Journal of Arak University of Medical Sciences

The Study of Validity of Physical Examination (Conjunctival Pallor, Nail Bed Pallor and Palmar Pallor) for Estimination of Severity of Anemia in Hospitalized Pediatric Patients in Amir-Kabir Hospital of Arak City From June 1999 to June 2000

Nemat Billan

The aim of this research is the study of sensitivity , specificity , positive and negative predictive value of conjunctival , nail bed and palmar pallor for estimination of severity of anemia. This study was done on pediatric hospitalized patients who were under 14 years old in Amir-Kabir hospital of Arak City. The results of this study show that total number of patients were 1341 , which 564 cases ( about 42% ) according to laboratory tests had anemia. Sensitivity of clinical tests in diagnosis of childhood anemia correlates with severity of anemia, for example, the sensitivity of palmar pallor for detection of mild anemia is 8.9% and for severe anemia is 100%. Also positive predictive value of clinical findings varies according to severity of anemia. Positive predictive value of palmar pallor for detection of mild anemia is 26.3% and for severe anemia is 94.8%. Generally , theses clinical tests have a high validity in diagnosis of severe anemia.

The Effectiveness of Metolopramide Infusion on Postoperative Pain Control in Imam Khomeini Hospital

Shirin Pazouki

Through a clinical trail, the effects of metoclopramide infusion compared with a placebo in order to assess the effectiveness of the medicine in Imam Khomeini and Vali-Asr hospitals of Tehran were brought under consideration in two groups, which passessed the necessary condition. Metoclopramide was prescribed as a bolus dose of 0.5m/Kg and then its infusion as 1m/Kg at 6 hours intervals, while the control group were only received normal saline for the same duration. Sampling was simple and there was no distinctions between the groups. In review of the postoperative pain the patients were precisely looked after for the next 24 hours of the operation by the ward nurses and if it necessitated narcotics were prescribed. The analysis of the results manifested that the metoclopramide infusion doesn’t lessen the necessity of using narcotics significantly (P=0.174), but it can increase the analgesic effect of narcotics in case group compared with the control group. (P=0.0344) and the intervals of needing narcotics have been more (P=0.0223). In addition, the control group had considerably less incidence of nausea comparing with case group (P=0.0094) and the degree of vomiting was nearly less too (P=0.157). The sedation degree was significantly higher than the case group (P=0.033). No any other side effects of narcotics or metoclopramide, including itching, restlessness and tremor were observed. Metoclopramide infusion can increase the analgestic effects of narcotics. Drugs and significantly lessens the need for narcotics during the first hours of postoperation, Moreover it reduces the incidence problems arising from the site of incision and prescription of narcotics with high dose can be dangerous.

The Prevalence of Hepatitis C Virus Among Blood Donors in Markazi Province

Seyed Ghavamodin Toulaei

The hepatitis C diagnosis is based on the determination of reactant antibodies with recombinant proteins. The method which is performed for HCV screening in all blood transfusion departments. This research is conducted as a cross-sectional study from Aug 97 to Jun 99, by referring to blood donors questionnairs in central department of blood transfusion of Markazi Province. The prevalence of HCV in healthy- blood donors is 0.4% using Elisa and 0/2% using RIBA. PPV of elisa is 55%. PPV of this method is the same in both sexes. There is no relation between positive result for HCV and demographic factors. The older blood donors have v, the less chance of positive result for RIBA method. Due to the significant difference between Elisa results approved by RIBA, it is necessary to revise the ways of conducting these tests and their reliabilities.

The Use of Neutralization Method for Isolation and Identification of Viruses in Gastrointestinal Clinical Samples

Mohsen Khaki

Various gastrointestinal viruses among infected and sensitive people are transmitted through fecal-oral. In some cases according to the type of virus and host conditions, they can cause gastrointestinal disease such as diarrhea and other infections. In some cases it may cause inflammation in tissues and organs post gastrointestinal infections. In this study feces or rectal swab samples were cultures on Hela cell culture media using specific antisera, and the cultured viruses were identified. The results of this study were showed that neutralization is a very available method in isolation and diagnosis of virus. This method can also be used for identification and isolation of viruses in various clinical samples in the pathological, epidemiological and vaccination studies.

The Prevalence of Asymptomatic Bacteriuria in Pregnant Women who were Referred to Health Centers of Arak

Afsane Zarganj Fard

The most common bacterial infection during pregnancy is urinary tract infection (UTI), its presentation in pregnancy includes asymptomatic bacteriuria or symptomatic infections such as pyelonephritis. The etiologic microorganisms of UTI are normal flora of perineum, vagina and anus. This study was conducted on 1736 pregnant w0men who were referred to health centers in Arak. Urinalysis and urine culture were done for all patients and a questionnaire was filled in by midwives or physicians. In patients with positive urine cultures the treatment was begun and second urine culture was performed 2 weeks after treatment. The results: The incidence of asymptomatic bacteriuria and cystitis were 6.3% and 1.3%. Also there was a significant relation between previous UTI and asymptomatic bacteriuria (p<0.02). There was no meaningful relation between age and parity with asymptomatic bacteriuria. The most common organisms was E coli which was detected in 87.5% of cases.

Presentation of a Case with Diffuse Telangectasia, Hematemesis and Nasal Bleeding

Ali Fani

A 56 years old female was admitted to our hospital, because of, dyspnea, tachycardia hematemesis and melena. In physical exams she was severely ill, pale, and tachycardia, with decreased breath sounds on the base of right lung, with BP, 100.60, and pulse rate of 120/min. Abdomen was soft In rectal exam streaky fresh blood and melena was observed. Diffuse red populace on face, trunk and oral mucosa were present with recurrent nasal bleeding since last year. In upper GI endoscopy and colonoscopy, diffuse telangectasic lesions in esophagus, stomach, duodenum and entire length of colon and streaky fresh blood in colon were observed, Under conservative treatment her bleeding stopped on the 10^th day after treatment. Collagen vascular diseases, coagulopathy and malignancies were ruled out by paraclinical examinations. Senile angiodisplastic diseases which are usually limited to colon and vascular ectasia can not be suggested because the skin and upper gastrointestinal tract is involved. Cancers, polyps and hemorrhoid , were ruled out by endoscopy and colonoscopy. Heriditary Hemorrhagic Telangictasia (HHT) is an Auto-Dom disorder with involvement of oral and gastrointestinal mucosa, skin and viscera. HHT involves capillaries, makes tortuous, fragile bloody spaces which can be manifested through infancy to old age. The most common manifestation of the diseases(in addition to nose bleeding and skin lesions), is the severe gastrointestinal bleeding, often leading to massive blood transfusion. Recommended treatment:
1-Coagulotherapy of hemorrhagic lesions. 2- Estrogen and progesterone therapy. 3- Amino caproic acid therapy for prevention of fibrinolysis. 4- In severe cases , surgical therapy is needed.

The Study of Frequency of Obstruction of Lacrimal Drainage System in Urban Society of Arak

Hamidreza Nikbin

Tearing is the most important complaints in ophthalmologic patients that one of its reasons is obstruction of lacrimal drainage system. Lacrimal drainage system include superior and inferior punctums that are joined to common canalicule by the superior and inferior canalicule at the medial canthus. Common canalicule leads to lacrimal sac and lacrimal sac is connected by the Nasolacrimal duct to inferior meatus. The most common cause of obstruction is NLD obstruction that in children, it is caused by the failure of canalization of 4 N.L.D (Naso Lacromed ducat). The research has been conducted among 2500 people in Arak city by muitistage sampling. 26 people had lacrimal drainage system disorder. This disorder was observed among all ages but it was mostly among 0-9 and 60-69 age. 18 patients (69.23%) were female and 8 other ones (30.76%)m were male. 21 people (80.76%) had unilateral disorder and 5 (19.23%) patients had bilateral disorder. Among the patients who had unilateral disorder, 11 persons (52.38%) had right side disorder and 10 persons (47.61%) had left side disorder. None of the patients were asymptomatic and all of them had tearing. 22 persons (82%) had obstruction in common cunalicule and one person in punctum.

The Study of Glucose-6-Phosphate Dehydrogenase Deficiency among icteric hospitalized neonates in Amir-Kabir and Taleghani Hospitals in Arak in 1998-1999

Mozhgan Hashemieh

The various enzymatic defects of red blood cells cause some genetical diseases, of which the most important and the most common is G6PD deficiency. G6Pd deficiency is one of the most common causes of hemolysis in newborn period and can lead to anemia, hyperbilirubinemia, and kernicterus. In this study we tries to find out incidence of glucose-6-phosphate dehydrogenase deficiency in icteric hospitalized neonates in newborns wards of Taleghani and Amir Kabir hospitals, in Arak city from December 1998 to January 1999. We concluded that: The total hospitalized, icteric neonates were 332, 63.86% were male and 36.14% of them were female. The icteric neonates with G6PD deficiency were 6.02% and 93.98% of them had normal G6Pd enzyme. All of the G6Pd deficient neonates were male. The onset of icter in G6Pd-deficient neonates was between second and 6^th day. In 80% of icteric G6PD deficient neonates, the bilirubin total was over 18 mg/dl.G6Pd deficiency in neonates with hemolytic anemia were, 12.5%. Positive familiar history in icteric neonates with G6PD deficiency were 15%. The rate of exchange transfusion among icteric G6PD deficient patients were 15%. The most common blood group in icteric neonates with G6PD deficiency was B+ (incidence 50%)

Taking Responsibility for Pediatrics Medicine Emergency

Nemat Billan

Pediatrics medicine Emergency is a priority rather than a pure scientific issue for the most vulnerable groups. So problem- finding and problem- solving should be managed by it. In this area knowing the indicators of taking responsibility and modifying qualitiable issues to quantifiable and measureable ones are great urgency. The following article is searching for a convenient solution to quantifying taking responsibility and managing pediatrics medicine emergency in terms of vulnerability as well.