Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
The relation between consanguineous marriage and mental retardation of the offspring
156
158
EN
Mohhammad H.
Nazarabadi
Dept. of Human Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad,
N
Arman
Arghami
Mashhad University of Medical Sciences, Mashhad, Iran.
N
Mohsen
Ghanbari
AcademicVice-Chancellor Office, Mashhad University of Medical Sciences, Mashhad, Iran.
mohsen_ghanbarius@yahoo.com
Y
http://mjiri.iums.ac.ir/article-1-10-en.html
http://mjiri.iums.ac.ir/article-1-10-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
An unusual case of median nerve compression with ipsilateral supracondylar process
152
155
EN
Dawood
Jafari
Iran University of Medical Sciences, Tehran, Iran.
N
Hamid
Taheri
Iran University of Medical Sciences, Tehran, Iran.
N
Hooman
Shariatzadeh
Iran University of Medical Sciences, Tehran, Iran.
N
Alireza
Pahlevansabagh
Department of Hand Surgery, Shafa Yahyaian Hospital, Baharestan Sq., Tehran, Iran.
pahlevansabagh@yahoo.com.
Y
Farid
Najd-Mazhar
Iran University of Medical Sciences, Tehran, Iran
N
Abstract The supracondylar process is a beak-like bony projection that arises from the anteromedial surface of the humerus. The process has rarely been associated with compression of the median nerve and seldom requires treatment. We report a case of a supracondylar process that caused tenting of the median nerve with elbow extension and pronation.
median nerve, Struthers’ligament, supracondylar process
http://mjiri.iums.ac.ir/article-1-9-en.html
http://mjiri.iums.ac.ir/article-1-9-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Significant weight loss, nausea, and vomiting due to strongyloidiasis:a case report
149
151
EN
Hossein
Froutan
Tehran University of Medical Sciences, Chairman of Gastroenterology Dept.
N
Ayatollah
Bayatian
Internal Medicine Ward, Imam Khomeini Hospital, Tehran, Iran.
bayatian@yahoo.com.
Y
Seied Mohsen
Razavizadeh
Imam Khomeini Hospital.
N
Mohsen
Nasiri-Toosi
Tehran University of Medical Sciences, Tehran, Iran.
N
Afshin
Shafaghi
Imam Khomeini Hospital.
N
Abstract Strongyloidiasis is caused by infestation with Strongyloides stercoralis, a free living tropical and semitropical soil helminth that has a larval form that penetrates intact skin. Clinical manifestations may be varied from an asymptomatic infection in immunocompetent hosts to a diffuse and fatal form in immunocompromised hosts. We report a 56-year-old man from Dezful (south-west of Iran) with a 6-month history of nausea, vomiting and significant weight loss (greater than 10%). Abdominal ultrasonography had no significant findings. Upper gastrointestinal series and abdominal CT were performed. Dilated bowel loops especially in the jejunum, with decreased mucosal folds were seen. Abiopsy specimen from the third part of duodenum showed strongyloides larvae, thus albendazole 400 mg twice a day for 3 days was initiated. He responded well to this treatment regimen.
strongyloidiasis, nausea, vomiting, albendazole.
http://mjiri.iums.ac.ir/article-1-8-en.html
http://mjiri.iums.ac.ir/article-1-8-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Outcome prediction of different groups of patients using a modified scoring system
145
148
EN
Abbas
Rabbani
Tehran University of Medical Sciences, Tehran, Iran.
N
Majid
Moini
Sina Trauma Research Center, Tehran, Iran.
moinim@sina.tums.ac.ir,
Y
Morteza
Taghavi
Tehran University of Medical Sciences, Tehran, Iran.
N
Hossein
Baradaran
Tehran University of Medical Sciences, Tehran, Iran.
N
Abstract Background: In this study we aimed to examine the discrimination and calibration of a severity characterization of trauma (ASCOT) in our setting to determine whether its usage is appropriate to predict outcome of our trauma patients. Methods: This study was conducted in three hospitals. All patients admitted in studied hospitals were divided randomly into two equal subgroups. In each group, new coefficients for ASCOT were derived from the first subgroup of patients. Then the newly developed model was validated in the second subgroup and the measures of discrimination and calibration were calculated. Results: 78% of our patients were male and 27% were children. The study mortality rate was 6%, and 20% of patients had penetrating trauma. The average age of our patients was 28 ± 19 (Mean ± Standard Deviation).The area under ROC for ASCOTwas 0.96 and Hosmer-Lemeshow goodness of fit p value was 0.81. Conclusion: In spite of many differences of the trauma care systems between our country and western countries, current survival probability models can be used in our country after customization and development of new coefficients derived from regional databases.
ASCOT, ISS, customization, Iran.
http://mjiri.iums.ac.ir/article-1-7-en.html
http://mjiri.iums.ac.ir/article-1-7-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Noise exposure and risk of hypertension: a cross-sectional study
141
144
EN
Mashallah
Aghilinejad
Faculty of Medicine of Iran University of Medical Sciences, and
Y
Masoumeh
Ghiasvand
Faculty of Medicine of Iran University of Medical Sciences, and Research Center of Occupational
N
Seyed Javad
Haji-Miresmaeil
Iran University of Medical Sciences.
N
Abstract Background: Previous studies have indicated an unspecific correlation between noise exposure and blood pressure disturbances. Blood pressure disturbances could be caused by the environmental hazards such as noise exposure. The aim of this study is to analyze whether there is a relationship between noise exposure and hypertension. Methods: Atotal sample of 218 workers working in a small workshop aged between 27 and 49 yrs answered the questionnaire in this survey. Blood pressure was measured in the sitting position after 5 minutes rest. Level of sound intensity in the workplace was measured by sound level meter (SKC Model CEL-480-440) and human noise exposure level was measured by audiometric device (MEVOX). The correlation between industrial noise and blood pressure was extracted. The t-test and Fisher’s exact test was used to compare the qualitative variables and quantitative variables with normal distribution as being applied in parametric tests. Odds ratio (OR) with 95% confidence interval (95% CI) was used to compare the magnitude of risk variables. Results: Sub-populations in this study consisted of 109 workers with noise exposure more than 85 dB (Case group) and the rest (i.e. 109 workers) with noise exposure less than 85 dB (Control group). High level systolic and diastolic blood pressure was more prevalent in the case group. Total hearing loss more than 25dB was significantly more prevalent in the case group (45% of case group have hearing loss). Adjusted Odds Ratio (OR) for the effect of age, food type and BMI on blood pressure was 3.56 (95% CI: 6.6 – 1.9). Conclusion: This study showed that high blood pressure (>_140/90 mmHg) was more prevalent in the case group. This finding persisted after adjustment was made for age, food type, and BMI. (Odds Ratio 3.56 (95% CI: 6.6 – 1.9)).
noise, hypertension, hearing loss.
http://mjiri.iums.ac.ir/article-1-6-en.html
http://mjiri.iums.ac.ir/article-1-6-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Fungal infection of the sinus and anterior skull base
137
140
EN
Morteza
Javadi
Head & Neck Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences,
N
Shabahang
Mohammadi
Head & Neck Surgery, Department & Research Center of ENT and Head &
info@shabahangm.com,
Y
Abstract Background: Invasive fungal infection is an opportunistic infection caused commonly by mucoraccae and aspergillus. It mostly occurs in patients with underlying disease. Since it has a high mortality and morbidity rate, considering a treatment strategy seems necessary. Objective: Since there has not been a clear protocol for treating these patients, we decided to establish a protocol for fungal infection of sinus and anterior skull base management. Methods: This retrospective and descriptive case study series included 30 patients. After confirming the pathogen, the authors came to a proper protocol for treatment which is mentioned later. Results: The site involvement included nose and orbital cavity (53.3%), anterior skull base and brain in conjunction with sinonasal (36.6%) and simple nasal cavity involvement (10%). 86.6% of the patients had underlying diseases. 56.6% of patients had diabetes as a single underlying disease, while 13.3% had both diabetes and renal failure in combination. Acute lymphocytic leukemia was present in 6.6%, renal failure in 3.3%, lupus in 3.3% and chronic lymphocytic leukemia in 3.3% of patients. Mortality rate was 40%. We categorized the patients into 3 groups: only sinonasal, sinonasal and orbit, and associated anterior skull base and brain involvement. Conclusion: Early diagnosis is an important factor in improving survival. Anterior skull base and brain involvement has a very poor prognosis.
sinusitis, rhinocerebral, nasal, orbital, anterior skull base.
http://mjiri.iums.ac.ir/article-1-5-en.html
http://mjiri.iums.ac.ir/article-1-5-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Ascitic fluid to serum bilirubin ratio for differentiation of exudates from transudates
132
136
EN
Amir Hossein
Boghratian
Hazrat-e-Rasool Hospital (Internal Ward. GI section),
boghratianmd@yahoo.com
Y
Majid
Chalian
Iran University of Medical Sciences, Tehran, Iran.
N
Hamid
Chalian
Tehran University of Medical Sciences, Tehran, Iran.
N
Yaser
Ghavami
Iran University of Medical Sciences, Tehran, Iran.
N
Abstract Background: Regarding the diagnostic errors of the classic criteria including serum ascites albumin gradient (SAAG), total protein concentration and the adapted Light et al’s criteria in distinguishing transudate versus exudates, we evaluated the ascitic fluid to serum bilirubin ratio as a new criteria in this regard. We also evaluated whether the combination of bilirubin ratio with each of these classic criteria improves the diagnostic accuracy. Methods: One-hundred ascitic fluid specimens were analysed prospectively whereas the category of fluid was assessed according to the clinical diagnosis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and the Youden’s index of each criterion alone and in combination with the bilirubin ratio were calculated. Results: SAAG seems to be the best criterion (specificity = 0.9090, PPV = 0.97, LR+ = 8.03, Youden’s index = 0.64). Bilirubin and LDH ratio criteria had equivalent specificity (0.8333 and 0.8205, respectively), accuracy (0.80 and 0.81, respectively), PPV (0.54 and 0.55, respectively), NPV (0.90 and 0.93, respectively) and LR+ (4.09 and 4.30, respectively) which generally were better than fluid total protein and total protein ratio but not as predictive as SAAG. The addition of bilirubin ratio to any criterion did not make any improvement. Conclusion: Ascitic fluid to serum bilirubin ratio, although not more predictive than SAAG, can be used as an alternative criterion in distinguishing exudative versus transudative ascitic fluid as it is more cost-effective in terms of laboratory processing and also more available.
Bilirubin gradient, ascites, transudative, exudative
http://mjiri.iums.ac.ir/article-1-4-en.html
http://mjiri.iums.ac.ir/article-1-4-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
Acrylic antibiotic-loaded bone cement: a basic study
125
131
EN
Hossein
Farahini
Orthopedic Surgeon and Fellowship of Knee and Arthroscopy, Rasool Akram
N
Mehdi
Ghorbani
Rasool Akram General Hospital.
N
Ehsan
Akbarian
Shahid Beheshti University of Medical Sciences.
eakbarian@gmail.com.
Y
Abstract Objective: The aim of this study was to evaluate the efficacy of antibiotic-loaded bone cement in controlling local infection and in regard to its physical characteristics, elastic modulus, and tensile strength in-vitro. Methods: Acrylic bone cement, based on polymethylmethacrylate (PMMA) was mixed with the powder form of three antibiotics, i.e., gentamicin, tobramycin, and cefuroxime with different doses below 2gr per 40gr of cement powder thereafter, liquid monomer was added to process the cement. Sensitivity to common clinical isolates was assessed by counting the inhibition zone of each ALBC disc in cultured strains. Elution with normal saline was performed to evaluate the effects on ALBC disks and their antimicrobial efficiency. Cement structure, tensile strength, and elastic modulus were assessed by biomechanical tests to understand the characteristics of ALBCs after loading antibiotics with different doses and two methods of vacuum and manual mixing. Results: Gentamicin, tobramycin, and cefuroxime reduced bacterial growth significantly with doses more than 1gr of antibiotics in 40gr of the cement. Cefuroxime was less efficient than the other two antibiotics in controlling pseudomonas. Elution with normal saline has not affected antibacterial results, significantly. All the 3 antibiotics had the same pattern of physical characteristics while loaded in bone cement. Gross structure of ALBCs with different doses of the three antibiotics was the same as non-ALBC and the elasticity or strength did not decline after loading antibiotics. The elastic modulus of ALBC was increased by boosting the doses of antibiotics however, doses of 1gr to 1.5gr were the optimal doses in this regard. The tensile strength of ALBC was increased by doses of 1gr to 1.5gr of antibiotics however, below and above these doses, the strength was decreased, but it did not exceed the basic strength of non-ALBC. Vacuum mixing method increased strength and elasticity more than manual one, remarkably. Conclusion: Optimal protective effects of ALBCs against infection could be seen with mixing doses of about 1gr to 1.5gr of antibiotics in 40gr of acrylic bone cements by vacuum method, while optimal elastic modulus and tensile strength could be achieved at the same doses.
ALBC, acrylic bone cement, antibiotic, microbiology, biomechanics
http://mjiri.iums.ac.ir/article-1-3-en.html
http://mjiri.iums.ac.ir/article-1-3-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
A novel bedside technique for differentiation of exudative from transudative pleural effusion
120
124
EN
Mohammad
Homayouni
Head of Dept. of Internal Medicine, Shohada-e- Tajrish Medical Center,
homayouni28@yahoo.com
Y
Reza
Hashemi
Shohada Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
N
Ashraf
Ashraf Askari
Shemiran Health Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
N
Abstract Background: At present, differentiation between exudative and transudative pleural effusion is based solely on laboratory measures and is time-consuming. Asimple bedside method would be of great help to differentiate between these two types of effusions. We present a new method for this purpose assessed in 46 patients. Methods: Standard laboratory tests and our method were tested using the same fluid samples in 46 patients with pleural effusion. Aprincipal in physics called the capillary tube law (h=2a/rpg) was used to compare the samples. The imbibition of the fluid level less than 15mm signified exudate and greater than 15mm signified transudate. Results: Our data shows that this method is 74% sensitive and 89.4% specific compared to the standard method when analyzed statistically by the chi-square and Kappa agreement (Cronbach’s K) tests. Conclusion: The capillary tube test has an acceptable validity for bedside diagnosis of exudative or transudative effusions.
exudate, transudate, pleural effusion, CTT
http://mjiri.iums.ac.ir/article-1-2-en.html
http://mjiri.iums.ac.ir/article-1-2-en.pdf
Iran University of Medical Sciences
Medical Journal of The Islamic Republic of Iran (MJIRI)
1016-1430
2251-6840
22
3
2008
11
1
A 5-year evaluation and results of treatment of chronic locked dislocations of the shoulder joint
111
119
EN
Ali Akbar
Khorsandi
Shafa Yahyaian Hospital, Iran University of Medical Sciences,
alikhorsandi@yahoo.com.
Y
Morteza
Nakhaei Amroodi
Shafa Yahyaian Hospital, Iran University of Medical Sciences, Tehran, Iran.
N
Maziar
Khorsandi
N
Syawash
Mirsaid Ghazi
Shafa Yahyaian Hospital.
N
Abstract Background: Chronic neglected dislocation of the shoulder joint can be defined as a neglected dislocation for more than a 3 week period. However, it has been shown that the negligence could range from a 24 hour period to 6 months1. Depending on age, signs, symptoms, etiology and types of dislocation, conservative treatment or surgical intervention could be considered. Methods: In this study, 16 patients (13 were male and 3 were female) were treated with chronic shoulder dislocations, 3 of which had bilateral dislocations. The age of this group ranged from 13-65 years with a mean age of 34 years. These patients were treated by closed or open reduction, either anterior, posterior or both approaches. Of 19 dislocations, 6 were anterior unilateral, 7 posterior unilateral, 1 anterior bilateral and 2 posterior bilateral dislocations. The mean period between dislocations and treatments was 3 months (from 4 weeks to 11 months), and the mean follow up period was 40 months (from 21 months to 5 years). Results: This study has shown that treatment varies according to pathology. In this study the mean size of head defects was 35% and the extent of severity determined the approach. Findings at the last follow up were assessed according to Rowe and Zarins score and of the 19 shoulders assessed, 9 showed good and 10 showed excellent results. There was no recurrence of the dislocation in any patient. Conclusion: In some selected instances, open reduction of a chronic locked neglected shoulder dislocation of a 6 months period or more in young patients is recommended.This method is, however, contraindicated in elderly patients in such cases a shoulder prosthesis is indicated.
locked neglected anterior or posterior dislocation, closed or open reduction, shoulder prosthesis
http://mjiri.iums.ac.ir/article-1-1-en.html
http://mjiri.iums.ac.ir/article-1-1-en.pdf