not significantly different between the participating men and women but other facial measurements were significantly different (Р<0.05). The head (ft-ft), eye (ex-en/R/L) and nose widths (al-al) and upper face height (n-sto), nasofrontal angle and nasal tip protrusion in the study population were not significantly different from Caucasians. The upper lip (sn-sto), lower face (sn-gn) and forehead heights (tr-n) and nasofacial angle of the female participants were not significantly different from Caucasian women but other facial measurements were significantly different (Р<0.05).
Conclusion: Most facial anthropometric measurements of Iranian subjects were significantly different from those of Caucasians. More precise studies with larger sample sizes are warranted to reach a common conclusion on the facial anthropometric similarities or differences between the two populations.

Background: Acute gastroenteritis is a major cause of morbidity and mortality among children in developing countries. Rotaviruses are recognized as the most common etiologic factors of gastroenteritis. In this study, we determined the epidemiologic features, clinical symptoms and molecular structure of rotavirus VP4(P) genotypes in children with acute diarrhea in Bahrami Hospital in Tehran Iran, during 2009 for justifying the routine use of rotavirus vaccines in children.

Methods: One hundred fifty fecal samples from 150 children with acute diarrhea in Bahrami Pediatric Hospital in Tehran, Iran were collected from January to December 2009. The patients’ mean age was 20.90+18.19 years (ranging from 1 month to 14 years). Fecal samples were transported on ice to the laboratory of virology department of Pasture Institute of Iran. The demographic and clinical data for each case were entered in an author-devised questionnaire. Group A rotavirus was detected by dsRNA-PAGE. Subsequently, rotavirus genotyping (VP4) was performed by semi-nested multiple RT-PCR and the phylogenetic tree of the Rotavirus nucleotides was constructed. The data were analyzed by statistical tests including Wilcoxon signed and Mann-Whitney U.

Results: Rotavirus was isolated in 19.3% of the samples, more than 90% of which had long RNA patterns. The predominant genotype (VP4) was P[8] (86%) and other genotypes respectively were P[6] (6.9%) and P[4] (6.9%).

Conclusion: A high prevalence of the P[8] genotype was found to be the cause of acute diarrhea. The analysis of P[8] genotype sequence showed a high level of similarity of the virus in this study with those of other Asian countries.

Background: Currently, share of the scientific output, citation per paper, and co-authorship for articles indexed in databases such as ISI Web of Science, are very important criteria for the evaluation and ranking of countries, researchers, institutes, articles, disciplines and journals in the world. Therefore, the main objectives of the study were to determine co-authorship, the average citation per paper and the most prolific Iranian university or institution in the field of immunology.

Methods: For performing this scientometric study, we employed survey methods and citation analysis of the indexed papers in the ISI Web of Science from 1974 to 2010.

Results: A total of 1775 articles by Iranian authors in the field of immunology had been indexed in the database for the aforesaid period. Most collaborations and co-authorship of Iranian authors was with their counterparts from the USA. The average citation per paper in the field was 6.26 per paper. Tehran University of Medical Sciences had the highest number of articles in the database.

Conclusion: According to the results, Iranians collaborated with American peers more than any other nationality andthe average citation per paper in the field of immunology is higher than that of other fields in Iran but lower than the global average. Tehran University of Medical Sciences is the most prolific university in the field.

Background: Lung diseases and lung cancer are among the most dangerous diseases with high mortality in both men and women. Lung nodules are abnormal pulmonary masses and are among major lung symptoms. A Computer Aided Diagnosis (CAD) system may play an important role in accurate and early detection of lung nodules. This article presents a new CAD system for lung nodule detection from chest computed tomography (CT) images.

Methods: Twenty-five adult patients with lung nodules in their CT scan images presented to the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran in 2011-2012 were enrolled in the study. The patients were randomly assigned into two experimental (9 female, 6 male, mean age 43±5.63 yrs) and control (6 female, 4 male, mean age 39±4.91 yrs) groups. A fully-automatic method was developed for detecting lung nodules by employing medical image processing and analysis and statistical pattern recognition algorithms.

Results: Using segmentation methods, the lung parenchyma was extracted from 2-D CT images. Then, candidate regions were labeled in pseudo-color images. In the next step, some features of lung nodules were extracted. Finally, an artificial feed forward neural network was used for classification of nodules.

Conclusion: Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate (P<0.05) for lung nodule detection.

Background: Anemia disease is the most common hematological disorder which most often occurs in women. Knowledge discovery from large volumes of data associated with records of the disease can improve medical services quality by data mining The goal of this study was to determining and evaluating the status of anemia using data mining algorithms.

Methods: In this applied study, laboratory and clinical data of the patients with anemia were studied in the population of women. The data have been gathered during a year in the laboratory of Imam Hossein and Shohada-ye Haft-e Tir Hospitals which contains 690 records and 15 laboratory and clinical features of anemia. To discover hidden relationships and structures using k-medoids algorithm the patients were clustered. The Silhouette index was used to determine clustering quality.

Results: The features of red blood cell (RBC), mean corpuscular hemoglobin (MCH), ferritin, gastrointestinal cancer (GI cancer), gastrointestinal surgery (GI surgery) and gastrointestinal infection (GI infection) by clustering have been determined as the most important patients’ features. These patients according to their features have been seg-mented to three clusters. First, the patients were clustered according to all features. The results showed that clustering with all features is not suitable because of weak structure of clustering. Then, each time the clustering was performed with different number of features. The silhouette index average is 80 percent that shows clustering quality. Therefore clustering is acceptable and has a strong structure.

Conclusion: The results showed that clustering with all features is not suitable because of weak structure. Then, each time the clustering was performed with different number of features. The first cluster contains mild iron deficiency anemia, the second cluster contains severe iron deficiency anemia patients and the third cluster contains patients with other anemia cause.

Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.