Journal of Gorgan University of Medical Sciences

Distribution of some Glycoconjugates in Notochord and axial vessels during early morphogenesis in Balb/C mouse embryos

M.M.Hasanzadeh-Tahery (M.Sc)

Background and Objective: Lectins are carbohydrate-binding proteins of plants or animal origin, which react with terminal sugars of glycoconjugates of cells and tissues. Glycoconjugates play essential role in several biological phenomena such as Cell recognition, proliferation, migration and differentiation. Notochord, a mesodermal derivative, induces nearby tissues, including Neural tube, sometimes and developing gut. Materials and Methods: The purpose of this study was to investigate distribution of glycoconjugates in component of notochord and axial vessels during mouse embryonic development. Results: Formalin fixed sections embedded in paraffin from 9 to 14 embryonic days of Balb/c mice were processed for histochemical studies by using four different horseradish peroxidase (HRP) labeled lectins including: Glycin Max (SBA), Vicia Villosa (VVA) and Maclura Pomifera (MPA) specific for GalNac terminal sugar and Lotus Tetragonolobus (LTA) that bind to ?-L-fucose terminal sugar. Our results revealed that approximately similar reactions were observed in notochord and axial vessels endothelium by using GalNac sensitive lectins during vessels morphogenesis. Fucose sensitive lectin reacted only with the notochord. The time and significant role(s) in tissue interactions and subsequent formation of adjacent tissues such as: Axial vessels development during critical morphogenic period. Conclusion: Furthermore, our findings indicate that fucosylated glycoconjugates may have no role in axial vessel formation and/or their interactions with the notochord during early morphogenic period.

Serum Zinc and Copper variation before and after hemodialysis in Gorgan

A.Marjani (Ph.D)

Background and Objective: Zinc and Copper are the important trace elements for human growth and body’s biological functions. These trace elements are the important cofactors of many enzymes. Serum variation of these trace elements are clinically important and should be taken into consideration, because fluctuation of these elements are behind many clinical manifestation in human. Diarrhea and vomiting can be the clinical symptoms associated with the toxic level of Zinc and Copper in the body. The concept behind this study is to determine the serum levels of Zinc and Copper in hemodialysis patients before and after dialysis, to explain the differences of such trace element concentration in these patients. Materials and Methods: This project is a comparative study. The sample population was 50 of hemodialysis patients chosen randomly from the patients referred to the 5th Azar Hospital in Gorgan (33 male and 17 female). The concentration of Zinc and Copper of these patients was determined before and after the dialysis. Results: The results from this research projects indicated that the average concentration of Zinc and Copper in hemodialysis patients after dialysis were 135.32±59.32 and 136.40±51.52 microgram/deciliter which markedly increase in compare to the serum concentration of these trace elements before the dialysis which were 78.38±37.46 and 89.92±32.54 microgram/deciliter respectively. On the basis of the results, we found in this study the average increased concentration of Zinc and Copper after the process of dialysis among the hemodialysis patients had a meaningful statistical variation (P<0.001). Conclusion: Uremia, dialysis blood tube, heavy metal contamination, the quality of dialysis membrane and the quality of water used for the process of dialysis can be a reason for the increased concentration of Zinc and Copper. Such increase in the serum concentration of these trace elements can be the basis for some clinical abnormalities. Therefore it is suggested to determine the rate of released Zinc and Copper from hemodialysis machine, before the procedure is done To enable the medical team to evaluate the serum Zinc and Copper and correct it by nutritional therapy.

Effect of Rocuronium on mean arterial pressure & heart rate in undergoing elective surgical patients ASA1

F.Rokhtabnak (M.D)

Background and Objective: From 1942 when Griffith & Johnson suggested that muscle relaxants are safe drugs for better laryngoscopy & intubation and good for skeletal muscle relaxation during surgery, many of muscle relaxants discovered with different effect, side effect and potency. Some of the muscle relaxants properties include rapid onset, short-acting, fast recovery, stability of hemodynamic, lock of histamine release and etc. Hemodynamic stability is one of the important properties of this drug. In this research we wanted to see effect of Rocuronium, which is an intermediate muscle relaxant on systolic, diastolic BP and HR of patients who is candidate for elective surgery. Patients and Methods: This research is an experimental study. We wanted to see the effects of Rocuronium that is an intermediate muscle relaxant on mean avierial pressure and heart rate of the patient who is coming to the hospital of Iran medical university hospitals for elective orthopedic surgery. The sample size calculated 30 patients. We choose our patients with simple randomized method. All of them were ASA1 and in the age of 20 to 50 years old. The patients didn’t receive any pre-medication until coming to operating room. In the OR they received 7 cc/kg ringer solution and then 70 µg/kg thalamonal was administered intravenously. 5 minute latter their BP and PR was checked, which considered baseline measurement. Induction of anesthesia was with Thiopental 5 mg/kg and Rocuronium 0.9 mg/kg. After 60 sec patients were intubated with direct laryngoscopy. The maintenance of anesthesia for first 10 minutes was with O2 50% and N2O 50% and for continue of anesthesia MR and Opioid depend on need. Results: We analyzed our data with paired to T-test and green house test. Systolic and diastolic blood pressure and heart rate changes was 5% lowest than baseline hemodynamic parameter. Conclusion: With attention to previous studies and observation of hemodynamic changes with muscle relaxants which uses in Iran, this drug (Rocuronium) have good effect on stability of hemodynamic parameters. Beside other properties of Rocuronium include: Rapid onset, lack of histamine release, intermediate acting and etc. We can said this drug is a good and safe muscle relaxant for use during anesthesia and surgery.

Helicobacter Pylori in functional dyspepsia

Sh.Semnanei (M.D)

Background and Objective: After distinguishing the role of Helicobacter Pylori in gastritis and peptic ulcer, some hypothesis were brought up about the probable interference of this germ in dyspepsia. This study was done in order to determine the prevalence of Helicobacter Pylori infection in persons conflicted with dyspepsia, attended in 5th Azar Hospital in Gorgan during 8 months (From 2001/Mar/21 to 2001/Nov/22). Materials and Methods: In this research, 270 patients with diagnosis of dyspepsia were endoscopic based on clinical examinations and paraclinical studies and after ruling out of erosive gastrodeodenitis and peptic ulcer, two biopsy samples were taken from antrum. Then, the samples were put in urea rapid test environment media. The required time for positive response was 15 minutes but to be completely sure about it, urea environment media consisted of biopsy samples were maintained for 2 hours. Any color changes during this time were considered as positive response. Results: Among 270 patients conflicted with dyspepsia 136 patties were male and 134 were female with age average of 40.9% Y/O. The patients with Helicobacter Pylori infection were 139 (51.5%) and the ones without infection were 131 (48.5%), and age averages were 44.4 Y/O and 37.3 Y/O, respectively. The prevalence of dyspepsia subgroups were as follows: Ulcer like 53.7%, reflux like 31.1%, non specific 9.6%, and dismotility like 5.6%, and the prevalence of infection among dyspepsia subgroups were as follows: Ulcer like 62.02%, reflux like 40.47%, non specific 46.15%, and dismotility like 20%. Other risk factors in these patients were as follows: Cigarette smoking 25.6%, NSAID 16.3% and alcohol drinking 4.1%. Conclusion: This study suggests that Helicobacter Pylori infection can have a role in formation of dyspepsia.

Frequency of stress hyperglycemia in admitted patients (2 days to 14 years of age) in Qaem Hospital, Hamadan

Z.Razavi (M.D)

Background and Objective: Stress hyperglycemia (Transient rise of blood sugar during acute physiologic stress) has been reported in adults in conditions such as trauma, burns, stroke, myocardial infraction and patients admitted for any cause in intensive care unit. In pediatric age group stress hyperglycemia occurs in febrile illness and sever gastroenteritis. Prevalence and importance of stress hyperglycemia is not fully appreciated by physicians. This study was designed to find the frequency of stress hyperglycemia in children and infants admitted in Qaem Hospital and comparing it with other studies in Iran and other countries. Physicians’ knowledge about these phenomena prevents unnecessary and sometimes dangerous intervention. Patients with stress hyperglycemia due to acute clinical illness may be at risk of developing diabetes in future and their follow up is important matter. Materials and Methods: This descriptive cross-sectional study was conducted from March 2001 to May 201 on 334 patients admitted in Qaem Hospital who needed blood sampling for diagnostic tests. Known cases of diabetes mellitus and patients who received corticosteroids or beta-agonist agent and dextrose containing intravenous fluids were excluded from study. Blood sugar was determined by glucose oxidas method. On serum samples within 30 minute-1 hour after blood sampling. Hyperglycemia was defined in our study as blood sugar more than 150 mg/dl, fever as 37.5°C auxiliary temperature, and dehydration status defined as criteria of WHO. Results: 334 patients from age 2 days to 14 years had inclusion criteria, of these 59.5% were male and 40.4% were female. 26.3% of patients had variable degrees of dehydration. 23.7% of patients had auxiliary temperature?38.5°C to 40°C. blood sugar were in the range of 37 mg/dl-325 mg/dl and there was stress hyperglycemia in 17 patients (5.1%). Stress hyperglycemia was obviously more observed in patients with higher temperatures, more sever dehydration or clinical deterioration. There was no case of diabetes mellitus throughout 1-year follow up. Conclusion: Stress hyperglycemia is a relatively frequent clinical and laboratory finding in patients admitted in pediatrics and neonatal wards. There is no relation between the stress hyperglycemia and final diagnosis of patients, however the more serious the clinical condition, the higher the temperatures or more sever dehydration rises the likelihood of stress hyperglycemia.

Central loop of the H-reflex: Influencing factors and their relationship

SH.Sadeghi (M.D)

Background and Objectives: Measuring the H-reflex latency (Tp) is an electrophysiologic test to evaluate the S1 root lesions This reflex traverses a relatively long course and its sensitivity to diagnose mild S1 root lesions is low, so investigators have tried to shorten this pathway Evaluation of the central loop of the H-reflex (Tc) is one of these efforts and may be more sensitive in diagnosing S1 radiculopathy (Compared to standard H-reflex latency). We have tried to determine its influencing factors and find the related regression equation. Materials and Methods: Forty volunteers were investigated with their informed consent. Their history, physical examination and a brief electrophysiologic study were normal. H-reflex latencies (Peripheral- central) of right gastrocnemius-soleus muscle as described in literature, right leg length and age were recorded. Results: This group consisted of 26 males (65%) and 14 female (35%). Mean latencies (And SDs) of peripheral and central H-reflexes were 28.8 (SD: 1.66) and 6.78 (SD: 0.3) milliseconds respectively. The correlation between Tc and leg length was significant (P<0.05). There was no significant correlation between Tc and age (P<0.05). Tc and Tp were correlated. These regression equations were found: Tc=0.04L+5.28, Tc=0.05Tp+4.56, Tp=0.04A+0.3L+16.13 (L: leg length in centimeters, A: age in years, Tc and Tp in milliseconds). Discussion: The results of this study, regarding mean and SD of Tc are in line with the previous studies, and regarding the influence of age on Tc are in contrast with only one study and in line with another study. Conclusion: The correlation between Tc and leg length was significant (P<0.05). There was no significant correlation between Tc and age (P<0.05). These regression equations were found. Tc=0.04L+5.28, Tcx=0.07Tp+4.56, Tp=0.04A+0.3L+16.13 (L: Leg length in centimeters, A: Age in years, Tc and Tp in milliseconds). We concluded that it is wise to use leg length for calculating normal Tc and limiting the normal values. On the other hand, the authors believe that more research on specificity and sensitivity of this test (To diagnose S1 radiculopathy) and comparing it with other diagnostic tools is needed.

Comparison of salivary and serum IgG antibody in diagnosis of Helicobacter Pylori

M.Nasrolahei (Ph.D)

Background and Objective: Most of the diagnostic methods of Helicobacter Pylori infection are invasive and time consuming. This study compared salivary IgG with serum IgG in diagnosis of H.pylori infection in dyspeptic patients in order to search for a non-invasive, cheaper and more tolerable method. Materials and Methods: In a cross-sectional diagnostic study, during one year (Feb 2002-Feb 2003) 200 consecutive patients (Age range 11-83) referring to Imam Khomeini Hospital. For upper gastroduodenal endoscopy were recruited. Three biopsy specimens were obtained from antrum and body of the stomach and three from duodenum. Histological examination (Hematoxylin-Eosin and Gimsa), rapid urease test and culture were performed. Saliva and serum were obtained before endoscopy and IgG antibody level were determined by ELIZA using Randim Kit (Roma, Italy). Sensitivity, specificity, positive and negative predictive values were evaluated by SPSS soft ware. Results: Salivary IgG correctly identified 120 out of 146 H.pylori infected patients (82%). Salivary IgG assay showed high sensitivity in the detection of H.pylori infected patients (88.2%). Specificity and positive predictive value of Salivary IgG were higher than those of serum (84.4% versus 83.1% and 92.3% versus 91.9%). Conclusion: Salivary IgG assay can be used as an alternative to other non-invasive methods for screening of H.pylori infected patients.

Twin birth weight discordance and risk of pre-term birth

E.Mobashery (M.D)

Background and Objective: The association between discordant growth and the complication of twin pregnancy has been recognized for more than 30 years. Recent publications have presented evidence that 30% or even 40% discordance presents the threshold for significant. Our purpose was to define twin growth discordance on the basis of perinatal outcome and other factors like maternal age pariety and systemic disease. Materials and Methods: Twins delivered at age more than 32 week’s gestation between 1998-2000 at Deziani Hospital Gorgan was identified. Birth weight, pre-term birth, maternal age pariety and systemic disease and sex of Twins recorded. Discordance was calculated as: 100×larger BW-smaller BW/larger BW. Results: The mean discordance for 435 twins was 8.18±6.79, 96.4% of pre-term birth associated with discordance?20%. 10.6% of mothers had a systemic disease and mean discordance in twins term and pre-term of normal mothers was 5.8±4.5, 7.9±6.3 and in systemic disease was 9±9.2, 11.1±8.8 (P?0.008). There were no differences in pariety age and sex. Conclusion: Twin birth weight discordance had now clearly been demonstrated to be a risk factor for pre-term birth. The effect was found particularly with discordances?20% after 32 week’s gestation.

Unconsumed drugs within Yasuj homes (During year 2000)

SN.Hashemi (M.D)

Background and Objective: Home surplus drugs are an important problem in the developing countries especially in Iran. Iran is one of the most important consumers of drugs in the world. Materials and Methods: The study was descriptive and limited one and included 257 families of Yasuj (25 clusters) that are selected by random sampling. The method of survey is done by questionnaires and intends to evaluate home surplus drugs on basis of value, dosage forms, which is wasted from the therapeutic categorie and expiry date of drugs. Results: The findings that 83% of families had home surplus drugs on basis of dosage forms tablets, capsules, syrup and ampoules (Vials) are ranked. On basis of the therapeutic categories, gastrointestinals, analgesics, antibiotics, CNS and antihistamines are ranked. 80.50% of families are covered by one of the current insurance organizations and 19.5% are not. Conclusion: The average value of drugs for every one family was 8869 girls and from macroeconomic point of view, it will be a huge amount of money budget of country.

Study of Cryptosporidium in children below five years of age with diarrhea in referring Ali-Asghar Pediatric Hospital of Zahedan

M.Dabirzadeh (M.Sc)

Background and Objective: Cryptosporidium is a parasite with worldwide distribution, a significant cause of diarrhea in children and immunodeficient patients. In some country this parasite is either or fourth factor of diarrhea in children. In developing country the prevalence rate of disease is increased but because of specific method recognition in special survey, information about prevalence in our country isn’t completely available. Materials and Methods: From December to March in Zahedan, capital of Sistan and Baluchestan province, 528 patient referred to Ali-Asghar Hospital, parasitology center, in 25 cases of whom Cryptosporidium Parvium was detected (4.7%). Results: The prevalence rate of disease was more in the 1-2 age group. The infants who didn’t use mother milk were significantly more commonly infected and children in nursery school similarly more infected. The majority of cases were detected in summer and spring, although there was no significant relationship between season’s prevalence. Conclusion: Although some C.parvum cases harbored Giardia Lamblia, there was no relation between the two infections.

Evaluation of underlying and precipitating causes of congestive heart failure

A.Shirafkan (M.D)

Background and Objective: Heart failure is the end stage of cardiac disease after that myocardium has used all its reserve and compensatory mechanism. This is a descriptive survey for determine underlying and precipitating etiology of congestive heart failure among patients who admitted on CCU and cardiac department of 5th Azar Hospital of Gorgan. Materials and Methods: In this study 145 patients aged between 19-87 years have participated by data collection using questionnaire and analysis by SPSS-10. Results: The results indicated. The most common underlying causes are myocardial ischemia (57.3%) and the most common precipitating factors is inappropriate drug therapy (75.8%). Orthopnea (86.2%) and ralls (82.8%) are the most symptoms and physical exam findings. AF rhythm with 24.1% is the most common arrhythmia and cardiothoracic ratio more than 0.5 is the most abnormal finding in CXR-PA. The average ejection fraction (EF) in male patients was 32.3% and in women it was 35.7%. There was meaningful relationship between male sex and EF (P<0.05). Conclusion: This study indicated that good control of HTN and preventing of (CAD) incidence are the most important factor to avoid from CHF and appropriating drug therapy has the essential role to maintain compensated state in heart failure.

The correlation between the duration second stage of labor and the newborn Apgar score in primigravida women admitted in Fatemeh Zahra Hospital (Sari-2000)

F.Nasiri Amiri (M.Sc)

Background and objective: To determine the effects of duration of second stage of labor on the newborn’s Apgar score in primigravida women admitted in Fatemeh Zahra Hospital. Materials and methods: Case control study on the 120 primigravide women (40 women with a duration second stage more than 2 hours and 80 women with a duration second stage less than 2 hours). The criteria such as pregnancy history, quality of prenatal care and socioeconomical status were the same for the both groups. Patients with preterm labor, cesarean section, multiple pregnancy, malpresentation, malformation and receipt sedation of narcotic less than one hours to baby’s birth were excluded. From this study statistically analysis had done by Chi-square and Z-test and person’s coefficient correlation. Results: Statistically significant relationship was observed between the age of the mothers and the duration second stage of labor, so that, the mothers with more than 30 years of age had prolonged duration in second stage of labor (P<0.05). More than half of the sample population had used oxytocin for augmentation of labor, which this difference was significant (P<0.05). Conclusion: The different studies showed that the duration of second stage of labor was significantly associated with fetal lactate and low Apgar score less than 7 at birth, but didn’t have any role in five-minute low Apgar scores and neonate morbidity.

Epidemiologic study of patients with oesophageal cancer referring to the Babolsar Shahid Rajaii Radiotherapy Center

KO.Hajian (Ph.D)

Background and objective: The south of littoral of Caspian sea is located on the Asian belt of oesophageal carcinoma, where has the highest incidence in the world. The objective of this study was to determine the epidemiologic aspects of patients with oesophageal carcinoma in the north of Iran. Materials and methods: Based on the existing data of medical charts, we conducted a descriptive study of 668 patients with oesophageal carcinoma who referred to Shahid Rajaei Radiotherapy Center in Babolsar during 1993 to 1999. The data was included age, sex, occupation, residence area, and history of alcohol, smoking, drug consumption, anatomic location and histologic type of tumor. We used T-test and Chi-square test in statistical analysis. Results: The mean (±SD) age of 668 patients was 62.8 (±11) years and the modal age group 60-69 years. The mean age of males was significantly greater than females (63.8 vs. 61.2 years, P<0.05) 54.5% of patients were male and 62.1% of males were farmers, 14.5% clerk, and 7% workers whereas 92.4% of females were housewives. Roughly, 0.7% of patients had a history of alcohol consumption, 19.3% smoker and 7.9% drug users and 50.3% of patients were residence of urban area. The most common histologic type of tumor was squamous cell carcinoma (91.3%) and 7% of tumors were adenocarcinoma. The ratio of men to women of adenocarcinoma was 3 to 1 Also squamous cell carcinoma was more common among men than women The relation between the histologic type of tumor and gender was significant (P<0.05). The most common location of squamous cell carcinoma was the upper third of oesophageal (47.1%) and for adenocarcinoma the lower third (86.4%). Also, we observed a significant relation between occupation and the histologic type of tumor. Conclusion: The results indicated that the frequency of oesophageal carcinoma is increased over the age 50 years. The relation of histologic type of tumor with location and gender are consistent with those reported in the other studies in the western countries, which shows the same pattern of epidemiologic aspects of this neoplasm in the world.

Assessment of level of knowledge, attitude and practice of employed nurses to nosocomial infection in teaching hospitals of Golestan University of Medical Sciences (2000)

AA.Abdollahi (M.Sc)

Background and objective: Nosocomial infections are the important problems in health care centers in the world. Incidence rate in different countries is very variable and has been reported about 5% to 15%. This research was done for ascertainment of level of knowledge, attitude and practice of employed nurses to nosocomial infection in teaching hospitals of Golestan University of Medical Sciences. Materials and methods: This is a descriptive and analytical study, total number of employed nurses (518), 189 male and 328 female. The research carried out using a questionnaire. The data was used to analyze the data SPSS software. Results: Results of research showed that 26.5% of nurses had very low knowledge, 63.9% medium knowledge and 9.6% good knowledge. About attitude 52.4% had negative attitude, 36.4% medium and 11.2% positive attitude. About practice 37.1% had poor practice, 49% medium and 15.9% good practice. In this research between attitude and knowledge, knowledge and practice there was not any meaningful correlation but difference between attitude and practice was statistically significant. Conclusions: The nurses are playing important role in prevention and control of nosocomial infection. So, it is necessary for nurses to have enough knowledge about how to control the infection and to have positive attitude, if they want to do their job property.

Ehler-Danlos syndrome (Case report)

B.Soltani (M.D)

Ehler-Danlos syndrome is rare disorder of collagen metabolism, characterized by skin fragility and hyperlaxity, hypermobility of joint. Type I collagen or III collagen is metabolically disordered. Our case report is 27 years old Turkaman male referred top dermatology clinic 5th Azar Hospital for disability, echymose and papyraceus scar. After clinicopathologic evaluation, the diagnosed case proved to be Ehler-Danlos.

Cervical Hemangioma: A case report

R.Azarhoush (M.D)

Hemangiomas are benign tumors, which considered being in distance between hamartomas and true neoplasms. Most of the hemangiomas arise in head and neck region and the others grow is trunk and extremities. Hemangiomas of the uterine cervix are rare. They are usually harmless and appear as dark red or purple mass. Our case is a 35 years old patient suffering from intermittent vaginal bleeding and had a well-defined polypoid mass in vaginal examination. The natural history of cervical hemangioma is regression and involution. Biopsy must be undertaken with circumspection because serious bleeding can occur.