Journal of Gorgan University of Medical Sciences

Distribution of Galactose-N Acetyl Galactoseamine on the surface of adult mice kidney cells

H.Mofidpour (Ph.D)

Background&Objective: Carbohydrate chains link to glycoproteins and glycolipids of the cell surface particulary their terminal sugars have key roles in cellular activities of almost all biological systems. Distribution of these glycoconjugates in adult kidney has not received fair attention yet. The purpose of this study was to identify in situ location of galactose – N – acetyle galactoseamine moleucles on the surface of the adult rat kidney. Materials&Methods: After the resection of rat kidney and rotin fixation with regular lectin histochemical technique, MPA and PNA conjugated to horseradish peroxidase, lectins specific to indentify these terminal sugars in rat kidney. Results: Intense reaction of PNA to collective tubules, less intense and reaction with luminal surface of proximal tubules and MPA identified distinct cells among distal tubules as well as glomerules were observed. Conclusion: It seems that this specific sugars related to the cellulars function of this region of adult kidney and probably genetically is regulated during embryonic development.

The study of effect of Piperine by hot-plate and Formalin test in mice

AA.Moghaddamnia (Ph.D)

Background & Objective: Black pepper is frequently used in Iranian traditional medicine as an analgesic (E.g, for toothache). This investigation was conducted to evaluate the response of mice to pain induced by hot-plate and Formalin test either with or without Piperine (One of the active substances of the pepper). Materials & Methods: This randomized experimental study was performed on mice. Hot-plate and Formalin tests were planned to pain measurement. The mice were divided into 2 groups in each arm of study (Hot-plate and Formalin test group). The data of control (Saline) and drug (Piperine) groups were separately compared in each arm of study with student t-test and ANOVA. The difference between each point of data was considered significant at P-value under 0.05. Results: There was not a significant difference in tolerance time of subjects between hot-plate and saline groups. Piperine (25, 50 and 75 mg/kg) along with Morphine (10 mg/kg) causes significant increase to saline group in tolerance time and also significant increase to Morphine group, but in Formalin test Piperine could have significant effect in decreasing the pain induced by of Formalin on mice. These effects are comparable with Morphine. In Formalin test, pain has 2 phases. The first phase is acute and the 2nd one is chronic that begins from 15-20 minutes. Acute pain has central effect and chronic pain has peripheral pathway and Piperine causes decreasing response to Formalin test at the first phase of pain. Naloxone can prevent these effects in all groups. In Formalin test and hot-plate, the effect of Piperine were dose dependent. Conclusion: Piperine can centrally act on the nociception pathway and its effect on Opioid system exhibits as an enhancement Opioid effect. The effects are dose dependent and will be inhibited by Opioid antagonist.

Comparison of the effects of topical Lidocaine spray applied oropharyngealy before and hypopharyngealy after induction of anesthesia on the pressor response to direct laryngoscopy and intubation

A.Parviz-Kazemei (M.D)

Background & Objective: The deterious effects of pressor response (Tachycardia and hypertension) are not hidden from any personal of anesthesia group. The present study is performed in Chamran Hospital affiliated to the university of medical sciences, Shiraz, with the aim to introduce the most effective, cheapest as well as the easiest method to prevent or reduce the pressor response to direct laryngoscopy and intubation. Materials & Methods: This randomized clinical trial was conducted in Chamran Hospital in Shiraz. 90 patients scheduled for elective surgical fixation of femur or tibia were randomly divided in group A (30 patients), group B (30 patients) and group C (30 patients). In-group A patients were directly sprayed with Lidocaine 10%, hypopharyngealy, after induction of anesthesia and 3 minutes before tracheal intubation. Patients in group B were sprayed with Lidocaine 10% oropharyngealy before induction of anesthesia while the patients, were awake, patients in group C were not sprayed with Lidocaine (Control group). Premedication and drugs used for induction of anesthesia were same in 3 groups. The heart rate, systolic and diastolic blood pressure were recorded in all patients included in the study, before tracheal intubation (Base line) just after tracheal intubation and 3 and 5 minutes after intubation. Results: Spraying Lidocaine oropharyngealy before induction of anesthesia and hypopharyngealy after induction of anesthesia both were effective in controlling the pressor response to laryngoscopy and tracheal intubation, but spraying Lidocaine oropharyngealy before induction of anesthesia is more effective than spraying Lidocaine hypopharyngealy after induction of anesthesia (P<0.05). Conclusion: According to the results of present study, applying Lidocaine spray, oropharyngealy is a simple, very effective as well as cheap method for controlling pressor response to tracheal intubation.

The inhabitants health status in high and low natural background radiation areas in Ramsar, north of Iran

A.Shabestani.Monfared (Ph.D)

Background & Objective: Ramsar a coastal city in the north part of Iran has among the highest levels of natural radiation known to exist in an inhabited area. This is mainly due to radium-226 and its progenies coming to the earth surface through hot springs. The health effect of low doses of ionizing radiation is not clear and is still under the matter of discussion. The study of the effects of high natural background radiation on human health was the main goal of this investigation. The present article is showing the results of the first phase of our work. Materials & Methods: This cross-sectional, analytical study was conducted on 101 families (402 residents) of high background radiation areas and 98 families (374 residents) from adjacent normal radiation areas. After description of the study and its objectives to the participants, they were asked to participate in interviews and complete questionnaires containing some socio-economic and health items. Some items of questionnaires were determined using the information recorded in local health centers in those areas. Results: Overall data showed no significant differences between the frequencies of any mental and physical disabilities as well as death, abortion and mental depression in residents of normal and high background radiation areas. However the frequency of some special diseases such as cardiac diseases and malignancies among residents of high background radiation area in comparison with ordinary radiation level areas was lower (P<0.05). Conclusion: These preliminary results, showed lack of ill effects and even some positive effects. Among population of high background radiation areas. Although we used census method for getting data, we believe that other radio-epidemiologic prospective studies can improve our knowledge about radiobiology of low doses of ionizing radiation.

Prevalence of Atopic diseases (Allergic rhinitis, Urticaria, Eczema) and its correlations in primary school children, Shiraz, Iran

SMT.Ayatollahi (Ph.D)

Background & Objective: Atopic diseases are one of the most common chronic conditions in children. A population based matched study was conducted to estimate the prevalence of atopic diseases and this study used to identify its correlations in primary school children aged 6-12 years in Shiraz (Southern Iran). Materials & Methods: This case-control study was carried out in 2228 primary school children. The children were selected using 2-stage random sampling from the 4 educational distrincts of for each child. The consultant physician examined the children with positive result. After diagnosis of eczema, utricaria and allergic rhinitis control groups were selected by using matching method (Age, sex, school). The correlations of atopic diseases were determined by conditional logestic regression. Results: The most important results were as follow: Prevalence of diagnosed allergic rhinitis, utricaria and eczema in primary school children estimated in order 5.2% (Boys: 5.2% & girls: 5.12%), 3.6% (Boys: 3.57% & girls: 3.7%) and 1.6% (Boys: 1.53% & girls: 1.7%). There was no significant association between atopic diseases and birth order, social class, parent’s education, parent’s smoking and period of breast-feeding. An increased risk of childhood atopic diseases were associated with familiar history of allergic rhinitis (P<0.05), familiar history of utricaria (P<0.05) and familiar history of eczema (P<0.05). Conclusion: Our study confirmed that familiar atopic diseases were significant predictors of childhood allergic rhinitis, utricaria and eczema among school children in Shiraz.

The determination of hearing loss in Thalassemia major

MH.Taziki (M.D)

Background & Objective: Major ?-Thalassemia is the most common form of anemia, which has a relatively high prevalency especially in the northern part of the country one of this disease side effect the hearing abnormality. This study has been carried out in Gorgan for the determination of the hearing level of ?-Thalassemic patients, and its relation with the level of serum Ferritin, the rate and the duration of blood transussion and dyspheral. Materials & Methods: In this study 95 patients with major ?-Thalassemia have been studied for the rate of hearing level. The variation parameter include age, gender, Ferritin level, the rate and duration of disferal consumption. Audiometry, tempanometry and physical examination carried out on all the patients. The findings from this research gathered and were analyzed using the SPSS statistical software. Results: 95 patients (190 ears) with age 3-29 year of old were gone under this study and only 72 ears had the threshold over 15 decibel, from this 43.9% were from sensorineural type of hearing. The 80% of ears’s thempograms were type A. The results from this study showed that there is a meaningful statistical correlation between the hearing loss and serum Ferritin level. The rate of dyspheral consumption, in each time and its duration (P<0.05). Conclusion: This study showed that high serum Ferritin level and the increased length of dyspheral consumption lead to the hearing loss in major ?-Thalassemia, therefore clinical examination of hearing interrally has to be carried out.

The comparison of neonatal growth indices in unwanted and wanted pregnancies

M.Afshar (M.D)

Background & Objective: Neonatal growth indices can be influenced by either wanted, or unwanted pregnancy. This research was done to compare neonatal growth indices (Height, weight, head circumflex) to in such pregnancies in Birjand (South-east of Iran). Materials & Methods: This study case-control study was done on a total of 400 women and their neonates in the Imam Reza and Mehr maternity hospital in Birjand between 2000 to 2002. The number of case (UWP) and control (WP) were 150 and 250 respectively. Data were collected through a valid and reliable questionnaire by face to face interviewing with mothers and the determination of growth indexes of the neonates. The results were analyzed employing X² and student T-test by means of SPSS software. Results: The results revealed that the mean weight of the neonates in the case group (3151±410.4 grams) was meaningfully (P?0.05) less than the mean weight (3243±484 grams) of the neonates in the control group (WP). Besides, the mean weight gaining of mothers during their pregnancy in the cases (9±3.2 kg) was meaningfully (P<0.05) less than control group (9.7±3.4 kg). Conclusion: The results of this study, shows the impact of wanted pregnancy on weight gain and health improvement of mothers and their infants. It is therefore recommend that the health centers, mass and even high schools officials provide enough training to prevent unwanted pregnancies.

The comparison of liquid diet starting 6 and 12 hours after cesarean delivery

A.Shafiei (M.D)

Background & Objective: One of the post-operational problems in the cesarean-section is ileus symptoms and the starting point of taking the liquid diet. Some controversy are about this procedures. This study was done to evaluate the rate of ileus symptoms of women who are offered oral hydration shortly after cesarean delivery. Materials & Methods: This study involved 276 women delivered by cesarean under general anesthesia that had no previous cesarean or laparotomy and indisposing and their operations had not been exceeded 90 minutes. For these patients a liquid diet for every other day, partly 6 hours and others 12 hours after operation was started. The patients were examined at the time of starting diet and 6 hours later for bowel sound, nausea or vomiting, abdominal distention and gas passage. 138 women were assigned to each procedure. Results: Nausea or vomiting cases in the early fed group, were more than 12 hourly diets (2.2% versus no case) and (12.3% versus 10.9%) but the difference was not statistically significant. The bowel sound in the early fed group were less than 12 hourly starting the diets, (15.2% versus 12.3%) the difference was not statistically significant. The 6 hourly starting of liquid diet had a significant effect in speeding up bowel movements (P<0.05). Conclusion: Early oral hydration after cesarean was well tolerated and it was associated with rapid return of propulsive bowel movements, so to do, this results in better reply to the physiologic request of the patients.

Effect of subdermal irrigation with Normal Saline on the wound infection in abdominal surgery of obstetrics and gynecology

M.Kashanian (M.D)

Background & Objective: Wound infection in post-operation is one of the side effect that bothering the patients’ quality of life. This study was done to determine the effect of subdermal irrigation with normal saline on the wound infection in abdominal surgery of obstetrics and gynecology. Materials & Methods: A randomized clinical trial of subdermal irrigation with normal saline versus no irrigation was performed on 200 patients who were candidate for abdominal surgery of obstetrics and gynecology. Contaminated wound was excluded. In the case group (100 patients) after facial repair and complete hemostasis, subdermic tissue was irrigated with 1000-milliliter normal saline and skin was closed. In the control group (100 patients) after facial repair and complete hemostasis skin was closed without subdermal irrigation. All of the patients were followed until complete repair of skin. Results: 2 groups were similar in age, BMI, duration of surgery and the type of operation. Wound infection was observed in 1% of case group and in 7% of control groups, which was statistically significant (P<0.05). Conclusion: Subdermal irrigation with normal saline is effective, simple, safe and not expensive which can reduce the wound infection and can be offered particularly in high risk patients for wound infection.

The relation between asymptomatic bacteriuria and preeclampsia

N.Bourghei (M.Sc)

Background & Objective: Asymptomatic bacteriuria (ASB) is a significant problem during pregnancy because it can be developed into more severe infections that may have repercussions for the health of the mother and unborn child. The aim of this study was to assess relationship between asymptomatic bacteriuria and preeclampsia in Gorgan. Materials & Methods: This case control study performed on 150 preeclamptic women (Case group) compared with 150 healthy pregnant women (Control group) who hospitalized from 2002 to 2002 (Gravid, age and history of preeclampsia was matched with 2 group). The questionnaires and checklist was completed, urine analysis, and urine culture were performed. The data analyzed with SPSS software and statistical descriptive and analytic such as: T-student, U-Mann Whitney. Results: The risk of preeclampsia in pregnant women with ABS was 3.2 fold to healthy pregnant women (OR=3.22, CI 95% for OR=1.99, 5.21). Conclusion: Asymptomatic bacteriuria may predisposing factor to preeclampsia, we suggest screening of ASB in the 1st prenatal care and follow in 2nd and 3rd trimester of pregnancy o prevent the main side effect in pregnancy and the safety of mothers.

The relation between Demodex mites with incidence of Acne Rosacea

M.Dehghan (M.D)

Background & Objective: Acne Rosacea is a recurrent chronic and inflammatory skin disease. According to the prevalence of Acne Rosacea, importance of determining its etiology and controversies about the role of Demodex mites in expression of the disease, this study has been done on patients who has been referred to Booali and Loghman hospitals during 1370-80. Materials & Methods: This research was a case-control study. The case group has been Acne Rosacea patients according to the pathologic report and there has been 2 control groups: One, who has had discoid lupus erythematosus (DLE) and the other one, those who has been affected by actinic Lichen Planus (ALP). The groups have been matched for their age and sex. Pathologic specimens being provided by skin biopsy technique, have been studied for the determining the presence and density of Demodex mites, the results has been recorded on special information sheets and their role in expression of Acne Rosacea and its odds ratio have determined. Results: This study has been done on 225 patients, 75 in case group (Acne Rosacea) and 75 in patients in each of the control groups (DLE and ALP). There was no statistical difference in the age and sex of patients in these groups. 16% of the control group and 38% of case group had Demodex mites (P<0.05) and the presence of this parasite has increased the chance pf expressing Acne Rosacea by 3.3 times. The mean count of Demodex mites in DLE and ALP groups has been 0.66 and 0.2 respectively, whereas, in case group, it was 1.4 (P<0.05). Conclusion: We concluded that the presence and density of Demodex mites increases the chance of expression of Acne Rosacea. Further studies for determining the effect of treating these mites in Acne Rosacea is recommended.

An epidemiological study of psychiatric disorders in Golestan province, 2001

MR.Mohammadi (M.D)

Background & Objective: The burden of psychiatric disorders in the developed countries has been identified by the screening questionnaires and standard clinical interviews at a high level, but the epidemiological studies of psychiatric disorders in our country are brief and their numbers are few. Providing essential mental health services to the people requires us to be knowledgeable about the present status of psychiatric disorders in the society. The objective of their research was to carry out the epidemiological study of the psychiatric disorders in the 18 years and above individuals in the urban and rural areas of Golestan province. Materials & Methods: 518 individuals selected through randomized clustered and systematic sampling methods from among the existing families of Golestan province and the schedule for affective disorders and Schizophrenia (SADS) questionnaires completed by the clinical psychologist. The diagnosis of the disorders was based on DSM-IV classification criteria. Results: The results of the study showed that the prevalence of psychiatric disorders in the province is 14.69%, which was 18.14% in the women, and 11.47% in the men. The mood and affective disorders respectively with 7.93 and 4.05% had the higher prevalence in the province. The prevalence of psychiatric disorders in this study was 0.97%, neuro-cognitive disorders 1.16% and dissociative disorders 0.58%. In the group anxiety disorders, panic disorder with 4.05% of had the higher prevalence and in the group of affective disorder, major depression, hypomanic and manic disorder with 1.93. Conclusion: This study showed that 7.53% of individuals that were studied suffered from at least one of the psychiatric disorders. The prevalence of psychiatric disorders in the province among the individuals in the age group of 41-55 years with 13.04%, separated or divorced individuals 50%, residents of urban areas 11.03%, illiterate individuals 12.75% and housewives 13.04% was more than other individuals in the sample. Being aware of this matter reveals the responsibility of the health policy makers and programmers, prevention, treatment and medical education more than before in relation to preparing application and executive plans in Golestan province for mental health.

The efficacy of DOTS strategy in treatment or failure of treatment in respiratory Tuberculosis

A.Abassi (M.D)

Background & Objective: About 1.3 billions people are infected with Tuberculosis (TB) all over the world. There is a close relationship between the quality of TB treatment and the rate of drug resistance. The recurrence epidemy of TB and increased resistance to some drugs was the basis for the WHO to suggest the directly observed short course treatment strategy or (DOTS) strategy, for the TB patients. Materials & Methods: This research was a cohort study and aimed to evaluate the epidemiological finding, the clinical basis and strategy of DOTS on improving, and prevention from failure of treatment and was compared with non-DOTS procedure. Sample population were total of 260 smear positive patients that had been under study for a period of 2 years (1999-2000). All of the patients were new cases. SPSS software and Fisher exact test was used to analyzed the data. Results: The rate of treatment failure in DOTS strategy in the beginning of 5th month was 1.7%, but in the control group the failure in the same period was 7.3% (P<0.05). Conclusion: This study indicated that the DOTS strategy is substantially increasing the success rate of TB treatment.

Effect of hemodialysis on plasma Lipid peroxidation and erythrocyte antioxidant enzyme in Gorgan

AJ.Marjani (Ph.D)

Background & Objective: Free radicals are formed in all living organisms during normal cell metabolism. Patients with chronic renal failure, which regularly dialyzed are the candidates for, free radical damages. The aim of this study with the discriminative information was to evaluate the effect of hemodialysis on Lipid peroxidation (The level of Lipid peroxidation expressed as malondialdehyde) and erythrocyte antioxidant enzyme (Glutathione peroxidase) before and after the dialysis and compared with control group, to find out the effect of hemodialysis on the level of Lipid peroxidation of plasma and the activity of erythrocyte antioxidant enzyme. Materials & Methods: This investigation was an analytical type of study and sampling procedure was according to purposive method. 22 patients with chronic renal failure (CRF) disease who were hemodialysed at 5th Azar Hospital of Gorgan dialysis center and 22 age and sex matched healthy control were recruited for this study. The data was analyzed by SPSS software using T-test. Results: Plasma malondialdehyde showed significant difference between the predialysis (And control group. It was increased in the postdialysis group (2.32±0.38 nmol/ml) when compared with predialysis (1.27±0.23 nmol/ml) and control group (0.98±0.17 nmol/ml). Erythrocyte antioxidant enzyme was decreased in postdialysis group (22.26±4.76 unit/gram hemoglobin) when compared with predialysis (29.66±5.95 unit/gram hemoglobin) and control group (37.52±6.26 unit/gram hemoglobin). There was also significant difference between control and predialysis group. Erythrocyte antioxidant enzyme was lower than control group in dialysis group. Conclusion: The observation of meaningful differences in reduction of erythrocyte antioxidant enzyme and increasing level of plasma Lipid peroxidation in the hemodialysed patients after the process of dialysis, maybe related with the patient, uremia, dialysis membrane (The loosing antioxidant enzyme through this membrane), and the dialysis process (May increase Lipid peroxidation during the dialysis process). These states of affairs may play an important role in progress of cardiovascular abnormality in hemodialysed patients. Due to this conditions a review of hemodialysis membrane, the techniques used in the dialysis, the consumption of various oral antioxidant, the elimination of active oxygens from the dialysis surrounding are among the measures which can prevent sudden cardiovascular abnormality in the hemodialysis patients and ultimately these important factors up-grade the patients quality of life.

The evaluation use of IPSS in urinary retention in post-general anesthesia in over 50 years men

S.Shakeri (M.D)

Background & Objective: Post-general anesthesia urinary retention is a common and bothering complication. In this study prediction value of IPSS for post-general anesthesia urinary retention was evaluated. Materials & Methods: This prospective study include 100 male patients over 50 years old who were candidated for nenurologic and non-nenurological elective surgery without any urology and neurologic past medial history. IPSS was calculated for each patient. The patients were followed in post operative period for urinary retention. Results: 1.8% of patients who had mild symptoms (IPSS=0-7) had urinary retention in 2nd 24 hours of post-operative period, 20% of patients who had IPSS=8-19 and 53.3% of patients with IPSS=20-53 had urinary retention at same period (P<0.05). Conclusion: IPSS can predict postoperative urinary retention in elderly male patients. If severe symptoms by IPSS was encountered the patients and health care personals must be cautioned about possibility of postoperative urinary retention and if required urologic consulation.

Prevalence of Celiac disease in north of Iran: Screening of an adult population in Sari

H.Tirgar-Fakheri (M.D)

Background & Objective: Studies about the prevalence of Celiac disease (CD) in western Asian countries are scarce and there is only one study on the prevalence of CD in healthy blood donors in Iran. The aim of this study is to determine the prevalence of CD in general population of the city of Sari in north of Iran. Materials & Methods: This was a descriptive study and the blood samples were obtained from 1438 person from general population (686 males, 752 females: Mean age 35.5 range 18-66 year) of the Sari which were selected by stratified randomized sampling method during 2003. Total serum IgA was measured in all and IgA-deficient cases were excluded. From this study all cases were analyzed for IgA tissue transglutaminase antibody (Human recombinant tTG). All persons who had a positive serology for tTG-Ab underwent small intestinal biopsy. The biopsy samples were classified according to modified Marsh criteria. Results: All of the samples had normal total IgA. 13 cases showed positive IgA-tTG Ab (6 males and 7 females, mean age 37.5 yrs). All subjects with positive serology except one of them were found to have small bowel biopsies compatible with gluten sensitive enteropathy. One of 13 had Marsh 0, 8/13 Marsh I, 3/13 Marsh II and 1/13 showed Marsh IIIa lesion. Conclusion: The minimum prevalence of gluten-sensitivity among general population in north of Iran is 1/120. This data confirms our study on healthy blood donors, which has published previously and is like of prevalence of Celiac disease in western countries. So Celiac disease is not a rare disease as it thought before in this area.

The comparative study of health status of medical students and para-medical students trainee

SH.Hosanei (M.D)

Background & Objective: There are a tramandous changes are happened after a person entered to the university. This period considered to be a very deligate part of student life. During this phase usually there are anxiety and combination of other problems, which could affect health status of the person. The mental health considered a high ranking items among the different groups in one society, especially more when we are talking about the medical sciences students, because these students are goings to look after other people health in the community, the health status of medical and paramedical students should be seriously taken into consideration. On the basis of these facts, this research has been set-up to investigate the mental health status of trainee medical and paramedical students of Mazandaran University of Medical Sciences. Materials & Methods: This research project was an descriptive analytical study on all of the medical and paramedical trainee students in 2nd term of the academic year 1999-2000 of Mazandaran University. The basis for this research’s was the questionnaires which contained the personal demographic and also GHQ tests. Results: The GHQ test was set up on physical disability, sleep disorder, anxiety and unsociable. In 2 groups of students and there was no differences between the 2 groups, in dimension of depression the prevalence among the medical students was more than para-medical student, that this difference was significant (P<0.05). Conclusion: In regard to the results of this research and the steady increase of mental problems numbers of suspected cases among the students, in addition to the attention of health authorities. The establishment of student’s advisory unit is required.

Urinary retention and nonfunctioning kidney secondary to bladder hernia (Case Report)

HR.Tajari (M.D)

Inguinal hernia is common in midlle age and elderly. It is in two form of direct and indirect. Often the hernia sac consists of omentum and or intestinal segmants, but bladder hernia is very rare. In present patient massive inguinal hernia and urinary retention were associated with ipsilateral nonvisulization and nonfuncting kidney that showed the disease is chronic in nature. The diagnosis is confirm by ultrasonography and retrograde cystography. In cystography, contrast maternal is show in scrotal cavity and commnication of it with bladder. In our case, the diagnosis is made preoperatively with ultrasonograpy and cystography. The patient able to void post-oprative day and scrotal enlargment is compelely reduce. In conclusion it is advised that in patients older than 50 years who have massive inguinoscrotal herina and prostatism cystography to be done mandatory and also preoperative diagnosis is to be made to prevente the injury of bladder and ureter in operating time.