Iranian Red Crescent Medical Journal Iranian Red Crescent Medical Journal http://www.irmj.ir 48 journal48 en jalali 1386 10 1 gregorian 2008 1 1 10 1 online 1 fulltext

en General Medicine General Medicine Original Article Original Article Background: The level of anxiety might affect information processing in various ways, and reduce people's performance particularly the adolescents. The present study was designed to investigate the relationship between levels of test anxiety and school performance of a group of adolescents. 536 second grade high school students served as the subjects of this study. Methods: Two questionnaires were used to collect the data including the student status, relevant information about the family and school performance. The Spielberger's Test Anxiety Inventory was also utilized to measure the level of test anxiety. Results: The results revealed a significant and negative correlation between test anxiety scores and Grade Point Average (GPA) of the students. Female students showed a higher level of anxiety in contrast to male students and school type (private, public and school for gifted students) affected the level of test anxiety. Conclusion: We showed the importance of school type on the level of test anxiety. The lowest level of anxiety was seen among gifted children who generally better adjusted themselves than their peers of average or below average intelligence. Gender; School performance; School type; Test anxiety; Iran 4 7 http://www.irmj.ir/browse.php?a_code=A-10-3-1&slc_lang=en&sid=en Masoumeh Mousavi M_mousavi110@yahoo.com 480031947532846001263 Yes Ruzbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran Tel: +98-711-6270571 H Haghshenas 480031947532846001264 No MJ Alishahi 480031947532846001265 No

en General Medicine General Medicine Original Article Original Article Background: Glucocorticoid therapy can induce osteoporosis. Bone mineral density (BMD) measurement has been used to assess the risk of fracture in these patients. The most important mechanism is diminished bone formation mainly at the sites with trabecular bone. The objective of this study is to evaluate the effect of alendronate on prevention of glucocorticoid-induced osteoporosis. Methods: During 18 months, in a prospective clinical trial, 72 patients with autoimmune disease were randomly divided into 2 equal groups. Group 1 (n=36) was treated with oral vitamin-D, 50000 IU twice weekly and calcium, 500 mg twice daily. Group 2 (n=36) was treated with oral vitamin-D, 50000 IU twice weekly, calcium, 500 mg twice daily, and alendronate, 10 mg per day. The patients were followed clinically, undergoing densitometry and X-ray of the spine and hip area for 18 months. Results: Change of BMD in the lumbar spine after 18 months of therapy was -1/67% and +2.4% in groups 1 and 2, respectively. Change in femoral neck BMD was -2.1% in group 1 and +1.8% in group 2. Conclusion: The administration of alendronate plus vitamin D and calcium was more effective in preventing bone loss due to glucocorticoid-induced osteoporosis than vitamin-D and calcium alone. Glucocorticoid-induced osteoporosis; Autoimmune disease; Bisphosphonate; Calcium; Vitamin D 8 11 http://www.irmj.ir/browse.php?a_code=A-10-3-2&slc_lang=en&sid=en N Saadati 480031947532846001266 Yes Department of Internal Medicine (Rheumatology), 2Endocrinology and Metabolism Research Center,Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rajabian 480031947532846001267 No

en General Medicine General Medicine Original Article Original Article Background: Evaluation of the ulnar nerve at the elbow is one of the most challenging areas in electrodiagnosis. The goal of this study is to determine the changes in motor and sensory nerve conduction velocity (NCV) of the ulnar nerve at the elbow area in different angles of the elbow flexion and also to define the optimum angle at which there is an ideal correlation between the elbow across and below NCVs of the ulnar nerve. Methods: Motor and sensory NCVs of the ulnar nerve were studied in 50 able-bodied subjects (100 limbs below and across the elbow segments to determine the effect of 5 different angles of the elbow (0º, 45º, 90º, 110º and 135º of the elbow flexion) on NCV changes of the ulnar nerve. At each angle, the elbow NCVs were compared with below and across segments. Results: At 0º of the elbow flexion, the across elbow NCVs were slower than the below elbow segments and at 45º there was no statistical difference between below and across elbow NCVs. At each subsequent angles of the elbow flexion, there was an increment in motor and sensory NCVs for the across compared to below elbow segment (P<0.05). This increment rose as the degree of flexion increased. So the most erroneous increment was found at 135º of the elbow flexion. Conclusion: Since elbow flexion at 45º was found to be the position of the least variation in motor and sensory NCVs between the across and below elbow segments, this position of the elbow flexion seems to be the ideal angle during the nerve conduction study of the ulnar nerve at the elbow area. In this position, the upper limit of normal difference between the across and below elbow motor NCVs (mean+2SD) was calculated 8 m/sec. Ulnar nerve; Conduction velocity; Angle; Elbow flexion 12 15 http://www.irmj.ir/browse.php?a_code=A-10-3-3&amp;slc_lang=en&amp;sid=en S Sattari sattari@med.mui.ac.ir 480031947532846001268 Yes 1Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran MR Emad 480031947532846001269 No

en General Medicine General Medicine Original Article Original Article Background: There is little information about the prevalence and risk markers of Trichomonas Vaginalis (TV) in Islamic Republic of Iran. This study aimed to determine the prevalence of TV and to examine the factors associated with this infection. Methods: A sample of 550 sexually active women aged less than 45 years living in Babol were enrolled using systematic sampling technique. They were interviewed using a questionnaire, and all the subjects underwent pelvic examination and a discharge ectocervix sample was collected for the diagnosis of TV using wet smear. Results: The prevalence of TV was 4%, there being a significant association between TV and the sociodemographic variables such as the husband’s education, and woman’s age (20-30 years). The behavioral markers significantly associated with the infection were, not using condom, having ever heard of lack of information about STD/HIV (Sexual Transmitted Disease), and protected last sexual contact in that month and cigarette smoking by husbands. The signs significantly associated with the infection were vaginal discharge, mucopurulent cervicitis, and redness of vulvovaginal. Syndromic diagnosis revealed a moderate sensitivity of 55% and poor positive predictive value for infection. Conclusion: The prevalence of positive TV is low in the studied women. Therefore, a net diagnosis using laboratory tests is necessary before the initiation of treatment. Trichomonas Vaginalis; Risk factors;, High-Risk behaviors 16 21 http://www.irmj.ir/browse.php?a_code=A-10-3-4&amp;slc_lang=en&amp;sid=en A Bakhtiari afbakhtiari@gmail.com 480031947532846001270 Yes Department of Midwifery, 2Department of Community Medicine, Babol University of Medical Sciences, Babol, Iran K Hajian-Tilaki 480031947532846001271 No H Pasha 480031947532846001272 No

en General Medicine General Medicine Original Article Original Article Background: Considering the marked difference between the clinical course and management of juvenile myasthenia gravis, congenital/genetic myasthenia gravis and transient neonatal MG, the differential diagnosis is very important. This study was undertaken to evaluate the clinical spectrum of myasthenia gravis in children and determine the factors helping clinicians in their diagnosis and management of the disease. Methods: In a retrospective study from 1994 to 2002, all pediatric patients with myasthenia gravis (MG) admitted to Department of Pediatric Neurology in Mofid Children Hospital affiliated to Shahid Beheshti University were enrolled. Results: Of 32 children, 7 and 25 suffered from congenital and juvenile types of MG, respectively. The initial symptoms in congenital MG were ptosis (7/7), limitation of eye movement (2/7) and mild generalized weakness (6/7). Although 85% of cases with congenital MG, tested positive for Tensilon test, no myasthenia crisis or spontaneous remission was observed in any of the patients. The female to male ratio was 1.5/1 which was correlated to adult MG. In children with juvenile MG, the mean age was 5.7±4.2SD years. The most common symptoms were ptosis in 96% and generalized weakness in 76% of the cases. 32% of patients experienced one myasthenia crisis. EMG was diagnosed in 83% and tensilon test was positive in 84% of the cases. One patient had hyperthyroidism and another had hypothyroidism and both were epileptic. Eight patients underwent thymectomy microscopically. Thymic follicular hyperplasia was observed in five cases (62%), and the remaining three cases were normal. 12.5% of patients recovered completely after thymectomy and there was no need for medication during the follow up. 50% of cases showed relative improvement but it was negligible in 37% of patients. Conclusion: This study revealed that thymectomy lacks remarkable prognostic influence. Myasthenia gravis; Children; Thymectomy; Congenital 22 26 http://www.irmj.ir/browse.php?a_code=A-10-3-13&amp;slc_lang=en&amp;sid=en S Inaloo sinaloo@sums.ac.ir 480031947532846001311 Yes Sorour Inaloo, MD, Department of PediatricNeurology, Shiraz University of Medical Sciences, Nemazee Hospital,Shiraz University of Medical Science, Shiraz, Iran. M Ghofrani 480031947532846001312 No H Eftekharian 480031947532846001313 No

en General Medicine General Medicine Original Article Original Article Background: Otomycosis is a superficial mycotic infection of the outer ear canal caused by many saprophytic fungi that could be considered as causative agents. Detection of the fungal agents in the external auditory canal could be valuable to determine the potential risk of otomycosis. The aim of this study was to identify the mycoflora of the human auditory canal in healthy individuals in Shiraz, southern Iran. Methods: During three months, a total of 486 ear samples of 243 healthy individuals (100 females and 143 males) were randomly collected by sterile swabs and cultivated on Mycosel and Sabouraud dextrose agar supplemented with antibiotics. Fungal isolates were identified using conventional methods and chromogenic media. Results: Ten point twenty eight percent of the individuals were positive for ear fungal infections. Fungal species belonged to eight genera including Penicillium, Cladosporium, Candida, Aspergillus, Alternaria, Rodotorula, Exophiala and Dematiaceous fungi. In this study, Aspergillus niger, the major cause of otomycosis, was not isolated. Conclusion: Our findings suggest that the normal fungal otic infections in the presence of predisposing factors could be a potential cause for otomycosis. Otomycosis; Mycoflora; Auditory canal; Aspergillus 27 29 http://www.irmj.ir/browse.php?a_code=A-10-3-12&amp;slc_lang=en&amp;sid=en Pakshir pakshirk@sums.ac.ir 480031947532846001307 Yes Keyvan Pakshir, PhD, Assistant Professor,Department of Parasitology and Mycology, School of Medicine,Shiraz University of Medical Sciences, PO Box 71345-1168,Shiraz, Iran. Sabayan 480031947532846001308 No Javan 480031947532846001309 No Karamifar 480031947532846001310 No

en General Medicine General Medicine Original Article Original Article Background: Peptic ulcer is one of the most frequent diseases of the alimentary tract, while mortality from perforated peptic ulcer still remains high. We conducted this retrospective study to determine the adverse operative risk factors for perforated hemorrhagic peptic ulcers in Shiraz, southern Iran. Methods: 896 patients with peptic ulcer were enrolled. A questionnaire was used to collect the data on age, gender, site of ulcer, presentation, endoscopic findings, type of peptic ulcer complications, method of treatment, surgical procedure, and results of the treatment. Results: Complicated duodenal ulcer was 15% in period I, and 11.5% in period II (P>0.05). The mean SD of the age of the patients was 42.711 years. The age of the patients with perforated duodenal ulcer was 4812.5 and in hemorrhagic patients 37.48.6 years. Perforation with hemorrhagic duodenal ulcer in the first period was 1.2% and in second period, 0.2%. In the second period, simple closure was done in 29 (74%) patients, and in perforated DU cases, conservative management was done in 23 (56%) patients. Conclusion: Although the number of complicated duodenal ulcer cases increased from period I to period II, complications of duodenal ulcer (Kissing disease) significantly decreased. Duodenal ulcer; Kissing ulcer; Epidemiology; Hospitalization 30 33 http://www.irmj.ir/browse.php?a_code=A-10-3-5&amp;slc_lang=en&amp;sid=en SV Hosseini hoseiniv@sums.ac.ir 480031947532846001273 Yes Gastroenterohepatology Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran B Sabet 480031947532846001274 No M Amini 480031947532846001275 No

en General Medicine General Medicine Short Communication Short Communication Background: There is a risk of viral hepatitis for children with leukemia. Both hepatitis B and C virus infections cause major problems in the management of leukemic patients. In this study, we evaluated the prevalence of HBV and HCV infections in children with leukemia receiving chemotherapy and blood products. Methods: 408 patients with leukemia (mean age=5.1 years) were screened for HBV and HCV in Ali Asghar Children's Hospital. Liver function tests, the number of transfusions, HBV and HCV serology were regularly monitored. In seropositive children, HBV-DNA and HCV-RNA were measured. Liver biopsies were performed in all patients with chronic hepatitis and the data of the study were analyzed using SPSS software. Results: HBsAg positivity, anti-HCV, and mixed HBV and HCV infections were found in 10 cases (2.5%), 8 cases (2%), and 1 case (0.2%) of children, respectively. Of HCV infected children, 8 had positive HCV-RNA. Mixed infection developed to chronic hepatitis in one case. Conclusion: Children with cancer are at a high risk for hepatitis B and C infections due to immunosuppression secondry to chemotherapy and multiple transfusions of blood products during the course of their disease. We observed an increasing incidence of chronic hepatitis B and C infections. Thus no patient developed any signs or symptoms of decompensated liver disease and did not suffer from any severe liver impairment over 8 to 20 years. Hepatitis B; Hepatitis C; Leukemia; Lymphoma; Children; Cancer 34 35 http://www.irmj.ir/browse.php?a_code=A-10-3-6&amp;slc_lang=en&amp;sid=en Sh Ansari shahladamavandi@yahoo.com 480031947532846001276 Yes Department of Hematology and Oncology, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran P Vossogh 480031947532846001277 No F Bateni 480031947532846001278 No

en General Medicine General Medicine Case Report Case Report Headache is one of the most common outpatient pain conditions encountered in both the private practice and emergency departments. Recognition of serious causes of headache requires a standardized diagnostic approach to history and examination. We will report a patient with iritis associated with elevated intraocular pressure (IOP) that presented with severe sudden onset headache mimicking intracranial hemorrhage. A 60-year old man, a known case of non-insulin dependent diabetes mellitus, referred to the emergency room due to severe, sudden onset of headache associated with nausea without any complaint of ocular problem except mild redness of the left eye. Considering subarachnoid hemorrhage subsequent work ups including brain CT scan and lumbar puncture were performed which proved to be inconclusive. The intraocular pressure (IOP) of the left eye was 50 mmHg and there was significant cell and flare in the anterior chamber. IOP was controlled by administration of intravenous manitol, topical antiglaucoma medications and steroid eye drops. The symptoms were relieved within a few days. This manuscript propounds the importance of the awareness of the possibility of serious headache as the presentation of ocular problems. Anaplastic thyroid carcinoma; Surgical intervention; Cancer 36 37 http://www.irmj.ir/browse.php?a_code=A-10-3-7&amp;slc_lang=en&amp;sid=en MR Razeghinejad mrazeghi@sums.ac.ir 480031947532846001279 Yes Department of Ophthalmology/Poostchi Ophthalmology Research Center, Khalili Hospital, Shiraz M Mosallaei 480031947532846001280 No M Farvardin 480031947532846001281 No

en General Medicine General Medicine Case Report Case Report A 25-year-old woman, a known case of vulvar rhabdomyosarcoma presented with bilateral breast nodules. Fine needle aspiration was performed. The smears revealed numerous round malignant cells, positive for malignancy. Histopathologic and immunocytochemical examination confirmed the diagnosis of metastatic alveolar rhabdomyosarcoma. The cytological findings of alveolar rhabdomyosarcoma of the breast are rarely reported. The clinical history and immunocytochemical study contributed to the diagnosis of metastatic alveolar rhabdomyosarcoma. Breast; Rhabdomyosarcoma; Alveolar type; FNA cytology 38 40 http://www.irmj.ir/browse.php?a_code=A-10-3-8&amp;slc_lang=en&amp;sid=en SM Owji smowji@sums.ac.ir 480031947532846001282 Yes Department of Pathology, 2Department of Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran PV Kumar 480031947532846001283 No H Noorani 480031947532846001284 No

en General Medicine General Medicine Case Report Case Report Colonic lipoma is a benign neoplasm that can lead to colonic obstruction but concomitant intussusception is rare in adults. In this case, colocolic intussusception due to a lipoma in descending colon occured. This was diagnosed using laparatomy, and any intervention to reduce it failed. So resection of the colon with mass and anastomosis were performed. After the surgery and 3 years of follow up, no complications were observed. We present this case, and briefly review the literature of colonic intussusception in adults. Colon; Lipoma; Intussusception; Adults; Obstruction 41 43 http://www.irmj.ir/browse.php?a_code=A-10-3-9&amp;slc_lang=en&amp;sid=en AA Salari ali_salari@hotmail.com 480031947532846001285 Yes 1Department of Surgery, 2Department of Pathology, 3General practitioner, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Sh Taghipoor 480031947532846001286 No AR Poormazar 480031947532846001287 No

en General Medicine General Medicine Letter to Editor Letter to Editor Cholestasis is a state of obstruction in bile duct and accumulation of bile salts in the body.1 It primarily leads to bile retention, regurgitation of bile into serum, and reduction of bile delivery into the intestine. These effects give rise to the worsening of the patient’s underlying liver disease and a systemic illness. 2 The vascular changes due to cholestasis are partly explained by several factors such as an increase in prostaglandins in bile salts, and in the level of endogenous opoids, endotoxinemia, and NO production. 1 By regarding these complications, this study was conducted to determine the frequency of peptic ulcer in patients with various types of cholestasis. Peptic mucosal lesions were observed in 42.3% (36) of patients in the mechanical cholestatic group and in 17.6% (15) of subjects in the non-mechanical cholestatic group (Table 1). 51 out of 170 patients with cholestasis (30%) had mucosal lesions. Table 2 shows that out of 38 cases with mucosal damage, 25 (65.7%) were in the mechanical cholestasis and 13 (34.3%) were in the non-mechanical cholestasis groups. Of 25 patients with mucosal damage in the mechanical cholestasis group, 17 (68%) had duodenal ulcer and 8 (32%) gastric ulcer. Therefore, the frequency of peptic ulcer in patients with mechanical cholestasis was more than that in those with non-mechanical cholestasis and in the mechanical cholestasis patients, the frequency of mucosal damage was more in the duodenum than that in the stomach. It is well known that the frequency of gastrointestinal ulceration is higher in jaundiced patients than that in the normal population. A previous report revealed an increase in gastric acid output and free radical formation, but a decrease in gastric wall blood flow3 in in rats with cholestasis.4 It was indicated that gastric mucosal susceptibility to injury is dependent on the normal flow of bile into the duodenal lumen, which appears to be a requirement for adaptive gastric cytoprotection.2 In another study, function of the liver and billiary system was evaluated in 130 patients with peptic ulcer, showing that 84.6% of the patients had some disorders in the hepatobilliary system.5 The results of this study showed significantly more mucosal erosions in patients with mechanical cholestasis than in those with non-mechanical cholestasis. The frequency of duodenal ulcer and peptic erosion was significantly more in patients with mechanical cholestasis than in those with non-mechanical cholestasis. It is concluded that mechanical obstruction is a risk factor for mucosal peptic erosion especially in patients with duodenal ulcer. 44 45 http://www.irmj.ir/browse.php?a_code=A-10-3-10&amp;slc_lang=en&amp;sid=en F Mansour-Ghanaei 480031947532846001288 Yes M Yousefi-Mashhour 480031947532846001289 No A Mahjoob 480031947532846001290 No F Joukar 480031947532846001291 No M Jamali 480031947532846001292 No

en General Medicine General Medicine Letter to Editor Letter to Editor On the morning (5:28 am at local time 01:57 am Coordinated Universal Time (UTC) of December 26, 2003,1-6 an earthquake measuring 6.5 on the Richter scale struck the city of Bam in the Iranian Province of Kerman in the east of country, resulting in the death of >40,000 people, 30,000 injured, and some 75,000 homeless. A total of 18,000 buildings (87% of all buildings), including 131 school buildings, and nearly every healthcare facility was destroyed. The water supply network, electricity, and telephone lines were disconnected.7 The 2,500 year-old historic citadel of Bam (Arg-e-Bam) was destroyed completely. It should be noted that two vector borne diseases (i.e. Malaria and Coetaneous leishmaniasis,7 were endemic in Bam (Table 1). In Bam at the time of the incidence, the risks of morbidity and mortality from communicable and noncommunicable diseases due to the breakdown of the health system grew sharply. Providing environmental, public health, and mental health services, managing the nutritional problems, waste and wastewater and rehabilitating of injured survivors were the main priorities during the recovery phase.8,9 During the rescue and aid to people who suffered in the earthquake in the early January 2004, a case of dog bite occurred to a 43 year old man who attended the area of incidence to help others. No signs and symptoms of zoonotic diseases were observed in him. Because of very fortunate prior vaccination of the dog against rabies. The wounded person was referred to Health Center in the area of disaster and vaccinated immediately within 20 minutes after the injury. Preventive measures were taken in order to prevent the similar threats in the disaster condition. In conclusion, all dogs in disaster areas must be vaccinated against rabies efficiently. Furthermore, care must be taken in case of using such animals in disaster areas. 46 47 http://www.irmj.ir/browse.php?a_code=A-10-3-11&amp;slc_lang=en&amp;sid=en A Mehrabi-Tavana 480031947532846001293 Yes