Jundishapur Scientific Medical Journal
Year:2010 | Volume:8 | Issue:4 (63)|Papers Count:18

Background and Objective: Impairment of alveolar mononuclear cell function due to cigarette smoking may increase the rate of respiratory infections. However, increased susceptibility of smokers to infections of other organs implies that tobacco effect is not restricted to the respiratory immune competent cells. The aim of this study was to assess the effect of smoking on urinary tract infection.Subjects and Methods: This prospective case-control study was performed among 51 cigarette smokers (as cases) and 51 non smokers (as controls), from Sept 2005 to Sept 2006 in Ahvaz. There was no sampling, all included population, were randomly selected based on attending the study. Urinary tract infection was diagnosed by urine culture (colony count 105 bacteria per ml (male/female) with sensitivity 90% and specificity 95%). A questionnaire including demographic and clinical characteristics was filled for each individual. Data were analyzed in SPSS 13 by chi square test, P<0.05 were considered significant.Results: The incidence rate of urinary infection in smokers and non smokers were 27.5% and 21.6% respectively (P>0.05). The rate of two or more attack of urinary tract infection due to relapsed infection in smokers and non-smokers were 50 % and 27.3% respectively (P<0.05). Infection with more than one microorganism in smokers and nonsmokers were 71.4% and 12.5% respectively (P<0.05).Conclusion: Cigarette smoking does not increase the risk of urinary tract infection, but, increases the number of involved microorganisms and in relapse of urinary infections.

Background and Objective: Diabetes Mellitus (DM) is a group of metabolic disorders which cause hyperglycemia. Like any other chronic disease, DM has physical and psychological adverse effects. One of its most important psychological effects is depression which involves considerable percent of these patients. Considering high prevalence of DM and its related depression, we designed a research to evaluate relation between social support and rate of depression in diabetic patients.Subjects and Methods: In this survey, 100 cooperative diabetic patients (50 women and 50 men) were studied. The patients were admitted in Golestan Hospital from Sep 2006 to March 2007. Data-gathering was accomplished by a questionnaire and social support and depression rate were assessed using Bek questionnaire. Finally, data were analyzed by SPSS software.Results: Correlation coefficient between results of social supports and depression tests was -0.54. These variants were significant and in inverse relationship. Relationship between social support and depression in male and female diabetic patients were significant and were inversely related. Prevalence of depression was 58.8% in men and 76.2% in women which has not significant differences (P=0.057).Conclusion: According to our study, there is an inverse relationship between social support and rate of depression in diabetic patients. No gender differences were found. Psychological aspects of DM and importance of social supports in treatment of depression related to DM must be considered.

Background and Objective: To evaluate cardiac status in patients with thalassemia major.Subjects and Methods: The investigation included thorough history taking, clinical examination, electrocardiography, chest radiography and echocardiography. One hundred and twenty young adults with thalassemia, following an adequate transfusional and chelation treatment regimen, without clinical signs of cardiopulmonary involvement.Results: 63 patients were female and 57 patients them were male. Mean age of the were 16.6 6 years (range 5-37 yr). Abnormal findings in ECG were found in 35.8% that the most common were nonspecific T wave and ST segment changes. Chest radiograph revealed increased cardiothoracic ratio in 30% of patients. Precardial effusion reported in 2.5%. No history of precarditis was reported in any patient. Mitral, tricuspid and pulmonary valve regurgitations were observed in 52%, 60% and 20% respectively. None of the patients had frank congestive heart failure. Ejection fraction and fractional shortening of the patients were 55.2% 5 and 31% 5 respectively. E/A <1 [early (E) and late (A) transmitral and transtricuspid peak flow velocities] were seen in 2.5% and 4.2% respectively. Pulmonary hypertension (PHT; defined as pulmonary artery pressure > 30 mmHg) was found in 8.3% of the patients, aged 19±8 yr. PHT correlated positively with irregular use of desferal (P<0.001).Age correlated negatively with ejection fraction (P<0.001), fractional shortening (P<0.05), mitral E/A (p<0.003) and tricuspid E/A (p < 0.014). In patients with abnormal ECG and CXR; ejection fraction reduced significantly (P<0.004). Left ventricular (LV) systolic dysfunction was encountered in 23.3% of patients, aged 20 5 years. Restrictive LV filling was suggestive in 32% of patients.Conclusion: Despite of regular usage of desferal and standard transfusion, there is also chance of cardiac complications in thalassemics. Echocardiographic examination appears a tool more reliable than clinical, electrocardiographic and/or chest X ray examination in assessment of young adult patient with thalassemia major. At present the most powerful predictive information includes a patient’s transfusion record, serial serum ferritin levels, and compliance to a chelation regimen.

Background and Objective For some people, the motive for attempting suicide is the transition (transfer) of their hopelessness feelings to others and also a try to change the other people's behavior. Rating hopelessness level can be helpful in predicting the possibility suicide. The purpose of the present study was investigation the relationship between hopelessness and suicide in patients with mood disorders.Subjects and Methods: This is an analytical–cross sectional study. The subjects were mood disorder patients who referred to the Golestan hospital psychiatry department (out/in-patient), with (n=30) and without (n=33) suicidal attempt, during 6 months. Patients completed Beck Hopelessness Scale (BHS). Then data was analyzed by SPSS software using logistic regression model and t test.Results: Comparison between two groups based on level of hopelessness by t-test showed there was a significant relationship between two groups (P<0.025). Investigation of data by logistic regression statistical model distinct, hopelessness with OR=1.190; 95% (CI=1.02-1.37) and male gender with OR=1.170; 95% (CI=0.227-6.02), can increase the risk chance of attempting suicide.Conclusion: The finding of this study suggest that hopelessness and male gender are important factors in predicting suicide attempting, and the most significant factor is the previous attempted suicides. Therefore, must be taken seriously. In order to prevent successful suicides, the hopelessness assessment in mood disorders patients is essential.

Background and Objective: Nosocomial infections are one of the most important causes of mortality and morbidity in neonatal intensive care units. In the present study the primary goal was to analyze the epidemiologic features of nosocomial bacteremia in Ahvaz Imam Khomeini hospital neonatal intensive care unit over a period of five years.Subjects and Methods: The subjects were 163 neonates patient with positive blood culture whose blood culture was negative at admission time.Results: One hundred and sixty three hospitalized neonates with positive blood culture were evaluated. Seventy one nosocomial bacteremia were diagnosed. Overall incidence of nosocomial bacteremia was 4.42% in whom 67.6 % were male. The median birth weight and gestational age was 1797 g and 33 weeks respectively. The most common pathogenic organisms were Klebsiella (50.7%), E. coli (14.1%), Pseudomonas aeruginosa (12.7%) and coagulase negative staphylococci (2.8 %). Mortality rate was 50.7%.Conclusion: This study documented that the type of bacteria responsible for nosocomial bacteremia in Neonatal intensive care unit of Imam-Khomeini hospital is different from neonatal intensive care units in developed countries and impact on the need for revision on selection of empirical drugs.

Background and Objective: Bacterial vaginosis is a change of vaginal flora with the normal lactobacilli flora is replacing by an overgrowth of Gardnerella vaginalis and anaerobic bacteria. Bacterial vaginosis is the most common cause of vaginal infection in women during their reproductive age. The relationship between bacterial vaginosis and increase of vaginal pH has been suggested use intravaginal acidification substance as a way for normalization of vaginal flora and treatment of bacterial vaginosis. The purpose of this study was to compare the effect of vitamin C vaginal tablet and metronidazole vaginal gel in treatment of bacterial vaginosis in patient referring to Ahvaz Amir Al Momenin hospital.Subjects and Methods: In This randomized clinical trial 60 non-pregnant women aged between 15-45 years with confirmed diagnosis of bacterial vaginosis by Amsel٫s criteria were randomly assigned to receive either 250 mg vitamin C tablet via vaginal route once daily for 6 days (n=30) or 5 gr of 0.75 % vaginal gel metronidazole once daily for 5 days (n=30). The results of both groups were compared for demographic characteristic, contraceptive and education level (p=0.8).The cure and elapse rate were evaluated in both groups after two (1 and 2 weeks) follow up visits. For statistical analysis descriptive statistics χ2, and Fisher's exact test were performed.Results: The results of study show that cure rate in vitamin C vaginal tablet was 76.7% and in metronidazole vaginal gel group was 80%, relapse rate of 9.5% and 5% respectively (P=0.7).Conclusion: Vitamin C vaginal table 250mg is as effective as metronidazole vaginal gel for treatment of bacterial vaginosis.

Background and Objective: Drug reactions are type of skin diseases that could appear as a kind of cutaneous inflammation such as maculopapular rash, urticaria, papulosquamous, pustule and bulla. Incidence of cutaneous drug eruptions gradually increase with drug consumption, therefore having knowledge about these reactions and the incriminating drugs can facilitate early detection and prevention of their recurrence. The goal of this research was to evaluation of incidence of cutaneous drug eruptions, from point of view of sex, age, incriminating drug and the pattern of the eruptions.Subjects and Methods: This was a retrospective and descriptive study. In this research all the patients with cutaneous drug eruptions referred to Imam Khomeini hospital, and a private office were evaluated during 2001-2006. Required data and information were gathered by referring to archieve of hospital and clinic. The information was: sex, age, incriminating drug, type of drug eruption, site of eruption-Incubation period and history of drug used.Results: Totally 110 patients with cutaneous drug eruptions which included 70 females (64 %) and 40 males (36 %). The maximum rate of incidence was seen at 3rd decade (21-30 years) and the minimum rate of incidence was seen in the age group of less than 10 years.Conclusion: The most common cutaneous drug eruptions were morbili form rash that occurred in 24 patients (22%). The most common drugs were antibiotics that have been seen in 28 patients (25%). Most drug reactions occurred in less than one week (55.5 %).

Background and Objective: Intra-uterine fetal death (IUFD) is a traumatic event for the family which occurs in about 1% of all pregnancies. In comparison with other countries this rate is increasing in Iran. Certainly many factors cause IUFD which include intra-uterine infection, lethal malformations, fetal growth retardation and placental abruption. The aim of this case-control study was to determine the risk factors of IUFD among our patients.Subjects and Methods: In this retrospective case-control study, which used a self-made questionnaire designed to assess the risk factors associated with maternal or fetal factors for intrauterine deaths. The samples included 953 records (358 cases and 595 controls). The data were collected form patents records in Imam Khomeini hospital during a five year period of 2001-2006. We used a questionnaire which designed for assessment of maternal and fetal factors. The questionnaire was filled by using collected medical records.Results: The estimated rate of IUFD was 4%. We found IUFD was related with older aged mother (P<0.002), previous IUFD (P<0.000), with Arab race (P=0.000), Malformation (P<0.000), fetal weigh (P<0.022), pregnancy complications (P<0.025) and maternal diseases (P<0.000).Conclusion: This study shows the rate of IUFD (4%) is increasing in Ahvaz. It is difficult to identify preventable factors of IUFD. However proper prenatal care consultation can facilitate early diagnosis may prevent complications and may reduce the incidence of IUFD.

Background and Objective: Helicobacter pylori treatment failure is becoming an important concern due to emergence of resistant strain. A major reason for the failure of anti-H pylori regimens in Iran is resistance to metronidazole. Studies have been shown that H pylori has lower resistant rate to ciprofloxacin and furazolidone. The aim of this open-label, randomized study was to compare the effectiveness and side effects of triple regimen containing furazolidone and ciprofloxacin with quadruple regimen containing metronidazole.Subjects and Methods: Cases were selected from patients who referred to gastroenterology clinic for evaluation of dyspepsia or other upper abdominal symptoms or signs. They included in the study if H pylori infection was confirmed by rapid urease test, or histological examination. Patients randomized into two groups (n=80 in each group) received 10 days therapy with: Regimen A: furazolidone 100 mg bid, ciprofloxacin 500 mg bid, and omeprazole 20 mg bid (FCO group). Regimen B: metronidazole 500 mg bid, tetracycline 500 mg bid, bismuth subcitrate 240 mg bid, omeprazole 20 mg bid, (MTBO group). The patients were observed for drugs complications during treatment period. Another 13C-urea breath test was performed 60 days after therapy.Results: One hundred and sixty patients (83 females and 77 males), mean age 39.5 (range 15–78) years were included. Three patients in MTBO group and two patients in FCO group failed to complete the treatment because of side effects of drugs. The intention-to-treat eradication rates were 72.5% for CFO group and 80% for TMBO- group (P>0.05). Side effects were seen in 18.8% of CFO-group patients and 20% of TMBO-group patients (P>0.05). Nausea and vomiting were common side effects in group A and vertigo and bad taste sensation were the major side effects in the Group B.Conclusion: Triple regimen containing ciprofloxacin and low dose furazolidone, is a low-cost and safe alternative second or third-line therapy for H pylori eradication.

Background and Objective: The impact of thalassemia major and thalassemia intermedia and their associated complications on quality of life (QOL) is largely unknown. Determining the degree of health impairment as perceived by the patient is essential information needed to recommend suitable therapy. The impact of thalassemia and its complications on the quality of life of these patients and their parents has been little studied. Therefore, the aim of this study was to comparison of quality of life in children with thalassemia and their parents.Subjects and Methods: In this descriptive–analytical study, the quality of life of 110 children less than 18 years with thalassemia referred to Shafa hospital of Ahvaz in 2007-2008 was studied using a demographic and quality of life questionnaire (COOP). The samples were chosen on the basis of a non-randomized sampling. The data was analyzed using descriptive and t-tests.Results: The mean QOL in patients less than 18 years was 72.98 ± 11.67 and in their parents was 65.1±13.32. In social activity (P=0.004), pain (P=0.002), emotion and affects (P=.000), quality of life (P= 0.047) and mean QOL (P=0.000) aspects, there were significant differences between the two points of view.Conclusion: Presented data suggest that all patients with thalassemia need to undergo QOL assessment so that interventions focused on affected domains can be implemented to improved QOL.

Background and Objective: Evaluation of the role of solvent and the effective factors in the compressibility of the extract powder of green tea leaves to produce a herbal tablet was the main aim of the present study.Materials and Methods: Green tea leaves were extracted by different solvents of ethanol, methanol, acetone, isopropyl alcohol and de-ionized water, separately in the proportion of 1:4 powders to solvent. The prepared extracts were dried by a freeze dryer. The presence of tannin and its assay was approved by Folin-Denis reaction. The extracted powder of each solvent was divided in to different sizes of 14, 18, 35 and 60 mesh by the USP standard sieves and then the flow properties such as repose angle, compressibility percent and also the type of deformation of particles during compression force, were studied. Carr's index was calculated for determination of compressibility percent and Heckel’s plot drawn to distinguish the plasticity or elasticity nature of green tea powder.Results: The most of tannin percent was obtained by the water solvent. The best compressibility percent with Carr’s index 12 was from the powder extracted by water, with 3% constant humidity and 60 mesh particle size. This powder with least of repose angle (250) showed the best flowability. The result of drawn Heckel's plot for this powder indicated a plastic deformation during compression with 95% confidence.Conclusion: It seems that the powder of green tea extracted with the water solvent shows a better extraction of active ingredient from green tea leaves, as compared with alcoholic solvents, and also, a more favorable compressibility with a plastic deformation to the compression force.

Background and Objective: The purpose of this study was to assess efficacy of Benson's relaxation technique on postoperative pain in coronary artery bypass graft (CABG) in patients. One of the most expressed complaines following CABG is chest pain originating from the operation site. Because of side effects from opioids, this is important to use non-pharmacological methods such as Benson's relaxation technique.Subjects and Methods: This clinical trial study, 80 patients candidate CABG randomly divided on to two equal groups, fot paint management we used Benson's relaxation+ analgeic drugs in test group and only of analgeic drugs in control group. The data collection tools consisted of demographic data, vital sign, and check list for amount of analgesic drugs and visual analogues scal for pain severity. Then pain severity, vital signs, and the amount of medication used were assessed before and immediately after relaxation. Finally data were analyzed by SPSS, t-test, and Chi square test.Results: The findings of this study showed the mean of pain severity within 24, 48 and 72 hours before and after relaxation in the intervention group in to two stage reduced and were significant difference (P=0.0001). Also, Mann-Whitney test showed that there was a significant deference in mean of pain severity between two groups after relaxation P£0.0001). In addition, paired t-test showed that relaxation technique in intervention group after surgery effected on the respiratory rate, heart rate, and diastolic blood pressers and there was significant difference before and after relaxation (P=0.05). Only point attention was significant difference in respiratory rate between two groups (P=0.01). Related with the consumption rate of analgesic drugs didn't show significant difference between two groups (P>0.05), but in intervention group consumption rate after 24 hours relaxation showed breif decrease.Conclusion: This study assumption Benson's relaxation technique not only can reduce postoperative pain in CABG pain, but also effected vital sign specifically respiratory rate and increased patients peacfulness (satisfaction). Therefore can be used as a complementary therapy with analgesics to relief pain.

Background and Objective: Multiple choice questions (MCQs) is the most common method for evaluation of students in higher education sectors especially universities of medical sciences. This method could be a valid tool in assessing the students, if the questions are prepared accurately and according to standard test criteria. This study was undertaken with the aim of investigation of structural flaws of MCQs designed for residency promotion exam in Ahvaz Jundishapur University of Medical Sciences.Subjects and Methods: In this cross-sectional study a total of 2400 MCQs designed for residency examination were analyzed for structural flaws and cognitive levels taxonomy. Each MCQ was examined using a prepared standard structural framework by assessors, structural flaws were determined. The MCQs were then, categorized into cognitive levels I, II, or III according to Bloom's taxonomy. SPSS software was used for data analysis.Results: Four hundred and two MCQs out of 2400 (16.8%) showing structural flaws, the most common ones were: grammatical flaws in both stems and options (20.4%); using negative stems (18.4%) and non-identical options lengths (18.4%). Among total tested MCQs, 71.9% were designed at lower cognitive level (taxonomy I), while only 28% belonged to higher cognitive levels (taxonomies II and III).Conclusion: The prepared MCQs, contained structural flaws and basically were at lower Bloom's taxonomy. Therefore, it seems that designing MCQs of residency examination needs to be revised and reformed.

Background and Objective: Ovarian cyst is the most common pelvic mass in women at reproductive age and the majority of them are functional and resolved spontaneously. The ovarian cyst's side effects are torsion, rupture or bleeding in to the ovarian cysts. The purpose of this study was to evaluate clinical and pathological findings in women with ruptured ovarian cyst.Subjects and Methods: This study was a cross-sectional one. The hospital records of 131 women who underwent laparatomy for ruptured ovarian cyst from 1994 to 2005 were assessed. Data analyzed using the SPSS version 9 soft-ware.Results: Most patients were aged between 20-30 years. The most common signs and symptoms were abdominal pain (100%), right ovarian ruptured (62.6%) and bilateral ovarian ruptured (3.1%). On the other hand, 56.5% of ruptured ovarian cysts were luteal cysts.Conclusion: The most common findings in the women with ruptured ovarian cyst is right ovarian cyst ruptured and luteal (functional) cyst as dominant pathology which occurred in women aged between 20-30 years.

Background and Objective: Pleuropulmonary complications, such as pleural effusion (PE) are encountered with an increased frequency among patients with end stage renal disease.Subjects and Methods: In the cross-sectional and prospective study we evaluated 253 patients who had received long- term hemodialysis between 2007 September and 2008 October for better understanding the incidence and causes of PE in this population.Results: The incidence of pleural effusion was 25 % (n=63, mean age 48.09±1.39 years, male to female ratio approximately 1.1). 66.6 % of the patients (n=42) had transudative PE and 33.4% (n=21) had exudative PE. Transudative PE resulted from heart failure in 64.3% (n= 27), hypervolemia in 33.3% (n=14) and cirrhosis in 2.4% (n=1). Parapneumonic effusion (n= 6), TB (n= 5), uremic pleurisy (n= 4), malignancy (n=2), unknown (n=2) and SLE (n=1) accounted for causes of exudative PE.Conclusion: Pleural effusion is a common complication in hospitalized patients receiving long-term hemodialysis. Since heart failure, hypervolemia and uremic pleurisy were the most common causes of pleural effusion, this problem should not be considered an obstacle in renal transplant recipients.