Hearing loss in acquired hypopthyroidism

Both clinical and laboratory evidence confirm that hearing loss can result from congenital and acquired hypothyroidism. There is a confirmed correlation between congenital hypothyroidism and hearing loss, but significant controversy still surrounds the association between acquired hypothyroidism and hearing loss.The aim of this study was to evaluate this relationship. Fifty patients with confirmed primary hypothyroidism, were studied and compared with 50 age- and sex- matched controls. All patients were evaluated in the hypothyroidism state before treatment with thyroxine. Auditory assessments included: Toutine ENT examinations, speech reception threshold, pure tone audiometry, speech discrimination score, acoustic reflex and tympanometery The hearing thresholds in all frequencies in both ears of the case group were higher than in controls. Also hearing loss frequencies, i.e. 2000, 4000, 8000 dB in the left and 4000, 8000 dB in the right ears in the case group, were higher than in controls. Hearing loss was symmetric, sensory neural and mild to moderate. Mean speech reception threshold in the right and left ears in the case group were 15 and 15.1 respectively and in controls, 10.6 dB for both the right and left ears. Mean speech discrimination score in the right and left ears in the case group was 97 and in the control group was 99 dB Results demonstrate a strong correlation between acquired primary hypothyroidism and hearing loss

Total dissolved solid modeling; Karkheh reservoir case example

The Karkheh Dam Reservoir with a capacity of more than 5 billion cubic meter is the largest dam in Iran with both agricultural and drinking usages. Its hydrodynamics and water quality were modeled and simulated to analyze the total maximum daily load [TMDL] of Total Dissolved Solids [TDS]. The simulation was supported with measurements of temperature and TDS measurements during two years. A laterally averaged 2D model called CE-QUAL-W2 was used for the simulation and hypothetical low height spillways were implemented in the model to avoid drying of the cells in the river branch. The model was then calibrated successfully with an absolute mean error of 0.71 [degree sign] C. More importantly, vertical stratification of temperature and TDS in the Karkheh Reservoir was reproduced by the model throughout year 2000 to 2003. The calibrated model was then used to simulate water quality response to various TDS reduction scenarios. Model results reveal that a 50% reduction of the TDS load is required for a 40% reduction of TDS in the reservoir outlet. The modeling of a complex combination of a steep and long river-reservoir system was another important achievement of this study

[Treatment of carotid paraganglioma: review of a 15 - years experience]

Carotid body tumor is a highly vascular mass occurring between the origins of the internal and external carotid arteries, and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of this tumor. 16 patients with carotid paragonglioma were treated in our institution during a period of 15 years. There were 12 women and 4 men with a mean age of 44 years. A slow growing painless lateral neck mass was the main finding in all patients. There was no evidence of a functional or malignant tumor. Carotid angiography and CT scan with contrast was performed in near all patients to define the vascular anatomy of the lesion. None of them underwent embolization. Complete tumor resection was done in all patients vascular reconstruction was necessary in two patients. Hypoglossal nerve was sacrificed in one patient and transient marginal nerve deficit was existed in one. No stroke occurred. High index of suspicion and earlier detection by radiologic finding and early surgical resection by an experienced team offer a safe and effective method for complete excision of tumor with a reduced morbidity rate

Adequate serum copper concentration could improve bone density, postpone bone loss and protect osteoporosis in women

To determine the protective impact of efficient serum copper concentration on BMD in women and to asses its impression on bone. six hundred healthy women through a national project in Iran, IMOS, were selected via a cluster random sampling and enrolled the study. They were divided to pre menopausal [404/600, 67.7% of total] and post menopausal [190/600, 32%of total] groups. BMD was measured by biphotonic absorptimetry DEXA for hip and lumbar spine. Morning serum copper concentration was determined by atomic absorption spectrometry. Mean age was 40.92 +/- 14.8yr .Mean serum copper concentration 105.85 +/- 40.15microg/dl and mean BMI= 27.13 +/- 4.81 kg/m2.Totaly 2.4% was smoking, 5% had regular physical activities three times a week and 17.5% was copper deficient. Prevalence of Osteoporosis in postmenopausal women was 12.9% in copper deficient persons vs. 11.3% in normal serum copper ones. No significant difference found according to serum copper concentration associated with BMI, age and vitamin D. Spine BMD revealed a significant correlation with serum copper content. [P= 0.001]. This correlation also existed for Total hip [P< 0.05]. Premenopausal women with serum copper level above 105 microg/dl revealed a significant difference in hip BMD compared to whom with less copper concentration. 1.02 +/- 0.13kg/m2 vs. 0.97 +/- 0.13kg/m2 [P = 0.001]. Copper had an independent role on determining hip BMD in pre menopaused women [P= 0.001]. copper has an independent role on bone density in all healthy women. It could have an adjourning factor for bone loss as well as a protective agent for Osteoporosis

Serum zinc concentration could predict bone mineral density and protect osteoporosis in healthy men

A growing body of investigations demonstrated the essence role of zinc on growing and maintaining bone tissue .The idea that zinc could enhance bone content and adjourn or prevent osteoporosis in men, has been experimented as a hypothesis. Six hundred healthy men [age 20-69 yr] through Iranian Multicenter Osteoporosis Study [IMOS] which is a national project running in 5 provinces in Iran for prevention and treatment of osteoporosis was selected via a cluster random sampling and enrolled the study. Bone Mineral Density was measured by biphotonic absorptimetry DEXA for hip and lumbar spine. Zinc morning serum concentration was determined by atomic absorption spectrometry. SPSS 11.5 was used for data analysis. Body Mass Index [BMI] has been calculated by Weight [kg]/Height [meter][2] for each person. The mean age was 40.83 +/- 15.06 yr .Mean BMI was 24.79 +/- 3.94 kg/m2, overlay 27.3% were smoking, 12.5% had regular physical activities three times a week and 12.2% had a history of renal stone. Among them 30.1% had zinc depletion, 56.8% normal range and 13.1% had serum zinc excess. 57.1% of individuals over 40 yr with hip osteoporosis were zinc deficient whereas 22.1% of them with normal BMD had this deficiency [P< 0.001]. It is concluded that zinc has a positive association with BMD in men over 40 yr and zinc deficiency is more common in osteoporotic individuals

CT patellar cortex tilt angle: a radiological method to measure patellar tilt

The role of patellar tilt in the anterior knee pain is indisputable. Traditionally, the lateral patellofemoral angle of Laurin has been defined in both the axial view and CT images for measuring the tilt of patella. We present a new angle, which is independent of the morphology of patella and directly relates to clinical assessment of the tilt, which is appreciated from palpation of the edges of the patella. 38 patients with anterior knee pain and forty normal control subjects were examined using CT scan of patellofemoral joint in 15 degrees of knee flexion. The amount of lateral patellar tilt was quantitatively assessed using the lateral patellofemoral angle, as described by Laurin et al, and the newly defined patellar cortex tilt angle. This angle is subtended by the line drawn along the posterior femoral condyles and the one parallel to the subchondral bone of patellar cortex. The fifteen-degree tilt was taken as normal cut-off point for patellar cortex tilt angle in the control group. In patients, the average tilt of patella, using the patellar cortex tilt angle was 15.26 versus 7.05 in the control group. Using Student's t test, the difference between the two means was significant [P<0.001]. The sensitivity and specificity of patellar cortex tilt angle were 40 and 90 percent, respectively There was a moderate agreement between our presented test and the lateral tilt angle test [kappa=0.40, P<0.001]. Our results indicate that patellar tilt can also be detected using patellar cortex tilt angle. We need more specific studies to determine the validity of the test

High intravenous fluid therapy prevents post-tonsillectomy nausea and vomiting

Background: post-operative nausea and vomiting [PONV] following surgical operations requiring general anesthesia are common and distressing. The incidence of PONV may be as high as 70% during the first 24 hrs. of tonsillectomy

Objective: this study determines the effects of intraoperative well-hydration on postoperative nausea and vomiting

Methods: 90 ASA I patients with age of 6-12 years scheduled for tonsillectomy under general anesthesia randomly assigned to receive either routine iv fluid plus intraoperative well-hydration plus 4 ml/kg/h Ringer's solution [well hydrated group; n=45] and routine iv fluid requirements [control group; n=45]. All study preparations were administered in a double blinded fashion

Results: during the first postoperative day, the incidence of nausea and vomiting were significantly lower in the well-hydrated group as compared with control [p<0.05]. There was no significant differences between males and females regarding the incidence of nausea and vomiting [p>0.05]

Conclusion: the present study showed that well-hydration reduces the incidence of post tonsillectomy nausea and vomiting, and high iv fluid therapy is a simple, effective, safe and well-tolerated technique for prevention of postoperative nausea and vomiting

[Comparison of the fasting blood sugar before and after antituberculosis 4 drug standard regimen]

Background: The aim of this study is comparison of FBS level, before and after anti tuberculosis therapy in patients with pulmonary tuberculosis

Methods and Subjects: 50 patients with pulmonary tuberculosis were studied. All of them had pulmonary tuberculosis and all of them received standard anti tuberculosis regimen. FBS levels before treatment and the 3[rd], 5[th], 7[th] and 14[th] days after treatment were determined. We used Paired t test to compare means

Results: There was not any significant difference between mean FBS of 3[rd] 5[th] 7[th] and 14[th] day with before treatment FBS. In males and age group less than 30 years old the difference between FBS levels of before treatment and 7 days after treatment was significant and FBS of 7[th] day was lesser

Conclusion: We emphasize that anti tuberculosis regiment does not cause diabetes mellitus in patients with pulmonary tuberculosis

[Comparison of the fasting blood sugar before and after antituberculosis 4 drug standard regimen]

Background: The aim of this study is comparison of FBS level, before and after anti tuberculosis therapy in patients with pulmonary tuberculosis

Methods and Subjects: 50 patients with pulmonary tuberculosis were studied. All of them had pulmonary tuberculosis and all of them received standard anti tuberculosis regimen. FBS levels before treatment and the 3[rd], 5[th], 7[th] and 14[th] days after treatment were determined. We used Paired t test to compare means

Results: There was not any significant difference between mean FBS of 3[rd], 5[th], 7[th] and 14[th] day with before treatment FBS. In males and age group less than 30 years old the difference between FBS levels of before treatment and 7 days after treatment was significant and FBS of 7[th] day was lesser

Conclusion: We emphasize that anti tuberculosis regiment does not cause diabetes mellitus in patients with pulmonary tuberculosis

Combined Monteggia lesion and elbow dislocation

This case is a 19-year-old soldier who suffered a combined elbow dislocation and posterior Monteggia fracture and dislocation [type II]. The ulnar fracture was managed by ORIF. The elbow dislocation was managed by closed reduction and immobilization in 90° flexion. The posteriorly dislocated radial head was kept reduced by a trans-articular pin. After 6 months elbow and forearm motion was restricted and X -ray revealed heterotopic ossification around the radial head. In further follow up there was no improvement in his range of motion. Treatment of these combined elbow injuries remains challenging

In-vivo monitoring of the response of falciparum and vivax Plasmodia to chloroquine in Bandar-Abbas and Kahnoudj, South-East Iran, 1997-1999

The in-vivo 28 days extended test was applied for monitoring of the responses of P. falciparum and P. vivax to chloroquine in malaria patients referred to Malaria Research Laboratory in Bandar-Abbas Training and Health Research Center. The selected patients were treated with standard dose of chloroquine [25 mg/kg over 3 days]. Primaquine was also administered in a single dose [0.75 mg/kg in the third day] as gametocytocidal in falciparum and weekly [0.75 mg/kg/w for 8 weeks] as anti-relapse in vivax cases. From 76 falciparum malaria patients, 63 cases were followed up for 28 days; in 40 patients [63.5%] the parasites were resistant to chioroquine at RI and RII levels. In 13 patients that the asexual forms of P. falciparum were disappeared in their blood by the day 7 and they were not accessible more than one and two weeks, the response of the parasite was considered as either sensitive [S] or resistant at RI level [SRI]. The rate of the chioroquine-resistant cases of P. falciparum among Afghan refugees was higher [86.3%] than the rate in Iranian patients [51.2%]. Totally, there is no significantly difference of chloroquine-resistant rate and levels of P. falciparum in the studied areas in compare to the results of previous study. In 323 vivax malaria tested patients the mean of parasite clearance time [MPCT] was 2.91 days [ranged 1-5 days] and the parasite is still highly sensitive to chioroquine

simple method of in-vitro culture of plasmodium falciparum in screw-capped vials

In a preliminary study carried out in a simple field laboratory in Bandar-Abbas, southern Iran, five isolates of P. falciparum collected from the patients was cultured in RPMI 1640 medium with human serum in the tightly closed screw capped vials without any devised system for adjustment of co2 and o2 mixture. The same isolates were also cultured, simultaneously, in Petri-dishes using Jensen-Trager candle, jar method. Although, the cultures could not be maintained more than 27 days, mostly due to unfavorable conditions existed in the laboratory, the longevity of parasites were more or less the same in both techniques. In this study the multiplication rates of parasites in the screw capped vials were higher than rates obtained in Petri dishes in candle jar method