Screening of long Q-T syndrome in patients with congenital sensorineural hearing loss
A.
Rafighdost
دانشیار گروه قلب و عروق
author
M
Salari
پزشک عمومی
author
text
article
2007
per
I ntroduction: The idiopathic long Q-T syndrome is an infrequent disorder, in which affected individuals have an unusual ECG repolarization abnormality presenting as syncope. Congenial long Q-T prolongation can be associated with congenital deafness in an autosomal recessive manner (Jerval and lange Nielson Syndrome). Materials and Methods: This descriptive study was accomplished in 2003, on 100 cases with congenital deafness as the case group and 100 cases with intact hearing as the control group. The two groups were similar with respect to sex and age. ECG performed for the both groups and Q-T duration was measured according to Bazet formula. Data recorded in a questionnaire and analyzed by descriptive statistics. Results: The cases were between 7- 12 years old, with the mean age of 9. Almost 50% of cases were female and 50 % were male. The mean Q-Tc duration was 0.42 sec in the control group, 0.42 sec in both females and males. The mean Q-Tc duration was 0.43 sec in the case group, 0.44 sec in female and 0.42 sec in male. In the case group, 44% had Q-Tc>0.46 sec (29% female and 15% male). In the control group, 28% had QTc= 0.44 sec (14% male and 14% female). Conclusion: The present study's data supported the presence of long Q-T syndrome in patients with sensorineural hearing loss in the studied population. So, Routine ECG screening is recommended in patients with congenital deafness.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
249
252
https://mjms.mums.ac.ir/article_5552_fdec50b9dba9e07e90abf4a9a20466bd.pdf
dx.doi.org/10.22038/mjms.2007.5552
Complications and Patency Rate of Portosystemic Shunts in Chronic Liver Diseases
M.H
Modaghegh
دانشیار
author
Gh
Kazemzadeh
استادیار
author
H
Ravari
استادیار
author
H
Esmaeili
استادیار
author
M
Farhoudi
استاد
author
M
Fadavi Eslam
دستیار تخصصی قلب و عروق دانشگاه علوم پزشکی مشهد
author
text
article
2007
per
I ntroduction:Cirrhosis is the most important etiology of portal hypertension worldwide. Even with improvements in noninvasive therapies, portosystemic shunts still remain one of the most important approaches after failure in medical treatment. Transjugular Intrahepatic Portosystemic shunt and liver transplantation are alternatively used in other countries. Evaluation of complications and patency rates can be a great help in choosing the best technique in patients. The aim of this study was to evaluate patency rate and complications of portosystemic shunts in patients with chronic hepatic diseases. Materiasl and Methods: In this cross sectional study, from summer 2000 to spring 2004, carried out at General and Vascular Surgery Departments 19 patients with portal hypertension underwent surgery. Patients with portosystemic shunts were followed up for at least one year after surgery, considering blood flow in anastomosis, using color Doppler ultrasonography and symptoms such as gastro intestinal bleeding, hepatic encephalopathy and etc. Data were analyzed using SPSS version 13 and descriptive statistics. Results:Male to female ratio was 1:1.7. Portosystemic shunt was performed for 16 patients (2 distal splenorenal, 10 central splenorenal, 2 portocaval, 2 mesocaval) and 3 underwent splenectomy. Of patients 2 complicated with pneumonia after a week, and 2 with encephalopathy. After at least one year, 66.6% of shunts were patent, 8% were closed and in 25.4% doppler ultra sonography could not localize the shunt. One patient died under surgery. There was no death at the end of the first year; but during a 6 years follow up, 6 mortalities occurred. Conclusion: The major etiology of portal hypertension in these patients was cirrhosis secondary to hepatitis B. This finding is due to the cultural and religious differences with other countries. There was no relationship between pneumonia and splenectomy (p= 0.45). Also, no significant difference observed between pre and post surgery encephalopathy (p =0.14). Mortality rate did not depend on pre (p= 0.09) and post (p= 0.11) surgery encephalopathy. Survival rate of patients was 94.7% after one year and 73.7% after 2 years, demonstrating better results in comparison with other similar studies.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
253
258
https://mjms.mums.ac.ir/article_5553_4c1b22b504f5478de2b8fd593b5f56fc.pdf
dx.doi.org/10.22038/mjms.2007.5553
Prevalence of Cardiovascular Risk Factors in Male Individuals with Hypertriglecamic Waist Phenotype
M
Saedi
کارشناس پژوهشی مرکزتحقیقات قلب و عروق
author
A
Akhava Tabib
پزشک عمومی
author
M.H
Jokar
کارشناس مرکزتحقیقات قلب و عروق
author
A
Yazdani
کارشناس مرکزتحقیقات قلب و عروق
author
text
article
2007
per
Introduction:I ntroduction: Metabolic Triad is one of the risk factors of cardiovascular diseases (CVDs) which has an effective, determinant effect on these diseases. Hypertriglyceridemia and abdominal obesity (waist circumference) are among CVDs risk factors and the increase of these factors can predict the occurrence of TM. This project was aimed to investigate the relation of high phenotype triglycerid and waist circumference with CVD risk factors. Material and Methods: In a descriptive cross-sectional study, carried out in the year 2005, in Isfahan, 6123 men were selected based on the results of IHHP’s phase I by random-cluster sampling method. Their blood sugar and blood lipids measured by blood sampling. Also, their blood pressure, waist circumference, height and weight measured. They were divided into 4 groups based on their tryglycerid and waist circumference: TgHWH group (TG³165mg/dl, waist circumference³102cm), TgHWL group (TG³165mg/dl, waist circumference <102cm), TgLWL group (TG<165mg/dl, waist circumference<102cm) and TgLWH group (TG<165mg/dl, waist circumference³102cm). Data was analyzed by SPSS software. The variables of these four groups studied by variance test. Regression logestic test, used to determine the prevalence of risk factors. Results:Theprevalence of risk factors in TgHWH group was higher than other groups and in TgLWL group lower than others. Also, it differed significantly these groups. The prevalence of TgHWH in the studied population recorded as 20.8%. Cholesterol, triglyceride, LDL cholesterol, Body mass index, and Blood Pressure in this group were higher and the mean HDL, was lower than others. Conclusion: In large population, it is impossible or non-economiccal and time consuming to evaluate all risk factors, in order to predict other CVD risk factors and to determine high risk people. However, according to the high prevalence of risk factors in people with TghWh, this phenotype can be used as a simple tool for evaluation in larger population.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
259
268
https://mjms.mums.ac.ir/article_5554_0c1734b8598899cb6a6ea443e80b9fde.pdf
dx.doi.org/10.22038/mjms.2007.5554
A Study of Hematologic, Hepatic and Renal Side Effects of Intramuscular Injection of Meglumine Antimoniate (Glucantime) on Patients with Cutaneous Leishmaniasis
M
Maleki
دانشیار بیماری های پوست
author
Z
Javidi
استاد بیماری های پوست
author
A.R
Taheri
استادیار بیماری های پوست،
author
M
Ebrahimi Rad
متخصص بیماری های پوست،
author
M
Rasti
پزشک عمومی
author
text
article
2007
per
I ntroduction: Cutaneous leishmaniasis is an endemic disease in many countries that is caused by different species of Leishmania. Nowadays, standard medication for leishmaniasis is pentavalent antimony compounds that are used intramuscular or intralesional. Though, they are drugs of choice, there are limitations such as hematologic, hepatic, renal and cardiac side effects. This study reviewed hematological, hepatic, and renal side effects of glucantim. Material and Methods: The present work was a pre- and post- treatment study on 35 patients with cutaneous leishmaniasis referred to Dermatology Department, Imam Reza Hospital, Mashhad. Their disease was confirmed by direct smear. The patients were treated with intramuscular glucantime 60mg/kg daily for 20 days. Complete blood count (CBC, diff), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), blood urea nitrogen (BUN), creatinine(Cr) were evaluted at 3 times: before treatment, on the 20th day of treatment course (last day of injection), and a month after the end of treatment. Demographic, laboratory and treatment results, and drug complications were recorded in a questionnaire. Data were analyzed by descriptive statistics. Results: Of35 patients in this study, 26 completed the course. Red blood cell count, hemoglobin and hematocrit levels significantly reduced (P<0.05), but no significant difference was shown in white blood cell and platelet count. The increase of serum SGOT and SGPT levels were considerable (P<0.05). Elevated serum levels of Cr and BUN observed in 11.5% and 34.6% of patients, respectively; and renal side effects were more common in females than in males (64% in females VS 10% in males). Conclusion: Systemic glucantime is associated with hematologic, hepatic, and renal side effects. Therefore, evaluation of hematologic, hepatic and renal statement in patients receiving glucantim, before and during treatment is suggested.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
371
378
https://mjms.mums.ac.ir/article_5555_1c2a032fb26e4e81e610f247db9580f4.pdf
dx.doi.org/10.22038/mjms.2007.5555
Comparison between Finger Bougie of the Pylorus and Pyloroplasty or Pyloromyotomy in Gastric Pull-up Esophageal Surgery
A
Jangjoo
استادیار جراحی
author
M
Mehrabi
دانشیار جراحی
author
K
Kavyani
دستیار جراحی
author
A
Amozeshi
دستیار جراحی - بیمارستان امام رضا (ع)
author
text
article
2007
per
I ntroduction: In gastric pull-up esophageal surgery, functional obstruction of the pylorus is seen in almost 20% of patients. The purpose of this study was launching finger bougie of pylorus instead of traditional pyloroplasty or pyloromyotomy. Materials and Methods:This descriptive study carried out from 2002 to 2004 on patients, admitted to the Department of General Surgery of Imam Reza Hospital, Mashhad. Of 58 patients with esophageal cancer, who underwent gastric pull-up esophageal surgery, pyloroplasty or pyloromyotomy was randomly performed on 31 cases (group A), and finger bougie of pylorus (group B) on 24 patients. On the 9th day postoperatively static function of pylorus was evaluated with gastric emptying study. Based on emptying time of the stomach, patients were divided into normal, delayed drainage and complete obstruction groups.Using a questionnaire, individual characteristics, surgical outcome and results of gastric emptying scan were recorded and analyzed by descriptive statistics, frequency distribution tables, Chi-2 and Chi- Square tests. Results: Of patients, 58 with average age of 58 years old were evaluated from these. 40 cases (69%) were male and 18 cases (31%) were female. Pyloric operations were finger bougie in 31 cases (53/4%), pyloromyotomy in 24 cases (42/4%), and pyloroplasty in 2 cases (3/4%). In 1 case (1/7%) pylorus was intact.Complications were, wound infections in 8 patients (13/8%), cervical fistula in 2 (3.4%) thoracic fistula in 1 (1.7%), chylothorax in 3 patients and tracheal injury in 1 patient. Gastric emptying time was measured in 53 patients with TC99 scanning. The result was normal in 44 cases (75/9%), delayed in 8 cases (13/8%), and gastric outlet obstruction in 1 (1/7%). Conclusion: Although transhiatal esophagectomy is considered as a palliative procedure, some surgeons prescribe it for all stages of the disease. Most of tracheal injuries are in membranous portion. In small tearing, conservative management with bypassing the site of injury by endotracheal or tracheostomy tube was recommended. Surgery is suggested in large tear or failure of conservative therapy. The first recommendation for fistula in cervical anastomosis is conservative. Early surgery is suggested in complete disruption, non responsive patient after 3 weeks, and intra thoracic fistula. In the present study the results of gastric emptying test in group A (finger bougie of pylorus) and group B (pyloromyotomy or pyloroplasty) were compared. Finger bougie of pylorus in gastric pull-up surgery is preferred and suggested.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
275
282
https://mjms.mums.ac.ir/article_5556_d903fb64c2ad530c57cd3b2901315910.pdf
dx.doi.org/10.22038/mjms.2007.5556
An Evaluation of Hirsutism at Khatam-Alanbia Hospital
M
Banihashemi
استادیار
author
S
Family
استادیار
author
Y
Nahidi
دستیارتخصصی
author
text
article
2007
per
I ntroduction: Hirsutism is a common problem with the presence of terminal (coarse) hair in female, in a male-like pattern, that has different etiologic factors. This project was carried out to determine the etiologic factors of hirsutism with clinical and para clinical studies. Material and Methods: This descriptive cross sectional study was performed at Khatam –Alanbia Hospital in Zahedan, Iran, from August 2001 to September 2003. Clinical and para clinical findings of 180 hirsute women, referred to Dermatology Clinic were evaluated. Paraclinical tests included serum testostrone, dihydroepandrostendion sulfate, thyroid stimulating hormone, follicle stimulatig hormone, luteinzing hormone, prolactin, 17-OH progesterone, and ultrasonography. Results: levels of one or more androgens elevated in 70 patients (39%). Poly cystic ovary syndrome was diagnosed in 96 patients (53/3%). A group of 80 patients (44/4%) with regular menstrual cycles and normal laboratory and sonographic findings had idiopathic hirsutism. Of patients 28, (29/2%) with poly cystic ovaries had regular menstruation. Late onset of adrenal hyper plasia, due to partial 21- Hydroxylase deficiency, was diagnosed in 4 patients (2/2%). Conclusion:There are various causes of excessive hair in women. The present study's results like other studies indicated that poly cystic ovary syndrome is the most common cause and a screening work-up should be recomended on all patients with hirsutism, even women with regular menstrual cycles.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
287
290
https://mjms.mums.ac.ir/article_5557_fce123f90e283d1d1c47f4bcbe2d2321.pdf
dx.doi.org/10.22038/mjms.2007.5557
Clinical Presentation of Hyperuricosuria in Children
F
Ghane
استادیار نفرولوژی کودکان
author
M
Esmaeili
دانشیار نفرولوژی کودکان دانشگاه علوم پزشکی مشهد
author
text
article
2007
per
I ntroduction: Hyperuricosuria (HU), defined as an increased uric acid excretion, has different symptoms in children and is responsible for the formation of kidney stone. This study was aimed to outline the clinical presentation and natural history of HU in children with hematuria, dysuria, discoloration of urine, and recurrent abdominal / flank pain. Material and Methodes: In this cross sectional study, from October 2002 to May 2006, 88 children with Hyperuricosuria at Dr Sheikh Hospital, Mashhad were evaluated. Urinalysis, urine culture, 24-hour urine collection for measurement of uric acid, Calcium and Creatinine, serum evaluation for BUN, Creatinine, uric acid, Calcium, Phosphorous and Hco3- and renal ultrasonugeraphy were carried out done for patients. All data were recorded and analyzed with descriptive statistical methods. Results: From 88 evaluated patients, 51% were boys and 48.8 % were girls. The mean age of children was 5.3± 1.2 years. The mean Urine Uric Acid was 13.4 mg/kg/24h and mean Urine PH was 5.3. Hematuria was not among the presenting symptoms in 41 patients. Thirty three patients had normal urinalysis at the first examination, 28 of them had microcalculi (< 3 mm in diameter) at renal ultrasonography and 12 had stones (4-13 mm). Dysuria and abdominal / flank pain were present in 22 and 17 patients, respectively. There was no microscopic hematuria in 24.3% of patients with microcalculi or stone. Family history of urolithiasis was positive in 63 of the children. Conclusion: Hyperuricosuria has to be suspected in children with dysuria, recurrent abdominal / flank pain, discoloration of urine, and familial history of urolithiasis. The lack of hematuria is not predictive of the absence of urolithiasis.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
291
294
https://mjms.mums.ac.ir/article_5558_d9fa5869f01c194a75bd709d80a284c8.pdf
dx.doi.org/10.22038/mjms.2007.5558
Evaluation of Apnea Test in Brain-Dead Patients
M
Gharavi
استادیار گروه بیهوشی
author
S
Zabihian
استادیار گروه جراحی اعصاب دانشگاه علوم پزشکی مشهد
author
text
article
2007
per
I ntroduction: Apnea testing is mandatory to confirm brain death. Serious side effects such as severe cardio-pulmonary complications, ICP elevation and pneumothoraces may occur during apnea testing. So, it should be performed as the last test after the other ones. However, its safety is a major issue .The aim of this study was to evaluate the results and complications of apnea test in brain dead patients in the course of three years. Material and Methods: This cross sectional study was corried out from 2002 to 2005 at Mashhad University of Medical Sciences with a simple sampling method on 57 brain dead patients in whom apnea test was performed by the authors. After preoxygenation the test was done in 10 minutes during which the patients had been disconnected from the ventilator. ABG analysis proceeded in minutes 2, 5, 8 and 10. The test result assumed positive if PaCO2 was increased up to 60mmHg or more than 20mmHg from baseline value. All patients should had been preoxygenated. The test stopped whenever predefined complications occurred. All the data collected in a separated questionnaire. Statistical analysis was done using SPSS software and with ANNOVA test. Results: From 57 brain dead patients in this study, 11 were female and 46 were male. The mean age of the patients was 25.28 years, ranging from 6 to 38 (SD= 14.3). Serious complications occurred in 11 patients including severe hypoxia in 10 and cardiac arrest in one. These complications were more common in patients, before testing, with an unstable cardiopulmonary condition than the ones with a stable condition (53.84% versus9.6%). The mean period from death time to apnea testing was between minimally 36 hours and maximally 11 days. It was 11 days in a patient aged 15. In all cases, the results of the tests were positive and supported by clinical diagnosis of brain death. Conclusion:Apnea test is an invasive test. It may reduces the organ reservoirs and potentially induces tissue ischemia, due to severe cardio-pulmonary complications. Also, it is not able to reject brain death diagnosis, if it has already been confirmed by the other tests. It seems that an alternative test with a high index of safety should be considered or some modifications are needed. At least, it is suggested to be avoided in patients with an unstable cardiopulmonary condition.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
295
300
https://mjms.mums.ac.ir/article_5559_35e22b34ae3a7087ee25d58d3fbae375.pdf
dx.doi.org/10.22038/mjms.2007.5559
Examination of Mechanisms Involved in Spasticity Reduction after BTX-A Injection in Hemiplegic Patients
M
Shaikh
دانشجوی دکترای فیزیوتراپی
author
H.A.
Hoseini
دانشجوی دکترای فیزیوتراپی
author
R
Abolfazli
استادیار و متخصص نرولوژی
author
N
Nakhostin Ansari
استادیار فیزیوتراپی
author
text
article
2007
per
I ntroduction: Spasticity is a common and disabling complication that occurs as a result of upper motor neuron lesion. Recently, Botulinum Toxin – A (BTX-A) has received a pronounced position in spasticity treatment because of its efficacy, high capability of selective effects and low side effects. In this study, through electrophysiologic tests, mechanisms involved in spasticity reduction following BTX-A injection were studied. Materials and Methods: This descriptive study was carried out in the year 2006, on 15 hemiplegic patients (age ranged 44- 70 yrs) with spasticity of ankle plantar flexors at Tehran University of medical Sciences. According to the Original Ashworth Scale (OAS), before and after intervention, spasticity of muscles was assessed. Electrophysiologic measurements consisted of amplitude of maximum H- reflex, M response and H / M ratio of soleus muscle, were recorded before and after injection. Toxin was injected in Gastrocnemius (200 units), soleus (75 units) and posterior tibialis muscles (50 unit). Data were recorded in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Results: Four weeks after injection, significant reduction in H- reflex, M response amplitudes and H / M ratio were seen. According to the OAS, severity of spasticity also, showed a meaningful reduction. H – Reflex amplitude had more expressive reduction than M response. Conclusion: Reduction of H -reflex amplitude and H / M ratio is the result of toxin effect on intrafusal fibers and reduction of M response amplitude is the result of toxin effect on extrafusal fibers. More significant reduction of H – reflex amplitude in comparison to M response, showed that BTX-A can reduce the spasticity through modification of gamma motor neuron system. Results of this study could help the therapists, in selecting the most efficient therapeutic exercises, for application after the BTX-A injection.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
301
308
https://mjms.mums.ac.ir/article_5560_3059e86b0bd2c7ab4fa04b2d13164314.pdf
dx.doi.org/10.22038/mjms.2007.5560
A Comparison between Results of Topical Nitroglycerin Ointment and Sphincterotomy in Chronic Idiopathic Anal Fissure
L.
Mohajerzadeh
متخصص جراحی عمومی
author
M.
Ghaemi
استاد جراحی عمومی
author
A
Jangjoo
استادیار جراحی عمومی
author
M
Shariati
استادیار جراحی پلاستیک و ترمیمی
author
H
Esmaili
استادیار آمار زیستی - بیمارستان امام رضا(ع)
author
text
article
2007
per
I ntroduction:Chronic anal fissure is a common problem, and there are different ways for treatment. The goal of this study was to compare the effectiveness and complications of topical nitroglycerin with internal sphicterotomy in the treatment of chronic anal fissure. Materials and methods: This randomized clinical trial study was performed from 2002 to 2005 at Imam Reza Hospital, Mashhad, Iran on 200 patients with symptomatic anal fissure, who randomly categorized into two groups of case (n=100) and control (n=100). The case group (A) treated with nitroglycerin ointment %0.2 twice a day for 6 weeks and the control group (B) recieved sphincterotomy. Individual, surgical and medical results data were recorded in the questionnaire. Data analyzed using descriptive statistics, frequency distribution tables, and Fisher test. Results: after 6 weeks of treatment, results showed that healing was not significantly different between the two groups, but after 6 months, difference was significant (p=0/11). Surgical group healed 100%. Headache in medical group was more noticable than the other group (p<0/001). But hypotension attack, palpitation, dizziness, and vomiting were not considerably different between the two groups. Conclusion: Internal sphincterotomy is superior to topical nitroglycerin in treatment of chronic anal fissure, with a high rate of healing, few side effects, and low risk of early incontinence.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
309
314
https://mjms.mums.ac.ir/article_5561_d83bab2c0506724ab76cb9cfce65523d.pdf
dx.doi.org/10.22038/mjms.2007.5561
The Comparison between Fluoxetin and Clomipramin in Children and Adolescents with Obsessive - Compulsive Disorder
A
Soltanifar
استادیار روانپزشکی
author
A
Abdollahian
دانشیار
author
A
Nasiraee
رزیدنت روانپزشکی
author
text
article
2007
per
I ntroduction:Obsessive compulsive disorder (OCD) in children and adolescents is apparently a much more common disorder than what believed before. Most studies concerning treatment of OCD has been based on experience from adult patients. Only a few controlled trials using medication in children with OCD have been conducted. The present study compared the efficacy of clomipramin and fluoxetin in children and adolescents with OCD. Materials and Methods: This double blind clinical trial, performed from 2002 for one year, at Mashhad Pediatric Psychiatry, compared the efficacy of clomipramin and fluoxetin in 26 OCD children and adolescents, randomized into two groups. Efficacy assessments included the child version of Yale -Brown obsessive compulsive scale (CYBOCS) and NIMH Global rating scale and Maudsely questionnaire. The study took 8 weeks long and assessments were accomplished before the treatment, 4weeks and 8weeks after it. Clomipramin was used 10mg/day in patients over 20 kg weight and increased to 50 mg /day in one week. Dosage then rose up to 3 mg/kg based on the clinician's decision. Fluoxetin was started with 10 mg/day and reached 20 mg/day in one week. Then titrated up to 1mg/kg/day based on clinical judgment of clinician. Three patients were dropped out because of different reasons and one patient discontinued using Clomipramin because of its adverse effects. Data were collected and analyzed using the descriptive statistics and Mann withney test. Results: There was a significant difference in the efficacy of the two drugs based on total CYBOCS score and the score of obsessions, compulsions and fluoxetine was more effective than clomipramin. However, there was no conciderable variation between them based on maudsely questionnaire, its subscales scores and NIMH Global rating scale score. The CYBOCS total score decreased to 44% and 49% after 8 weeks of clomipramin and fluoxetin consumption, respectively. Conclusion: The results suggested that fluoxetin is at least as effective as clomipramin in short term treatment of children and adolescents with OCD. More studies with larger sample size and longer time for follow-up are recommended.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
315
320
https://mjms.mums.ac.ir/article_5562_e8baf6a3a7f80751afdcde42d35777a0.pdf
dx.doi.org/10.22038/mjms.2007.5562
The relationship between Severity of the Systemic Inflammatory Response Syndrome (SIRS) and Its Etiology and Outcome
A
Heydari
استادیار بخش بیماریهای عفونی بیمارستان امام رضا ( ع ) -دانشگاه علوم پزشکی مشهد
author
M.J
Ghaboli
استادیار بخش بیماریهای عفونی بیمارستان امام رضا ( ع ) -دانشگاه علوم پزشکی مشهد
author
text
article
2007
per
I ntroduction: SIRS is known as a condition with the presence of four criteria of: Fever or hypothermia. Tachypnea. Tachycardia. Leukocytosis or leukopenia or bandemia. Sepsis is defined as the SIRS with an infectious etiology. Incidence rate is increasing during the recent 15 years. The key point in treatment of sepsis is early diagnosis and beginning of treatment according to the signs before the occurrence of complications like hypotension. This study was done to evaluate the relationship between the severity of SIRS and its etiology and outcome. Materails and Methods: This descriptive study was carried out in the year 2004 on 306 cases of SIRS, referring to Infectious ward of Imam Reza hospital, Mashhad, Iran. The study was accomplished through completing questionnaires, after getting medical history, physical and laboratory examinations (including CBC, urine analysis, platelet count, and ESR) of patients. Then the sensitivity, specififity and positive predictive values for SIRS regarding differentiation of infectious from non- infectious diseases were studied. In addition, the severity of SIRS and its effects on mortality, also, the effects of severe SIRS on any infection in platelet count and ESR were evaluated. The Results were arranged as charts, graphs and described by MANN-WHITENY, T-student. Results:According to the number of patients final diagnosis included pneumonia (n=56), meningitis (n=35), unknown origin infections (n=34), urosepsis (n=25), and miscellaneous etiologies such as brucellosis, hepatitis, etc. There were 23 non-infectious patients and 17 mortal cases. The highest mortality rate was in pneumonia (n=7) that often had serious leukocytosis. Severe SIRS has 20.1 % sensitivity and 95 % positive predictive value for diagnosis of infection. Conclusion: There was no statistically significant difference between the two groups, regarding the primary vital signs, laboratory findings, age, sex, and mortality rate. The mortality rate didn't have any relationship with thrombocytopenia, increased ESR or sex; but was related to hypotension, serious leukocytosis and severity of SIRS. Based on the primary vital signs and laboratory findings, the severity of SIRS has a clear correlation with the mortality rate. Heuce it is recommended that much attention should be paid to the documents of vital signs and routine laboratory findings for the early diagnosis and treatment.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
321
326
https://mjms.mums.ac.ir/article_5563_c84ccfda74f5140403816231ae0a69ea.pdf
dx.doi.org/10.22038/mjms.2007.5563
Comparative Efficacy of Citalopram and Nortriptyline in Geriatric Patients with Major Depressive Disorder
N
Mokhber
استادیار روان پزشکی دانشگاه علوم پزشکی مشهد
author
A
Talaei
استادیار روان پزشکی دانشگاه علوم پزشکی مشهد
author
A
Soltanifar
استادیار روان پزشکی دانشگاه علوم پزشکی مشهد
author
text
article
2007
per
I ntroduction: Major depressive disorder is a common and disabling disorder that causes high rates of morbidity and mortality. Nortriptyline is a tricyclic antidepressant that has been used for geriatric depression since a long time ago. Prescription of SSRIs in geriatric depression has been increased recently, because of more favorable profile of their side effects. This study designed to compare the efficacy of nortriptyline and citalopram in geriatric depression, Because of the importance of choosing the most appropriate medication in geriatric population. Materials and Methods:The present study was a single blind clinical trial, performed from February 2005 for a one year period. Patients age above 60 years referred to Ibne-sina hospital with the confirmed diagnosis of major depressive disorder, based on DSM-IV-TR criteria, were included in the study. These patients were randomly divided into two groups: one group (n= 37) taking citalopram 10-20 mg/day and the other group taking nortriptyline 25-150 mg/day (with the mean dose of 100 mg/day). The efficacies of medications were assessed after 8 weeks based on the change in HDRS. Finally, 72 patients completed the study and 13 patients (5 from citalopram group, 8 from nortriptyline group), for different reasons discontinued the medication. Data analyzed using descriptive statistical tests and chi square. Results:Demographic data and HDRS scores did not show statistical considerable variance in the two groups. Also, Changes in HRDS scores before the treatment and after 8 weeks were not significantly different between them. Insomnia was seen in 5 patients taking citalopram (13.4%). Three patients (8.1%) in the citalopram group and one patient (2.8%) in the nortriptyline group complained from nausea in the early treatment phase. Headache was seen in 8.1% and 2.8% in the groups taking citalopram and nortriptyline, respectively. In the patients taking nortriptyline, the most prevalent complaints were dry mouth (28.5%) and drowsiness (22.8%). Conclusion: Results showed that both drugs are efficient in the reduction of geriatric depressive symptoms and HRDS scores decrease was more than 50% in both groups. No significant difference was seen between the efficacy of two drugs and this result is consistent with the previous studies. These findings need to be confirmed with further researches.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
322
327
https://mjms.mums.ac.ir/article_5564_e7cfa5d86da8d06e17f231b4dd54eb06.pdf
dx.doi.org/10.22038/mjms.2007.5564
Two Cases of Hepatotoxicity Due to Ketokonazole
F
Moradimoghaddam
استادیار (فوق تخصص گوارش)
author
A
Mokhtarifar
استادیار (فوق تخصص گوارش)
author
H
Saadatnia
استاد (فوق تخصص گوارش)
author
text
article
2007
per
I
ntroduction: Ketoconazole is an antifungal agent of Imidazole group which is used in different parts of the body, such as skin, nails, vagina, and etc. Hepatotoxicity is one of its potentially fatal complications which can be manifested as cholestasis, hepatitis, and fulminant hepatic failure. Hepatic complications of this drug are usually started during 6 weeks, but also they have been reported up to 6 months after the treatment. If the LFT changes are mild, the treatment can be continued cautiously, however, it is necessary to stop it evident hepatitis and jaundice are to be occurred. In this group, Fluconazole as a new agent doesn't have severe hepatic complications, so it is preferred in many cases.
Case Reports:In this study two cases of 36 year old women, died because of fulminant hepatic failure due to Ketoconazole induced hepatitis are reported. In both cases, viral and autoimmune hepatitis have been ruled out.
Conclusion:Despite the rarity and irreversibility of Ketoconazole induced fulminant hepatic failure, it is essential in most cases to pay attention to the hepatotoxicity symptoms carefully.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
111
111
https://mjms.mums.ac.ir/article_5565_3b22f82849824b5f8fe50c1a288057fa.pdf
dx.doi.org/10.22038/mjms.2007.5565
A Rare Case of Primary Orbital Yolk Sac Tumour (YST)
B
Memar
استادیار پاتولوژی
author
A.
Aledavod
استادیار رادیوتراپی
author
S
Amoueian
استادیار پاتولوژی
author
N
Tayebi mebodi
استادیار پاتولوژی
author
M
Farzadnia
استادیار پاتولوژی،
author
M
Ahadi
متخصص داخلی
author
A.K
Sabermoghaddam
استادیار چشم پزشکی
author
F
Farhadi
دستیار پاتولوژی
author
text
article
2007
per
I
ntroduction: The endodermal sinus tumor (EST) or yolk sac tumor (YST) is a malignant germ cell neoplasm that usually arises in gonads, but on rare occasion occurs in extragonadal sites such as mediastinum, retoperitoneum and intra cranium. Orbit is an extremely rare location for this tumor.
Case Report: In this report a primary yolk sac tumor in the orbit of a 17 months old child is presented. Patient had a rapidly progressive proptosis and high level of serum alpha fetoprotein (12500 IU/ml). After surgical biopsy and histopathological diagnosis, the patient treated with 4 courses of a 3 drugs chemotherapeutic regimen. A period of 6 months follow up did not reveal any sign of recurrence.
Conclusion: Although yolk sac tumor is very rare in orbit, a rapid and correct histopathological diagnosis in conjuction with immunohistochemical and other paraclinical evaluation and at last, effective chemotherapeutic regimens can provide a good prognosis and even cure for the patient.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
349
353
https://mjms.mums.ac.ir/article_5566_d41d8cd98f00b204e9800998ecf8427e.pdf
dx.doi.org/10.22038/mjms.2007.5566
A case report of Alveolar Echinococcosis
F
Berenji
استادیار انگل شناسی
author
S
Mirsadraei
استاد پاتولوژی
author
L
Asadi
متخصص آناتوموکلینیکال پاتولوژی
author
A.
Marofi
متخصص جراحی عمومی
author
A
Fata
ستاد انگل شناسی،
author
M
Shahi
دانشجوی کارشناسی ارشد انگل شناسی
author
text
article
2007
per
I
ntroduction: Echinococcus multilocularis is the cause of alveolar hydatic cysts in intermediate host, found in the liver and lungs. Alveolar hydatid diseas is the most lethal of helminthic diseases, with radical surgery still being the only curative therapy. The aim of this study was to report a splenic alveolar hydatic cyst.
Case Report: The patient was a 62 years old man, from a rural region of Ghochan, Khorasan Province, Iran, who was referred to surgeon, complaining left upper quadran abdominal pain. In CT scan 2 cysts were seen in the right lobe of liver and a septal cyst in spleen. After operation, evacuating and unroofing of the liver cysts, splenectomy was performed.
Diagnosis was based on pathologic and histologic examinations. In macroscopic examination spleen was massive and cystic, composed of multiple irregular cysts with infiltrative appearance.
The inner part of cysts contained brown necrotic and gelatinous material, at microscopic examination there was a thin acellular laminated layer but the germinal layer and protoscolex were not seen. After a week the patient recovered and left the hospital with good general condition.
Conclusion: In conclusion, the presence of this case showed that life cycle of echinococcus multilocularis can be completed in this province. Medical managers and practitioners must notice this disease as a differential diagnosis for malignant of liver and spleen, as well as for prevention and control of the disease itself.
medical journal of mashhad university of medical sciences
دانشگاه علوم پزشکی مشهد
1735-4013
50
v.
3
no.
2007
354
357
https://mjms.mums.ac.ir/article_5567_d74a692ed00b2e3328d283631cb1f8bb.pdf
dx.doi.org/10.22038/mjms.2007.5567