History and Objectives: Nocturnal hypoxemia in patients with chronic obstructive pulmonary disease (COPD) is a frequent side effect. Because there is frequent occurrence pulmonary hypertension and cardiac arrhythmia in these patients, it is important to diagnose and treat nocturnal hypoxemia. In this research we investigated the changes of hypertension and hypoxemia during day and night in patients with COPD who were referred to the internal medicine ward of Shaheed Beheshti hospital in 1999.

Materials and Methods: A descriptive study was conducted on 68 patients with COPD. Arterial blood gas measurement was performed from radial artery in supine position in duplicates in the day and at night. Mean PaO2 and PaCO2 during day and night and changes of mean PaO2 in different levels of hypercapnia were determined.

Results: Night time decrease in PaO2 and SaO2 and increase in PaCO2 was significant compare to the day time values (Day: PaO2=62.2±13.9 mmHg, night: 57.6±12.2, P<0.001, day: SaO2=88±7.5%, night: SaO2=66±9%, P<0.001, day: PaCO2=46±7.5 mmHg, night: PaCO2=47.6±8 mmHg, P<0.001). The decrease in PaO2 during night in patients with PaO2<60 mmHg was more than in patients with PaO2>60 mmHg (7.4±12.7 mmHg, 1.4±7.6 mmHg, respectively, P=0.019). In patients with PaCO2<45 mmHg and PaCO2>45 mmHg, PaO2 in the day and night were 66.8±12.7 mmHg, 62.1±10.4 mmHg, 57.7±13.8 mmHg, 53.1±12.4 mmHg respectively. The amount of changes in both groups was 6.97% and 7.85% respectively.

Conclusion: Hypoxemic and hypercapnia are increased during night in patients with COPD. The amount decrease in nocturnal hypoxemia depends on its amount in the day. The amount of decrease in hypoxemia depends on the degree of hypercapnia. In patients with COPD, who has hypercapnia and hypoxemia, O2 delivery in the night and the improvement of hypoxemia is very important.

History and Objectives: Considering the high incidence of thyroidal nodules in mountainous and hot regions of Kashan and the importance of its rapid diagnosis and treatment and the existence of controversies in this field, this study was performed on referrals of health centers in Kashan with thyroidal nodules from 1998 to 2000.

Materials and Methods: The clinical trial strategy of this study was performed on 65 patients. At first, they were tested for FNAc and operated according to indications (Lobectomy, isthmectomy, pyramidectomy, subtotal and/or total thyroidectomy). The biopsies were evaluated pathologically and diagnostic value of FNAc was determined.

Results: Out of 65 studied cases, 55 patients were female and 10 cases were male. In addition, in 5 cases (7.7%), there existed a state of malignancy according to pathological evaluation and FNAc. Meanwhile, the sensitivity and specificity was 100% for FNAc.

Conclusion: FNAc has a high diagnostic value of thyroid nodules and it is recommended to be performed before surgical operations of the thyroid gland for all of the cases to reduce unwanted and costly operations.

History and Objectives: Fluoxetine is an anti-depressant drug that specifically inhibits serotonin re-uptake. Since fluoxetine can lead to bradycardia and may have pro-arrhythmic and anti-arrhythmic properties, this study was carried out to evaluate the effect of fluoxetine on ouabain-induced arrhythmia in isolated atrium of Guinea pig.

Materials and Methods: In this study, Guinea pigs from both sexes (350-600 g) were used. The animal’s atrium was totally isolated from the ventricle. Thirty-two isolated atria were studied in 4 groups, that is, control, fluoxetine, ouabain and ouabain in combination with fluoxetine. The isolated atria were inserted into modified Oxygenated Krebs solution. Therefore, the mentioned drugs were added to the bath and 20 min later, ionic content of the tissue was measured.

Results: Fluoxetine (2-16 µg) can produce a short increase in contractile force (4 min), but finally decrease force and rate of isolated atrium. Ouabain (1.2 µg/ml) can lead to atrial arrhythmic after 1.5 min and after 16 min leads to total toxicity, asystole and atrial cease. Fluoxetine pretreatment (4 µg/ml) can delay the occurrence of arrhythmia up to 5 min (P<0.05). Meanwhile, survival time for atrium increased to greater than 40 min (P<0.05). Ionic measurement of atrial tissue showed that ouabain by itself can increase the level of sodium, but no such effect on potassium and calcium levels. In addition, fluoxetine in itself can significantly increase potassium level (P<0.05). Administration of fluoxetine and therefore, ouabain can attenuate the toxic effect of ouabain on ionic changes and even return it to normal level.

Conclusion and Recommendations: It is concluded that fluoxetine has a direct negative inotropic and chronotropic effect on isolated atrium as a possible result of inhibition of sodium and calcium channels and it can probably prevent ouabain-induced toxicity and arrhythmia in atrium of Guinea pig through stabilization of cell membrane and/or prevention of ionic changes that is a quinidine-like effect.

History and Objectives: Considering the high incidence of congenital abnormality of anterior abdominal wall and its increasing trend and various reports on the efficacy of treatments and lack of information in Iran, this study was carried out of referrals of Ali Asghar hospital from 1991 to 2000.

Materials and Methods: This research study was performed on existing data collected from the medical records of the affected infants and individual characteristics, kind of disorder, accompanied disorders, age, duration of hospitalization, treatment strategy and its result were collected and statistically analyzed.

Results: In this study 30 infants (18 males and 12 females) were evaluated. In this respect, 7 patients had gastroschisis and 23 patients had emphalocele. Meanwhile, there was a mortality rate of 60% and in 40% of them there existed a successful outcome. In this regard, the success rate was 69.6% for emphalocele and 28.6% for gastroschisis (P<0.06). In addition, 3 patients under treatment deceased in cities other than Tehran.

Conclusion and Recommendations: These results showed that the incidence rate for these abnormalities is an average of the reported rate in references and the treatment strategies for emphalocele are more effective than for gastroschisis. In addition, it is recommended to perform researches for finding appropriate and selective treatments for both kinds of abnormalities. In this respect, it is strongly recommended to study the effect of nutrition on the treatment outcome for gastroschisis.

History and Objectives: Since the fungus Kumbuja contains various useful chemicals and the significant of treatment of open wounds and for evaluation of the effect of this fungus, this study was conducted in laboratory of anatomy of Shaheed Beheshti Unv. Med. Sci. in 1998.

Materials and Methods: The experimental strategy of this study was carried out on 70 male adult rats in two groups, i.e. control and experimental groups. Then, each group was divided into 3 sub-groups according to duration of study (4, 7 and 15 days). The experimental group received the fungus Kumbuja for a period of 30 days and control group received tap water. Then, a wound was created in the skin. At the end of study, two samples of skin were taken. After histological processing, number of fibroblasts, macrophages and neutrophils were counted. In addition, tensile strength of the tissue was calculated. Student’s t-test was used for statistical analysis.

Results: Number of fibroblasts in control and experimental groups were 88±10.9 and 103.6±13.5 respectively. The increase of fibroblasts at 4th day (P<0.05), the decrease of neutrophils (P<0.01) and the increase of tensile strength (P<0.05) at 7th day was significant.

Conclusion and Recommendations: It is concluded that consumption of this fungus can accelerate healing of open wound in rats and it is recommended to conduct more studies for isolation of its effective chemicals and its applicability in human beings.

History and Objectives: Considering the high incidence of breast cancer and its known prognosis and the existence of controversies on the role of patient’s age, tumor malignancy and its prognosis, this study was carried out on referrals of Mostafa Khomeini, Shohadayeh Tajrish and Loghman Hakim from 1993 to 1999.

Materials and Methods: The case-control strategy of this study was conducted on 200 patients with breast cancer. In this respect, 100 cases with lymphatic involvement and tumor size greater than 2.5 cm were selected as bed prognosis (Case group) and 100 cases were selected as good prognosis (Control). Then, their age was determined and tumor malignancy was determined using Bloom-Richardson criteria and they were selected as I, II and III groups. For statistical analysis, student’s t-test and X² test were applied and O.R. was determined for patients and population.

Results: This study was conducted on 200 patients in control (n=100) and case (n=100) groups. The age of control and case groups was 42.5±8.8 and 53.4±12.2 years respectively with a difference of 11 years between them (P<0.001). In addition, it was found out that breast cancer at ages greater than 50 years increases the risk of malignancy 17-fold. Meanwhile, malignancy type III relative to type I is more effective for the development of malignancy (5.6-fold) (P<0.0005).

Conclusion and Recommendations: It is concluded that age and malignancy play an essential role in the development of tumors with bad prognosis. It is recommended to apply preventive measures for known malignancies.

History and Objectives: Considering the incidence of essential depression in patients with physical complaints and lack of precise information in this field, this study was conducted in Akhavan hospital in 1999.

Materials and Methods: The descriptive strategy of this study was carried out on 300 male and female patients. All of the hospitalized patients were randomly divided into control (n=150) and case (n=150) groups and their personal characteristics were recorded. Then, Beck test was applied and for those patients with marks higher than 11, a psychiatric interview was arranged according to DSM-IV diagnostic criteria. The statistical X² test was used for analysis.

Results: Case group consists of 35 male and 115 female patients and control groups comprised of 83 male and 67 female patients. The highest frequency was that from women with an approximate age of 40 years. The incidence of essential depression was 80% and 27.3% in case and control groups respectively. The most common complaints were those from head and neck (35.5%), musculoskeletal (33.7%), gastrointestinal (18.4%) and cardiovascular and respiratory (12.4%) systems. In addition, there was a relationship between essential depression and physical complaints (P<0.0001).

Conclusion and Recommendations: With regard to the high incidence of essential depression, it is recommended to conduct more studies in this field.

Background: Non-ulcer dyspepsia is a prevalent problem that made patients visiting the doctor. Different medications are used, such as cimetidine, ranitidine, metoclopramide and omeprazol. The present study was conducted in Kashan in 1995-96 to determine the effects of cimetidine on non-ulcer dyspepsia.

Materials and Methods: It was a double-blinded clinical trial with concurrent controls. Patients who had at least one of the following signs or symptoms for 3 months were included: Bloating, nausea, vomiting, reflux, belching and heartburn. Physical examination and necessary tests were used to rule out any underlying disease and endoscopy was applied to exclude any organic GI problem. Patients were randomly distributed in two groups of case and control. Case group received cimetidine 200 mg/qid for 2 weeks and the control group received placebo.

Results: Of 70 patients, 40 were males and 30 were females. The mean age (±SD) of case and control group was 30.1±8.1 and 29.1±9.1 years, respectively (NS). Partial or complete improvement of signs and symptoms were shown in 86.6% of patients in the case group and 82.9% of control subjects.

Conclusion: Results have revealed that cimetidine is an effective agent for non-ulcer dyspepsia. Surveying the efficacy of other drugs is highly recommended.

Background: Noise pollution is an environmental problem of big cities that cause hearing loss sleep disorder, hypertension and GI problems. Determining the noise pollution is of utmost importance to access suggested standards. The present study was carried out in different districts of Kashan in 2000 to determine the noise pollution.

Materials and Methods: During this descriptive study four different settings of Kashan were included districts of heavy traffic, hospital setting, residential areas and residential-industrial areas. Noise Dosimeter and Sound Level Meter were used in 24 stations for 8 hours (8AM-12 and 16PM-20PM) during a 9-month period. Leq was determined in each station.

Results: Leq of districts of heavy traffic, hospital setting, residential areas and residential-industrial areas was 76.6, 56.6, 56.7 and 54.8 db, respectively. There was no significant difference between morning and afternoon periods.

Conclusion: Noise pollution was obvious in districts of heavy traffic, hospital setting and residential areas. Further studies are highly recommended.

Background: Despite recent progresses in renal transplantation, acute rejection during the first year is the most common cause of kidney loss. Recently, Mycophenolate Mofetil (MMF) was used as an effective agent. We have compared the effects of Mycophenolate Mofetil and Azathioperine (AZA) in prevention of acute rejection of renal transplantation in patients referring to Hashemi Nejad hospital in 1997-2000.

Materials and Methods: 60 patients had entered this clinical trial and divided in two groups. One received MMF (2 g/d) as well cyclosporine A and prednisone and the other received AZA+cyclosporine A+prednisone. Groups were matched according to the times of transplantation, underlying disease and other confounding factors. Patients were followed up for 6 months regarding the acute rejection, hematological. GI, liver and infectious complications.

Results: MMF group included 16 females and 14 males with the mean (±SD) age of 37±12 years, however AZA group included 17 females and 13 males with the mean age of 35±11 years. Acute rejection was reported in 10% and 27% of MMF and AZA groups, respectively (P<0.09). Creatinine was reported 1.3±0.4 and 1.3±0.3 mg/dl, respectively (NS). Leukopenia was found in 20% and 23% of patients, respectively, however, thrombocytopenia was reported in 3.3% and 6.7%. Elevated liver enzymes were noted in 26.7% and 30%, respectively. Icter was found in 2 patients of the AZA group. GI bleeding was noted in one patient who received MMF that was recovered after the drug cessation. Cytomegalovirus was shown in 2 patients of the AZA group.

Conclusion: Results have revealed that MMF could effectively decrease the acute rejection of renal transplantation side effects were not significantly differed, however, further studies with greater sample size are required.

Background: Irritable Bowel Syndrome (IBS) is the most common cause of GI-man visits. Recent trend was seen towards neurotransmitters, however these drugs are expensive. We have determined the effects of fluoxetine, nortriptyline and amitriptyline in IBS patients referred to a private GI clinic in Tehran in 2000.

Materials and Methods: 173 patients had entered this clinical trial. Diagnosis was made according to the Rome criteria. Patients were concurrently allocated in three groups. Fluoxetine 20 mg/d, amitriptyline 25 mg/d and nortriptyline 25 mg/d were given to individuals of each group, respectively. Pre- and post-test data were collected and recorded in a checklist.

Results: The study population included 53 cases as the “Constipation group”, 57 as the “Diarrhea group” and 63 as the “Abdominal Pain group”. 50 patients received fluoxetine, 69 nortriptyline and 54 received amitriptyline. Fluoxetine has effectively increased the defecation times of constipated individuals (From 2.56/week to 12/week, P<0.02), but was ineffective for diarrhea individuals (NS). Amitriptyline has improved the defection pattern of constipated and diarrhea individuals (2.31/week to 6.54/week and 17.26/week to 11.79/week, respectively, P<0.02). Nortriptyline had the same effect as amitriptyline (2.67/week to 6.33/week and 20.64/week to 12.23/week, respectively, P<0.01). Fluoxetine and TCAs were significantly improved the abdominal pain, bloating and general performance of affected patients. Amitriptyline has shown more side effects than nortriptyline and fluoxetine (P<0.01).

Conclusion: Fluoxetine was shown to be more effective than TCAs in constipated patients, however in patients with diarrhea it seems to be less effective.

Background: With respect to the known complications of malnutrition, especially in vulnerable group of children under 5, the present study was conducted in Shaheed Beheshti University of Medical Sciences in 1997 determine the prevalence of malnutrition and its association with economic indices.

Materials and Methods: 1028 under-5-year-old children referred to pediatric clinics in Tehran were included in a descriptive-analytical study. Patients were distributed in two groups of case and control, matched according to the confounding factors. Groups were determined following the recognition of malnourished children. Thus, malnourished children were included as the case group and 550 normal children were considered as control. Demographic data including sex, age and family size were all recorded. Having 33 children excluded due to the secondary malnutrition, malnutrition severity was assessed according to the weight and height of age.

Results: 161 (16.2%) children including 77 boys and 84 girls were malnourished. Family size of 3 or 4 was found in 22.4% and 32.7% of the case and control group, respectively. These figures were 31.3% and 28.5% for family size of 7. Significant associations were found between children malnutrition and family monthly income (P<0.0001), family size (P<0.02) and maternal education (P<0.03).

Conclusion: With respect to the effect of economic indices on malnutrition this should be considered as a priority, thus, complications and expenses would be decreased.

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: Due to the relatively high prevalence of cervisitis and its complications such as pelvic inflammatory diseases that may lead to infertility, the present study was designed in order to determine the prevalence of gonococcal cervisitis and drug resistance of those in Kashan in 2001.

Materials and Methods: A descriptive study was carried on patients with cervisitis referring to gynecologic clinics. After physical examination and diagnosis of cervisitis, the sample collected from endocervix. The specimens were cultured on Thayer-Martin agar plates. After identification of isolated gonococci by standard methods. Antibiogram tests were performed to determine the sensitivity or resistance of gonococci to common antibiotics. The data were presented using descriptive statistical analysis.

Results: Of 315 women patients with cervisitis, 2 (0.63%) had gonococcal cervisitis, both of whom were under 25 years old. The age at which their sexual activity started was ?20 years and they have both frequency and dysuria. One of them had revealed resistance to vancomycin and the other had resistance to ceftriaxon.

Conclusion: Due to the relatively high prevalence of gonococcal cervisitis in western country, the prevalence of 0.63% in this study is not hazardous. Meanwhile, gonococci in this area are sensitive to common antibiotics

Background: Evaluating the process of child’s growth monitoring is of utmost importance to detect malnourishment. The present study was conducted with the aim of determining the trend of infant growth from birth to 2 years in the rural community of Babol and compare this with NCHS.

Materials and methods: This exiting data type study was conducted on monitoring growth system in Babol rural communities, which were covered by health centers. 429 children with their birth between 1994 to 1996 were selected through a cluster sampling technique. The percentiles of height and weight were calculated and compared with NCHS standard.

Results: Results have revealed that the weight of 67.5% of infants was between 50^th and 97^th NCHS standard at 1 month. This figure was reduced by increasing the age to 45.2% at 6 month, 42.6% at 12 month and 44.2% at 24 month. Girls’ growth profile showed a 5-20% reduction as compared to boys. Results also showed that the reduction of height in comparison with standard, was began at age 1 to 3 month. The 50^th percentile of height was close to the NCHS, but after 3 month it deviates from NCHS. A significant difference was observed between 50^th percentiles of height and weight with NCHS (p< 0.05).

Conclusion: The results indicated that Iranian infants’ growth can not be evaluated with NCHS standard. It is necessary to provide national and local charts of the growth for Iranian children.

Background: It is essential to have a proper vessel route to do hemodialysis that is done by applying A-V fistula. In the current study complications and patency rate of side to side anastomosis with distal limb venous ligation have been evaluated during one year follow up.

Materials and methods: This study was carried out on 62 randomized CRF patients who received AVF by side to side anastomosis and patency rate of this technique were evaluated in six months and one year periods.

Results: Complications were reported in 12.9%, the vast majority of which were mild and none of them needed reoperation. The patency rate revealed to be 93.56%.

Conclusion: AVF by side to side anastomosis with distal venous limb ligation can have low complication and high patency rate. However, a longer time follow up and comparing with other techniques are needed for more accurate conclusions.

Background: Consanguineous marriage is one of the most important etiology of morbidity and anomaly in neonates and children, for which annually thousands of neonates and children sacrifice. This study was performed in Shabihkhani hospital in Kashan to determine the prevalence of congenital anomalies among consanguineous marriages.

Material and methods: All neonates born in Shabihkhani hospital in 2000-01 were included and initial data including sex, gestational age, type of delivery, prenatal care, drug history, special disease in mother, type of anomaly, history of still birth or anomaly in previous pregnancy were recorded. Type of anomaly in the first 24 hours was distinguished for further classification. Paraclinic tests and consultations were also used.

Results: Of 3529 neonates, 768 (21/8%) were born of a consanguineous marriage and the remaining 2761 (78.2%) from non-consanguineous marriage. Totally, 109(3.08%) deliveries were led to neonate’s anomaly, of these 7.03% were in the consanguineous marriage group (72.3% in first-cousin marriage and 27.7% in second-cousin marriage) and 2% in the other group.

Conclusion: The prevalence of consanguineous marriage in our study was relatively high and the rate of neonate anomaly of consanguineous marriage was more than what expected. Obviously, in case of consanguineous marriage, the rate of anomaly clearly increased.

Background: Due to the relatively high prevalence of febrile convulsion and considering the possibility or recurrence in case of not preventing and also with respect to the problems occurred during the treatment with Phenobarbital, the present study was conducted on children referring to Shaheed Beheshti hospital in Kashan to draw a more appropriate approach to the treatment of febrile convulsion with better outcomes and less side effects.

Materials and Methods: 100 children with febrile convulsion were enrolled for this clinical trial. Children were assigned in two groups. In the case group diazepam was administered at a dosage of 0.8 mg/kg/d in three divided doses at the time of fever. The control group was received oral Phenobarbital at the dosage of 5 mg/kg/d. children were followed for recurrence of febrile convulsion at two months interval for 6 months.

Results: The study population included 61 boys and 31 girls. The recurrence rate was 6% and 14% in the case and control group, respectively (NS).

Conclusion: Since diazepam offers a more effective prevention of recurrence of febrile convulsion while posing less side effects, it seems to be more appropriate for prevention of febrile convulsion.

Background : Carbon monoxide is a colorless, tasteless and odorless gas which is one of the main pollutants considered as a major air pollutant by Environment Protection Agency (EPA). Its side effects on behavioral performance, central nervous system, visual acuity, cardiac and pulmonary functional changes are developed in case of maximum 8-hour concentration of greater than 9ppm. Headaches, fatigue, drowsiness, coma and finally death are known as other side effects. The present study was conducted to determine the concentration of this dangerous gas in Kashan city.

Materials and methods : This descriptive study was performed to measure Co in Kashan in 2000. To meet this demand, Kashan was divided in eight regions and Co was measured in 64 congested and 64 residential areas by Co-Detector.

Results : Results have indicated that residential areas are free of Co but congested areas have shown to be highly polluted.

Conclusion : Bear in mind the dangerous side effects of CO, sources of air pollution in congested areas, (transportation) must be equipped with control devices. Meanwhile, interventions in order to reduce traffic can be helpful.