History and Objectives: Cataract surgery is one of the most common surgical methods performed on the eye. Endophthalmitis is one of the complications of the eye, which may have serious adverse effect on the patients. In order to address this issue, epidemiologic analysis of microorganisms most prevalent in the anterior chamber fluid among patients undergoing cataract surgery in Matini hospital was investigated in 1996 and 1997.

Materials and Methods: A descriptive study on 86 individuals was performed. After sterilization, cataract surgery was performed and after the placement of the lens (ECCE+PCIOL) in the anterior chamber, 0.1mL of the anterior chamber fluid was taken and blood agar and anaerobic thioglyculate plates were inoculated. The extent of infection and confidence interval for the population was obtained. Demographic characteristics of the patients were recorded.

Results: 7% (6 cases) of patients and in the population as whole (CI=12.3 up to 1.6) had microbial growth in their anterior chamber fluid. Staphylococcus coagulase negative was prevalent in men (5.4%) and women (8.2%). Endophthalmitis was not present despite of microbial growth.

Conclusion: 7% of patients had infection which the great majority of them were in their 70-90. Older patients had higher colony count around the eyelash and conjunctiva. This may contribute to increased rate of infection of the anterior chamber infection during the cataract surgery.

History and Objectives: Detection of intestinal parasitic infection is usually performed with multiple fecal specimen examination. The present study will show a relationship between the number of samples studied and the detection of intestinal parasitic infection among patients complaining from indegestion.

Materials and Methods: A analytical study was conducted on 150 patients, 72 men (48%) and 78 women (52%), who were referred to the internal medicine clinic of Shaheed Beheshti hospital during the first half of 1996. Three fecal samples were taken in triplicates every other three days and examined for parasitic agents by formalin-ether method at the Central Diagnostic Laboratory of the University. The results of three samples and three different days of sampling were analyzed by the statistical relativity test.

Results: The prevalence of parasitic infection from the first sample collection was 43.3% (65 patients), after the second sample examination, 56.7% (85 patients) and with the third sample 65.3% (98 patients). The prevalence of infection for the first, second and third day was 43.3%, 23.5% and 20% respectively.

Conclusion: The number of fecal samples studies has significant effect on the detection of intestinal infection. However, the prevalence rates were lower compared to previous studies. Therefore, it is recommended that a similar study on healthy individuals may be conducted.

History and Objectives: Arterial blood gases (ABG) have various clinical diagnostic values, however their normal values are not known in our country. Therefore, this investigation was conducted in order to determine normal values for PaO2, PaCO2, HCO3- and pH among healthy 18-74 years old in autumn and winter of 1995 in Kashan.

Materials and Methods: A descriptive study on 121 randomly selected healthy individuals from medical records. Arterial blood was taken from the radial blood arteries in order to determine the normal values and the confidence intervals.

Results: Normal values of PaO2 were 91.9±9.8 mmHg and 94.4±11.5 mmHg in men and women respectively. The linear formula was PaO2=103.59-0.29 X age (year) and PaCO2 values were 38±3.5 mmHg and 36±4.36 mmHg for men and women respectively. The normal values for HCO3- were 22.6±2.12 meq/L and 21.4±1.96 meq/L for men and women respectively and pH values were 7.4±0.02 and 7.4±0.04 for men and women respectively.

Conclusion: Values for arterial blood gases can have clinical application in Kashan and it is suggested that they may be used in clinical laboratories.

History and Objectives: Seizure is a definitive sign of neurological diseases in children. Irreversible neurological damages can be prevented by rapid diagnosis and proper treatment. The present study was undertaken to determine the prevalence of neonatal seizure among newly born and other newborn patients hospitalized in Kashan hospitals in 1995-1996.

Materials and Methods: A descriptive study was carried out on 5526 newborns and 770 newborns admitted to the hospitals. Diagnosis of seizure was on bases of patient’s record and examination by staff of neonatal unit and pediatric residents. The underlying causes of the seizure were determined on the basis of patient’s profile, physical and neurological examination, laboratory data and CT-SCAN records.

Results: The prevalence of the seizure was 1.3% and 11% among newly born patients and newborn admitted to the hospitals respectively. Hypoxic encephalopathy ischemia (Asphyxia) was the most prevalent cause of seizure (41%). Metabolic (18%), infectious (15%), cerebral hemorrhage (11%) and other cause (15%) were among other cause of seizure among newborns.

Conclusion: Since hypoxic encephalopathyic ischemia is the most prevalent cause of neonatal seizure, further research is needed in order to find out the reason for its appearance and its prevention.

History and Objectives: Due to the high mortality rate and the high incidence of complications of severe preeclampsia throughout the world particularly in the developing countries and regarding the controversies on the therapeutic effects and complications of Nifedipine and Hydralazine and in order to compare the therapeutic effect of this 2 medications, the present study was performed on patients with severe preeclampsia hospitalized at Shabihkhani maternity hospital during the years 1367 and 1377.

Materials and Methods: A clinical trial study was performed on patients with ?+2 proteinuria, blood pressure of 160/110 that was measured at least on 2 occasions at an interval of 3 hours or clinical manifestations of severe preeclampsia. Patients were randomly classified into 2 groups. In one group sublingual Nifedipine was administered at a dose of 5 milligrams (Equal to 5 drops) and in the other group, which was considered as the control group, Hydralazine was administered as injection at a dose of 5 milligrams. The effect of the medication on systolic and diastolic blood pressure, fetal heat rate and urinary volume was evaluated at 30 and 60 minutes after the administration of the medication. Also the effect of the medication on Apgar score and hospital length of stay of the neonates were studied.

Results: 2 group were similar, percent reduction of systolic blood pressure 30 minutes after the administration of the medication was 11.4% and 8.03% in the Nifedipine and Hydralazine group respectively (P<0.01) and the percent reduction of diastolic blood pressure 30 minutes after the administration of the medication was 18.7% and 10.9% in the Nifedipine and Hydralazine group respectively (P<0.01). Average urine volume 30 and 60 minutes after the administration of the medication were 68 and 128.8 milliliters in the Nifedipine group and 29.3 and 53.8 milliliters in the Hydralazine group (P<0.01). Average fetal heat rate changes thirty and 60 minutes after the administration of the medication were 1.36 and 0.92 in the Nifedipine group and -2.4 and -1.77 in the Hydralazine group.

Conclusion: Nifedipine administration results in a more fall in systolic and diastolic blood pressure and a more urine volume production than Hydralazine. Hydralazine produces a significant decrease in fetal heart rate. Apgar score at five minutes and hospital length of stay of the neonates does not differ significantly in the Nifedipine group in comparison with the Hydralazine one.

History and Objectives: Children’s growth is important and it has significant economical, social and health consequences. In our society, there is no social growth chart for children. This investigation is designed to prepare new growth charts for Iranian infants in Kashan.

Materials and Methods: A longitudinal study was carried out on 400 newborns infants in Kashan. They were grouped on sexual basis and their weight and height were measured. On the basis of the data collected, statistical analysis was carried out and growth charts were drawn.

Results: Weight for female and male newborn infants were 3.23±0.35 kg and 3.30±0.39 kg respectively. Height for female and male newborn infants was 50.53±1.86 cm and 50.92±1.98 cm respectively. In comparison of 50th weight percentile for age and height for age growth charts with 50th percentile NCHS growth chart was shown that our infants growth till 3-4 months were almost the same as NCHS but then decrease rapidly (Particularly weight) than standard growth charts.

Conclusion: Weight and height for our newborn infants are the same as NCHS but our growth charts from 6-7 months are slower than NCHS growth chart. So drawing of new charts for every country is recommended.

History and Objectives: Light’s criteria in which serum and pleural LDH activity and proteins levels are the most common variables to differentiate exudative from transudative pleural effusion, for the past 3 decades. Several other biochemical parameters have been suggested, one of which is serum pleural effusion albumin gradient (>1.2: transudate, <1.2: exudate). The present study was performed to assess diagnostic value serum and pleural gradient in the patient with pleural effusion.

Materials and Methods: A descriptive study was carried out on 76 patients. In a sitting position, pleural fluid aspiration was obtained and albumin, lactate dehydrogenase (LDH), protein level and at the same time blood total protein, LDH and albumin was obtained, on the basis of Light’s criteria, pleural fluid is categorized as exudate or transudate. 76 patients presented with pleural effusion referred to the Shaheed Beheshti hospital (Kashan) were studied according to the Light’s criteria and gradient method.

Results: According to Light’s criteria, 41 patients (54%) had transudate and 35 patients (46%) had exudate. These measures were 59% and 41% respectively in gradient method. Thus discrepancy was noted in 6 cases, labeled exudate according to Light’s criteria however transudate according to gradient method. Sensitivity, specificity, positive and negative predictive value were 82.9%, 95%, 93.5% and 86.6% respectively for gradient method.

Conclusion: Sensitivity of Light’s criteria is higher than albumin gradient, but the gradient method has a higher specificity for patients who are clinically suspect of transudate but labeled exudate according to Light’s criteria, albumin gradient is helpful.

History and Objectives: Growth and development of children has an important role in life and one of the basis of general health. The most important determinants of growth in children are weight, height and head circumference. Because the most rapid period of growth of brains is the first year and increase of head circumference indirectly indicates brain growth, so, regular measurement of head circumference and it’s comparison with standard curves is important in health centers for monitoring of head circumference growth use from standard curves NCHS. Genetic, nutritional and social status of infants will have direct effect on the body growth charts and adjustment to a given population under study is essential. The present study is carried out to address such a purpose.

Materials and Methods: In this longitudinal descriptive study, 200 girls and 200 boys with weight between 2.5-4 kg born as the Shabihkhani hospital were evaluated in first 6 months, monthly and in the second 6 months. Bimonthly head circumference was measured and statistical analysis is presented.

Results: In this study average HC for boys and girls were 34.6 and 34.4cm respectively. The 50th percentage increment of HC in boys during the first year of life was 12.12cm and for girls was 11.56cm. Average growth of HC during the first 3 months of life in boys was 5.7cm, second 3 months 3.15cm and second 6 months of life was 3.25cm. Average growth of HC during the first 3 months of life among girls was 5.63cm and second 3 months was 3.02 cm and in second 6 months of life was 3.91cm.

Conclusion: In this study, average rate of HC after birth in boys and girls was similar to reference tests. In addition, head circumference growth rate during the first year of life in comparison with NCHS charts did not show any significant difference. So we used NCHS charts for monitoring HC growth in the Kashan.

History and Objectives: Due to the increased frequency of Tuberculosis for the past ten years, specially in developing countries (e.g. Southeast Asia) and importance of role of health care in prevention of the disease. BCG scars and PPD response after BCG vaccination in neonatal period was determined. Their relationship in infants, who come to treatment to health centers of Kashan in the summer of 1998.

Materials and Methods: This is a descriptive-analytical study. 400 infants (3 months old) who come to treatment and health centers of Kashan. Infants receiving BCG vaccination in neonatal period and PPD test were selected.

Results: More than 93% of vaccinated neonates had BCG scar in 3 months old. 53.31% of infants 3 months after vaccination had positive Mathuex test. The bigger BCG scar had bigger Mathuex test induration size.

Conclusion: Due to the importance of preventive measures in control of disease and efficacy of BCG vaccination in prevention of Tuberculosis (Specially in lethal forms) BCG vaccination is necessary in neonatal period in our country and principle of storage and production of good vaccine solution and their usage by experienced staff should be taken into consideration.

History and Objectives: Due to the importance of and different factors related to failure of pregnancy and since little is known about failure of pregnancy in Kashan, the present study was carried out in order to determine prevalence and factors related to failure of pregnancy in Dr. Shabihkhani hospital in Kashan in 1998.

Materials and Methods: A descriptive study concerning 1077 pregnant women and failure of pregnancy including abortion and fetal death and its relationship with maternal age, paternal age, parity and previous abortion was carried out.

Results: The prevalence of failure of pregnancy, abortion and fetal death was 13.8%, 11.4% and 2.4% respectively. High maternal age was the most prevalent factor involved with abortion (21.8% with the age of 40 or older and 10% with age group of 20-30). The prevalence of abortion and fetal death was increased with maternal age, paternal age, previous history of pregnancies (>6 time) and previous abortion.

Conclusion: The parental age in the time of pregnancy, previous abortions and parity were significant factors in failure of pregnancy. Further studies on the factors related to failure of pregnancy are recommended.

History and Objectives: Due to the importance of diagnosis of the abnormal epithelial cells of cervix and usual diagnostic method of Pap smear and various reports of ability of Pap smear in diagnosis of abnormal epithelial, in order to determine positive predictive value of Pap smear with abnormal epithelial cells comparing with the biopsy and patients characteristics this study was carried out among women referred to Shabihkhani hospital of Kashan in 1996-1999.

Materials and Methods: A clinical trial was performed on all women with abnormal Pap smear candidate to biopsy. Data were collected by interview and reports of Pap smear, type, results of biopsy were recorded. Analysis was performed and positive predictive value was determined.

Results: From 65 patients analyzed, all samples had abnormal epithelial cell determined by Pap smear test. The positive predictive value of the detection of the disease was 78.5%.

Conclusion: Considering the ease, relative inexpensiveness and availability of the Pap smear and relative low predictive value, further investigation in order to upgrade the quality of Pap smear test and to increase the diagnostic power of abnormal epithelial cells is needed. In addition, a new clinical trial design is required.

Background: Asthma is a prevalent chronic pulmonary disease presented in 20% of population. Steroids have been shown to be effective in asthma treatment however, controversies are arisen in the route of administration. The present study was conducted in a private clinic in Kashan to determine the effects of different routes of corticosteroid administration (Oral, injection and inhalation) on asthma attack.

Materials and Methods: 120 patients had entered this clinical trial. Patients were distributed in three groups oral, injection and inhalation group. All subjects received salbutamol. Spirometry was performed before and after the therapy and then results were analyzed.

Results: The study population included 63 males (52%) and 57 females (48%) with the mean age of 39.9 years. Comparison of FEF25-75, FEV1 and FVC results showed non-significant differences between the oral and injection groups, however, they were more effective than inhalation corticosteroids.

Conclusion: Administration of corticosteroids either orally or by injection can be easily used to control asthma attack. Inhalation therapy is less effective and is not recommended.

Background: Electroconvulsive therapy (ECT) is a useful non-pharmacologic tool for treating major depression and other neurologic disorders. However, it may lead to bradycardia and consequently to tachycardia and hypertension. Atropine is considered as premedication of choice. We have studied the cardiovascular response following the ECT procedure.

Materials and Methods: 80 patients had entered this double-blinded clinical trial. Patients were randomly assigned in either case or control. The case group was intravenously given 0.5mg atropine before the anesthesia induction, however, the control group received 1ml normal saline. Blood pressure and heart rate were monitored 1 minute after the induction and at minutes 1, 3 and 5 after ECT.

Results: The case and control groups were composed of 31 males and 9 females. The mean age of case and control group was 35.3±7.8 and 33±7.6 years, respectively (NS). At minute 3, the mean blood pressure was higher in the case group (P=-0.43). At minutes 1 after induction and 5 after ETC the mean heart rate was faster in the case group (P<0.05).

Conclusion: Administration of atropine as a premedication agent may lead to transient hypertension, meanwhile those who haven’t received atropine (Control), had no bradycardia. We don’t suggest atropine as the routine premedication agent before ECT, especially in whom hypodynamic heart, usage of sympathetic inhibitor and previous history of bradycardia following the ECT procedure exist.

Background: There are various pathologies causing abnormal uterine bleeding (AUB), of which, some are predisposing for cancer, thus, we studied frequency of different pathologies in patients referring to Shabihkhani hospital in Kashan, 2000-01.

Materials and Methods: It was a descriptive study. Initial data including method of contraception, parity, age, severity of dysmenorrhea and bleeding pattern were all recorded. Samples were obtained by D&C procedure.

Results: The study population included 200 patients with the mean age of 46.2±6.2 years. Endometrial tissues were insufficient in 11. Proliferative endometrium was by far the most frequent pathology. Adenomatous hyperplasia was more commonly seen in para-8 women (0.6%), however, atrophic endometrium was frequently observed in para-9 and higher females (0.6%). Cystic and adenomatous hyperplasia was commonly found on obese females. There was no relationship between the results of pathology and the presence and severity of dysmenorrhea.

Conclusion: Cystic and adenomatous hyperplasia (Predisposing to endometrial cancer) was more commonly seen in obese patients.

Background: Nosocomial infections is a common source of infection in hospitalized patients. Prior reports have shown the possibility of venous catheter infection, too. The present study was carried out to determine the venous catheter infection of patients admitted to ICU and its related factors in Shaheed Beheshti hospital in Kashan in 2000.

Materials and Methods: It was descriptive study. Patients for whom IV catheters were removed were included. Then the 3cm of the catheters were cut aseptically and put in Thayer-glycolate. In case of growth within the next 7 days, the sample would be passage on agar. Finally the type of cultured bacteria as well as its antibiogram was determined. Infectious related factors were considered as: Age, sex, duration of catheter usage, duration of ICU hospitalization, catheter-induced phlebitis and the location of catheter.

Results: Of 100 cultured catheter removed from 36 patients, 29% revealed to have infection, among which, staphylococcus coagulase-negative was the most prevalent (18%). Age, duration of catheter usage, duration of ICU hospitalization, catheter-induced phlebitis and the location of catheter had no effects on infection rate (NS).

Conclusion: Staphylococcus coagulase-negative is the skin normal flora and do not cause severe infection, thus the true rate of infection is less. Needless to say, the venous catheter infection is a critical problem seeks further attention in hospitalized patients.

Background: Considering the prevalence of myocardial infarction (MI) and the importance of its early diagnosis in prevention of complications and life threatening conditions, this study was performed on patients admitted to Shaheed Beheshtee University Hospital at Kashan to determine the prevalence of delay in seeking treatment and to investigate the reasons for delay.
Materials and Methods: This descriptive, applied, study was performed on 200 patients suffering from MI. The relevant data such as age, gender, income, education, history of heart disease, the first referral center, the means of transfer to the hospital, the site where pain was first felt, the relevant signs and the amounts of delay were recorded in a questionnaire, and then were analyzed using statistical indices such as  x2, OR, CI.
Results: Of 200 studied patients, 138 (69%) were male of all patient 131 (56.5%) patients had referred late. The highest rate of delay was seen in women (n= 47 [75.8%]) (p 0.029), OR: 2.014. The older the patient, the longer the delay (p 0.0008) particularly, in the age range of 45-60 (n= 28 [54.1%]). The patients with lower education level (n = 73 [74.5%]) and lower income (n = 34 [79.1%]) had longer delay (p 0.01). Of all patients, 154 (77%) had been visited by a general practitioner prior to their referral, while only 46 (23%) had referred to the hospital directly. Out of 154, 137 (89%) had delay time longer than 8 hours 14.5% had called Emergency Medical Service (115) for seeking help,  (p 0.0254). and 85.5% used other means to reach the hospital. Moreover, the presence of signs like nausea, vomiting, shortness of breath, and headache related to chest pain were recorded in 88.4% of patients when they were admitted to the hospital. Punctual admission was more in patients with MI signs who lived in town, than those who were on the outskirts (60.7%). The onset of pain during the night made late referral (52.4%). Finally, the most common reasons for delay were the expectation of spontaneous relief (50%), considering noncardiac causes  and underestimating the patient which were more common in men (56.2%).
Conclusion: Considering the delay in the majority of patients (56.5%) and the significance of punctual admission to the hospital, the delay was due to the lack of awareness of the disease, patient’s low education level, and low income.