Jundishapur Scientific Medical Journal
Year:2006 | Volume:4 | Issue:4 (47)|Papers Count:11

Objectives: Sickle cell disease is an inherited red cell disorder characterized by diverse clinical courses. Some individual patients follow a more severe course that begins shortly after birth, whereas others are infrequently ill. The purpose of this work was to study the correlation between clinical severity with laboratory data in sickle cell disease patients in the hope to find data that can be used to predict the severity of clinical episode of sickle cell disease and therefore preclude the application of unnecessary interventions which are only needed for severe episodes.Methods: In this study, during one year period, 78 patients suffering from sickle cell disease (48 HbSS, 21 SC, 9  βthalassaemia) who attended the Haematology Clinic at the Department of Clinical Haematology of Manchester Royal Infirmary in England were studied. Red cell indices and haemoglobin analysis were examined when the patients were in their steady state. Red cell indices were determined using Syismax NE 8000, and haemoglobin variants (HbA2, HbC, HbS, HbA and HbF) were identified by fully automated Bio Rad HPLC, The patients were categorized as severe mild and moderate according to their clinical states. Correlation between clinical severity and laboratory data was assessed using multivariate statistical methods.Results: The results, as expected, showed a significant correlation, at p <0.05, in the whole group of phenotype with the total Hb, HbS, HbC. There was a positive correlation (r=0.32, p<0.05) between clinical severity and HbS level in all patient groups and negative correlation (r=-0.41, P<0.05) between clinical severity and HbF level in the SS but not in the SC or S-βthal patients.Conclusions: The high level of HbF, found in all patient groups, therefore could not be the underlying reason for the amelioration of the clinical severity and there must be other factors such as genetic, nutrition and immunity that might affect the clinical status of sickle cell patients.

Objectives: Hospital nasal carriage, among health care staff, of methicillin resistant S. aureus (HNC-MRAS) have an important role in !1°spital-acquired infections (HAI) in admitted patients, which can lead to various complications such as wound infection, catheter related bacterimia, neonatal sepsis, with high mortality rates and socio-economic and health impacts. The aim of the present case-control clinical trial was to compare the efficacy of various antimicrobial treatments in the control of MRSA.Methods: Seventy six HC-MRSA of the heath care staff who were positively identified as HC-MRSA in Razi hospital, an educational hospital of AJUMS, were randomly allocated into 5 groups. The first group was used as placebo-treated control. The remaining groups were treated for seven days twice daily with intra-nasal application of 2% mupirocin ointment, 2% vancomycin jell, or orally 500 mg cloxacillin QID plus daily 600 mg rifampicin or 2Tablet adult co-trimoxazol twice daily plus daily 600 mg rifampicin.Results: The results showed that there was significant reduction in the MRSA following intranasal mupirocin ointment and voncomycin jell which eliminated 93% and 86% of nasal carriage respectively. Oral treatment (cloxacillin 500mg Q6h plus rifampicin 600 mg daily) or (co-trimoxazol 2 adult tablets Q12h plus 600 mg rifampicin daily) resulted in 100% elimination of nasal carriers in HNC- MRSA.Conclusion: These results suggest that HNC-MRSA can be controlled with intranasal mupirocin or vancomycin. In cases that do not respond to topical treatment or due to drug hypersensitivity, cloxacillin plus rifampicin or co-trimoxazol plus rifampicin are recommended.

Objectives: Tension headache is the most common type of headache. Tension headache is mostly caused by stress, anxiety and depression. The treatment of this type of headache is achieved by pharmacological and non-pharmacological methods. Drugs used in its treatment can predispose to over use, side effects and increased costs. The purpose of this study was to evaluate the effectiveness of massage in the treatment of chronic tension headache.Methods: This research is semi-experimental study in which 25 women suffering from chronic tension headache were treated by massage during a 5-weekperiod. During the intervention the subjects were massaged on their posterior parts of the neck and shoulders for 20 minutes twice a week and were asked to record their headache indexes four times a day on a checklist. Headache indexes included: intensity and frequency of headache and quantity of analgesics taken. Headache intensity was recorded by an 11-point criterion. The collected data from the second, third and fourth weeks of investigation were recorded as the data of ongoing intervention. While those collected from weeks 1 and 5 were considered as pre and post-treatment values.Results: The headache indexes showed a meaningful difference in the three stages of per, during and post intervention (p<0.01).Consequently the recovery rates for each index was 52%, 39% and 57% respectively.Conclusion: Massage therapy influences the intensity, frequency and quantity of analgesic intake in chronic tension headache and can cause faster recovery or reduce the intensity of tension headache.

Objectives: Dosimetry of radiotherapy treatment beams is a very important procedure for successful radiation therapy because it facilitates estimation of an accurate delivery of radiation dose to a cancerous volume of tissue. It is believed that a decrease of 10%-15% in radiation dose delivery will result in a decrease in the chance of cure by a factor of 2 or 3. While an increase in radiation dose will increase the chance of irreversible damage. The aim of this study was an extension of Clarkson method for estimation of percent depth dose (PDD), in order to be able to calculate the PDD under a step-filter as wedge PDD distribution.Methods: The PDDs were calculated with different step-filters sizes: 8x8, 8x10, 8x12, 8x14, 8x14 and 8x16 cm2 in Cobalt-60 fields, the depths of calculations were: 5, 10, 15, 20 cm. The calculated results of measurements were made by use of (PPD)d=5/(PDD)d=15  and (PPD)d=10/(PDD)d=20 relationships and the related values were compared with each other. Dose measurements were carried out at water phantom by Farmer Ionisation Chamber and the related electrometer. Results: The average of the absolute values for 8x8 to 8x16 cm2 filters were found to be 0.3861, 0.3347,0.2381,0.2416 and 0.3293 respectively. This value for all fields is equalled to 0.3059.Conclusions: The proposed formula in this study, could be used as a useful guide for measurement PDD and can be time-saving in the treatment planning of patients requiring radiotherapy.

Objectives: Diabetic nephropathy is one of the most important late complications of diabetes mellitus (DM) which leads to a high rate of morbidity and mortality. In initial stages of diabetic nephropathy, there are some pathologic changes in kidneys and rising of GFR. After several years, micro albuminuria is usually present, which may progress to overt proteinuria and end stage renal disease. This study was designed to assess the prevalence of microalbuminuria in type 2 DM patients visited Razi Diabetes Center of Ahvaz Jundishapur University of Medical Sciences.Material and Methods: A questionnaire included age, sex, time from diagnosis of DM, history of hypertension and hyperlipidemia were filled out for each patient. Laboratory studies include: serum level of BUN, Creatinine, Triglyceride, Cholesterol, 24 h urine collection for measurement of urine creatinine, volume, micro albumin , U/A and U/C were performed for each patient.Results: Ninety out of 199 patients were men and 108 were women (age ranged between 36 to 60 years). 127 patients (63.7%) showed normal urinary micro albumin (less than 30mg/day), 70 patients (35.2%) microalbuminuria (microalbumin excretion between 30- 300mg/day) and 2 patients (1.1%) macro albuminuria (24 h urine microalbumin ≥ 300mg/day). 99 patients (43%) had hypertension (BP ≥ 140/90 mmHg). 121 patients (61%) had diagnosis of DM for less than five years, 29 (14.5%) between five and ten years and 24 patients (12%) more than 15 years. 41% of patients had familial history of diabetes mellitus and 40% had hyperlipidemia (Triglyceride >250 or Total cholesterol >200 or both). Hyperlididemia, higher age group of patients and longer duration of diagnosis of DM had significant effect on the level of micro albuminuria (p< 0.001, <0.001, <0.000 respectively). There were no significant differences between microablumuric and non-micro albuminuric patients, in level of BP and family history of DM.Conclusions: Prevalence of micro albuminuria in the studied group is relatively high (35.2%). Furthermore, hyperlipidemia, older age and duration of DM are risk factors for developing microalbuminuria.

Objectives: In order to reduce the number of sonography examinations, as well as costs and anxiety associated with this procedure, this study was conducted for allocation the best day for performing this procedure in order to identify the dominant follicle. Methods: In this cross sectional descriptive study one handred infertile females received 100 mg clomiphen citrate from day 3 to 8 of the menstural cycle. The diameter of the dominant follicle as well as endometrial thickness were measured daily by serial sonography from day 12 to 15 of cycle. Results: The diameter of the follicle in 70% of cases was 15 to 30 mm on day 13 of the menstrual period. The minimum measurement of endometrial thickness was on day 12 in 84% of the cases. While the maximum measurement was on day 15 in 67% of cases. Thirty six percent of the patient did ovulate mainly on day 14ofmenstural cycle. There was a positive correlation between the growth of the follicle with increase in endometrial thickness in 31% of patients, which was meaningful on day 14 of menstural cycle (p<0.05). Conclusions: The findings from this suggest that the best day for prediction the probibility of ovulation by a single sonoraphy eximation is on day 13 of the cycle.

Objectives: The azygos venous system under the diaphragm at the superior part of posterior abdominal wall varies in its origin. Commonly, the azygos vein begins by the union of the ascending lumbar and subcostal veins on the right side. It passes through the aortic opening or posterior to the right crus of diaphragm enter the thorax and lying on the right side of the vertebral bodies, it ascends on the vertebral bodies and then arches over the root of the right lung to enter the superior vena cava. It receives the right lower eight posterior intercostals veins and at its convexity the superior intercostal veins join it. The hemiazygos is formed on the left in a manner similar to that of the azygos and receives the lower posterior 9th to 11th intercostal veins. The accessory hemiazygos receives the 5 to 8 intercostal veins, these two veins enter the azygos vein. The upper posterior intercostals veins forms the left superior intercostal vein which drains into the left brachiocephalic vein. The aim of the present study was order to investigate the variation of the azygos venous system in human cadavers. Methods: For this purpose 10years of study was carried out on 40 male cadavers (with the proximate age of 40 to 80 years).Results: In all cases the azygos vein lied on the right side of the vertebral column and also no bilateral azygos vein was observed. In the 5% of cases the hemiazygos was absent and the related intercostal veins drained directly into azygos. In 2.5% of the cases the accessory hemiazygos has not been formed and consequently the intercostal veins of 5 to 8 with a single trunk. ran anterior to the vertebral column, then joined the azygos vein. Finally, in 25% of cases the hemiazygos and accessory hemiazygos communicated with each other and by a single channel at the level 8th vertebra enter the azygos vein. Conclusions: The network of azygos venous system is corresponded to the general patterns reported in Gray's Anatomy, however the azygos vein was not observed neither on the left nor in front of vertebral column and in one case the hemiazygos was absent. The knowledge of these variations will be important in study of radiographic, dissection and surgery of the posterior mediastinum.

Objectives: Serological diagnosis of cystic echinococcosis (CE), caused by Echinococcus granulosus, has been performed by different techniques. The lack of a standardised method for antigen preparation affects the sensitivity and specificity of the tests. The aim of this study was to assess the usefulness of Echinococcus granulosus protoscolex antigen, obtained from naturally infected sheep, using ELISA and immunoblot techniques.Methods: Overall we tested 353 serum samples comprising: one hundred sera from surgically confirmed cystic echinococcosis, 200 sera from native healthy sheep and 53 heterologous sera were evaluated.Results: ELISA results showed 86 of samples of hydatidosis sera were positive and 14 samples showed negative. While 14 samples of heterologous group showed cross reaction. The sensitivity and specificity of ELISA obtained 86% and 75.5% respectively, On the other hand, protoscolex of Echinococcus granulosus, after electerophoresis by SDS-P AGE, showed 13 anti genic bands of 28-112 KDa that reacted with serum samples. With immunoblot test, 93 samples of hydatidosis sera showed positive reaction with anti genic bands and 7 samples were negative. The 38 KDa band showed good immunoblot specificity and 59 KDa antigen showed high sensitivity. Overall cystic echinococcosis diagnosis by immunoblotting indicated 93% and 64.1% sensitivity and specificity respectively. Conclusions: The findings from the present study suggest that protoscolex can be considered as a good source of antigenic component in serological cystic Echinococcos granulosus. Furthermore, the use of the combination of ELISA and immunoblot techniques for confirmation of laboratory diagnosis of human echinococcosis is advantageous. In addition, 38 KDa antigen is the most specific fraction of protoscolex in immunological tests.

Objectives: Aphthous stomatitis is one of the common mouth problems. Several medical procedures have been suggested for its treatment. Diphenhydramine has been commonly used to control aphthous pain because of its local anaesthetic effect. One of the important factors that determine its effectiveness in the treatment of aphthous ulcer is persistent at the location. Some of mucoadhesive drug formulations such as Adcortyl (containing corticosteroids) have several inherent side effects like candidiasis. The purpose of this research was to prepare a mucoadhesive formulation of diphenhydramine in a suitable base which can be used in the treatment of aphthous stomatitis.Methods: In the first stage, low-density propylene glycol (LDPE) and liquid paraffin were used for preparing the plastibase by shock cooling method. This base was quality-tested and the suitable method to prepare the mucoadhesive base was determined. In the second stage of work, ten formulations. containing different concentrations of gelatine, pectin, Na-CMC were prepared. The adhesive strengths, the occlusivity and the spreadability of the pastes were studied. The selected preparations were tested for drug release studies by Franz diffusion cell.Results: The results showed that the selected formulation has the adhesive strengths equal to 109 mNcm-2 similar to the commercial product with a release drug flux rate of 6.7µg/cm2 min.Conclusions: These results showed that diphenhydramine can be formulated in a mucoadhesive base with proper mucoadherence, exclusivity, occlusivity spreadability with suitable release profile that makes it useful for use in aphthous stomatitis.