Journal of Gorgan University of Medical Sciences

The comparative efficacy of Haloperidol (IM) plus Lorazepam (PO) and Risperidon plus Lorazepam in the management of acute agitation

H.Toofanei (M.D)

High prevalence of acute psychotic agitation in psychiatric emergency centers, necessitates finding an medication with less side effects and more efficacy. Concerning the reports about the efficacy of atypical antipsychotics (Even in oral route) in such cases. We decided to examine the efficacy of these drugs in comparison with older ones (Oral Risperidon plus Lorazepam and Haloperidol (IM) plus Lorazepams. The sample population included 60 acute psychotic agitated patients admitted to emergency room of Ebne-Sina psychiatric center. The exclusion criteria were seizure disorder-pregnancy-substance abuse, developmental disorders and other major medical problems. These patients were randomly divided in two groups. The first group was given Haloperidol (5 mg/IM) plus Lorazepam (2 mg/PO) and in the second group, Risperidon (2 mg/PO) plus Lorazepam (2 mg/PO) were administered remission was assessed based on the total score and scores of subclasses of PANSS including: Hostility, incooperativeness hallucinatory behaviors, impulse dyscontrol and excitement on time zero, 30 and 60 minutes. The results were analyzed using the proper test analyzer. Significant decrease in PANSS scores were observed in each group (P<0.001). There was no significant differences in total score and scores of subclasses between 2 groups. 3 patients of each group needed additional dose 1 hour after the first one. The mean time to induce sleep in Haloperidol group was 60 minutes (SD: 33 m) and in the Risperidon group 55 minutes (SD: 34 m). The present study similar to previous ones showed that the efficacy Risperidon plus Lorazepam (PO) in the control psychotic agitation was equal to that of intramuscular Haloperidol plus oral Lorazepam.

Comparison of Mg-Sulfate and Indomethacin in management of women with preterm labor

M.Asgharnia (M.D)

A great number of drugs have been used to inhibit preterm labor but none has been completely effective. This study has compared. The efficacy of Indomethacin and Mg-Sulfate for delaying delivery in preterm labor. In this randomized controlled trial study 120 pregnant women with intact membrane and preterm labor, cervical dilatation at least 2 cm were studied and if they had premature rupture of membranes, gestational age less than 24 or more than 32 weeks, complete cervical dilatation, severe hemorrhage, chorioamnionitis and triple or higher order gestation excluded from study. Subjects are randomly managed with Indomethacin 25 mg every 6 hours for 4 doses or Mg-Sulfate initially 4 gr/IV followed by 2 gr/h IU infusion until uterine activity diminished or decrease. The success of management was considered as either reduce or stopping the uterine contractions, and no increase in cervical dilatation or effacement. Statistical analysis were performed with Chi-square and T-test. The 2 groups understudy had the same inducer maternal matched maternal age, gestational age, parity, dilatation and effacement at initiation of study, frequency of uterine contractions. Delivery was delayed 24 hr in 66.6% and 48 hr in 58.3% by Mg-Sulfate, also delayed 24 hr in 40% and 48hr in 35% by Indomethacin (P<0.0001). No complications were reported in each group. Mg-Sulfate is more effective than Indomethacin in delaying preterm labor.

Evaluation of some of the metabolic bone index during hyperthyroidism

H.Nasri (M.D)

Increase blood level of thyroid hormones due to hyperthyroidism can change the balance between resorption and bone formation and result in hypercalcemia, increase Alkaline Phosphatase and increase in urinary Calcium excretion. Due to these finding and the nutritional conditions of our country in Calcium containing food, we decided to evaluate some of bone indexes in hyperthyroid patients. 30 women, 6 men between 17-40 years (23 patients) and more then 40 years (13 patients) were the sample populations. The control subjects were 35 healthy people 17-40 years (25 persons) and more than 40 years (10 persons). The serum Calcium, phosphorus and Alkaline Phosphatase were determined in these hyperthyroid patients. There were a meaningful correlation between the Alkaline Phosphatase of hyperthyroid patients compared to normal subject (P<0.05) in the patients more than 40 years old, and (P<0.01) in the 17-40 years patients. There were no differences between serum Calcium of hyperthyroid patients and normal subjects. The results from this investigation indicate that in hyperthyroid patients the average Alkaline Phosphatase level is higher than normal subjects. On the other hand the reason for not having a meaningful differences in Calcium level between the hyperthyroid patients and normal population may be due to low dietary intake of dairy produce and proteins in daily diet, which results in low amount of Calcium in nutrition.

The evaluation of HLA class I association with allergic Asthma

E.Alijani (M.Sc)

Major histocompatibility complex (MHC), which plays a major biological function in immune response, is generally associated with so many human disease. During recent years a new clinical relevance of MHC disease. On the other hand there is a strong correlation between some autoimmune diseases and MHC system such as in some allergic abnormalities and its relation with HLA antigens. In order to investigate this concept 30 atypic asthmatic patients and 100 healthy controls were selected. Human leukocyte antigen (HLA) typing was performed by standard NIH procedures and the results analyzed. The frequency of HLA-A2, A11, Aw19 and HLA-B51 decreased in atypic asthmatic patients with no association recorded significantly between HLA-C and allergic asthma. The results of our study indicated that there was a significant relationship between allergic asthma and HLA-I antigens.

Comparison of the Ornithine Carbamyltransferase with Aspartate Aminotransferase and Alanine Aminotransferase in patients with liver diseases

HR.Joshaghani

Liver is an important organ with major role in carbohydrates, proteins and lipids metabolism. In addition, secretion and excretion of toxic materials occur in this organ. Exposure to a variety of infectious agents such as parasitic, viral, bacterial or toxic materials may lead to liver damage. Today, one of the best way for investigation and diagnosis of liver damage is measurement of some liver enzyme such as Alanine Aminotransferase (GPT or ALT), Aspartate Aminotransferase (GOT or AST). Since, these enzymes exist in other tissues, measurement of other specific enzyme is required. In this study activity of Ornithine Carbamyltransferase (OCT), the second enzyme in urea cycle, in 56 patients with liver problem (Cirrhosis and viral hepatitis) was determined. SGPT, SGOT, Alb, Bil, ?GT and ALP tests were performed. To assess the health and unhealthy liver in both control and sample groups. Our data shows a correlation between activity of OCT with SGOT (R=0.782, P<0.001) and with SGPT (R=0.857, P<0.001). Since OCT enzyme is specific for liver, further investigation of activity of this enzyme in assessment of other liver problems is required.

Solvent exposure can cause neurobehavioral effect

SH.Hosseininia (M.D)

Solvent exposure can affect human health. It can cause different effects in different part of the body. One of the most important side effects is neurobehavioral symptom including mood disorders, short memory, and tiredness. To determine the frequency of neurobehavioral effects in patients of a car producing plant in Tehran and comparing them with other workers in the same plant whom was not being exposed to such solvents. All of car painters (78 persons) as our case group and 83 non-painters as our control group were selected by simple random sampling and neurobehavioral abnormality was assessed by Q16 questionnaire. Neurobehavioral disorders based on above questionnaire was observed in 46% of car painters vs. 36% of non-painters (P=0.10). The significant differences were observed in perspiration without any particular reason (Q8) and feeling irritated without any particular reason (Q4). There was not a significant difference in observed frequency of neurobehavioral abnormalities in patients vs. non-painters, however both of these frequencies were higher than expected frequency reported in other reports.

The study of effective factors on persisted diarrhea in under five year old children Gorgan and Agh-Ghala health center

A.Abbasi (M.D)

Diarrhea is one of the main reasons of mortality among children in the developed countries and half of all death is due to persisted diarrhea. This research is a cross-sectional and analytical study done on 708 children with acute diarrhea in village around Gorgan, to find out the effective factors on having persisted diarrhea in children under 5 years old. Face to face interview and determining the variable factors and examining health center records on children with acute diarrhea were the basis for filling the corresponding questionnaires. 14 days after the start of acute diarrhea, which was the second part of this research, the above questionnaires were fully completed by calling on the patient’s home. According to our investigation the risk factors related to the persisted diarrhea were as follow: Age, ethnicity, children length of breast feeding, chlorinated water, children consumed food at the time of acute diarrhea. The results from this investigation indicate that with 95% about probability 10.7%-11.3% of patients with acute diarrhea end-up with persisted diarrhea, which means diarrhea, was continued for more than 14 days. Therefore by controlling the above risk factors the mortality rate due to acute diarrhea could be reduced.

Gross congenital malformations in 10000 births (Gorgan Dezyani Hospital 1997-99)

MJ.Golalipour (Ph.D)

It is reported that the rate of congenital malformations is about 2-3% at birth. They are one of the major causes of morbidity, mortality and disability in childhood are later in adulthood. The aim of this study was to determine the rate of gross congenital malformations that were preset at birth. The other factors studied were anatomic locations of anomalies, neonatal sex, race, maternal age and race. This study was a cross-sectional descriptive study, and the sample population was 10000 births. The rate of congenital malformations was 10.1/1000 in our sample 11.8/1000 in male and 7.5/1000 in female neonates. The rate of malformations in musculoskeletal system were 3.8 In CNS 2.8 and in urogenital system 2.5 per 1000 births. It was concluded that the most frequent malformations in CNS, musculoskeletal and urogenital system were cystic spina bifida, clubfoot and hypospadias respectively. The rate of malformations newborns were 14.5 per 1000, 8.5 per 1000 and 17 per 1000 birth in Turkman, native Fars and Sistan racial groups respectively. The results from this investigation showed that there were relations between rate of over malformations, races and sexes of individuals.

The comparison of environmental Mycobacteriums in the regions with high and low prevalency of TB in Golestan province

E.Ghaemi (Ph.D)

All the different kind of Mycobacterium species except Tuberculosis Leprae and Bovis are considered as environmental Mycobacterium, which usually can be isolated from sand, water and dusts. In addition to the role of their pathogenesis, they can stimulate the immune systems. The immune mechanisms following Mycobacterium environmental contamination can be either protect or destroy the immune system when facing the disease related to the Mycobacterium. The Golestan province has got 2 regions from the point of view of TB epidemy, it is higher in the east. The aim of this project is determine the prevalency of various types and strains of environmental Mycobacterium in the east and west of the region. The samples were collected from both regions from the wet sand, and muddes covered with grass and following their preparation they were cultured on the Lowen Stein Jenson. The total of samples were 220 from these 120 samples were from the region with epidemy of TB out of these we had 25 samples with positive culture (20.8%) and 47 type of mycobacterium were isolated, the most common forms of them were Mycobacterium Fortuitum (34%), Mycobacterium Flavesens (21.2%), Mycobacterium Chelonae (12.8%). From 100 samples taken from the region with low epidemy of TB 66 samples were with positive culture (66%) which 114 strains of Mycobacterium were diagnosed. The most common forms of these microorganisms were Mycobacterium Flavesens (20.1%), Mycobacterium Chelonae (18.4%) and Mycobacterium (16.6%). In conclusion in all the Golestan province without taking notice the TB epidemy form 220 samples 91% were positive culture (41.2%) which 161 different strains were diagnosed out of these the most common were Mycobacterium Fortuitum (21.8%), Mycobacterium Flavesens (20.5%) and Mycobacterium Chelonae (16.8%). The epidemy and variousity of environmental Mycobacterium in the region with low epidemy were much higher than the region with high epidemy and in regard to that these differences are due to the bioenvironmental factors. So therefore this can indicate that the possibility of higher contact between the immune systems and the environmental Mycobacterium. These Mycobacteriums can act as Booster of BCG vaccine which can continuously stimulate the immune systems and this can help the body’s proper responses when facing with the TB Mycobacterium.

The level of stress among Gorgan University of Medical Sciences hospital operation room's personals and its relation to some related factors

SH.Kolakari (M.Sc)

Stress is applied to the collection of somatic, emotional and mental reaction, which can disturbed the equilibrium in human beings. One type of stress is work in dependent stress environment, which can affects on personnel due to its internal stressful factor. The object of this research is to investigate the rate of stress in operating room personnel and its relationship with some relevant factors. The present study has been done on 104 personnel of operating room in hospitals belong to the Gorgan Medical Sciences University. The tools for collection data were questionnaire, which contained demographical variables, physical and mental environment stress factors in operating room life stress scale. The results from this investigation indicated that 54.4% of all personals had a mild stress. The stress factors present in the operation room were inconvenient smells the highest with 76% uncooperated team work was the other factor with 29.7% and personnel equipment was (42.6%) it become clear from this investigation that there is a reverse between stress and demographical variables, of stress has a meaningful relationship with age (P=0.01) and years of service in the operation room which means as the age and working in the operation room increased the level of stress decreased. According to the results from this investigation it is suggested therefore to use the old and well-experienced staff to work in the operation room to avoid such problems.

Hydatidosis: A rare case of bilateral tubo ovarian Hydatid cyst

K.Ghafarzadegan (M.D)

Hydatidosis is a parasitic infection mostly in found in the liver and lung due to echinococus species. But occurrence in other locations is possible. Purpose of this report is to describe a case of bilateral Hydatid cyst in ovaries. Clinical findings with this uncommon location are poorly specific and diagnosis required histologic examination after surgical removal. Imaging and serology is useful to differentiate Hydatid cyst from benign and malignant tumors. This obligatory to examine lung and liver as the main sites of cyst when you are being faced with unusual location of Hydatid cyst especially in endemic area such as Iran. Our patients was a 35 years old woman with history of 4-month abdominal pain in left and right lower quadran. Sonography showed two cysts in adenexal lesions after surgical removal, they were sent to pathology lab. Hydatic cyst membrane was seen in histologic examination of two cystic masses.

The role of cell wall in growth rate of Mycobacterium Tuberculosis

E.Ghaemi (Ph.D)

Mycobacterial diseases are among the oldest disease known to human beings. There are a lot of bitter memories of Mycobacterial invasion especially Tuberculosis and leprosy in human mind, even now after discovery of etiology, diagnostic tool, prevention, and treatment, still, the recalling the above diseases are frightening to human being. Although leprosy isn’t an serious disease nowadays but the TB after a long period of quietness, is going to be an serious risk factor for mankind, especially in third world countries, after cooperating with HIV. Some atypical Mycobacteria, which have weak pathogenicity now, adapt themselves to the new condition and present as a dangerous cause of disease. The researcher that have made themselves familiar with such Mycobacterial features, trying hard to discus carefully the specifities and weak points of these bacteria, to fight them back. The aim of this review article is to highlight one of Mycobacterial characteristic, which is bacteruosis slow growth rate.