Jundishapur Scientific Medical Journal
Year:2006 | Volume:5 | Issue:1 (48)|Papers Count:13

Objective: Staphylococcus aureus (s. aureus) is an important pathogen and is one of the most common infectious agents in hospitals. S. arerus induces serious complications in hospitalized patients. Medical staffs are the main source of infection in hospital and transmit this organism to patients. Thus a study on prevalence of S. aureus carriage among health care personnel may provide a valuable information for infection control programs.Methods: This is a descriptive cross-sectional study. The study included 240 hospital personnel. The specimens were obtained with swabs from the anterior nares or nasopharynx, the ecological niches of S. aureus, and cultured according standard guidelines. MRSA strains detection was achieved with disk diffusion method. Antibiotic susceptibility of S. aureus strains was determined with disk diffusion method according to the recommendations of the producer (PadtanTeb Company). Results: The results showed that the prevalence of nasal pharyngeal and nasopharyngeal carriage among the attending staff were 22.5, 6.3 and 2.9 respectively. While 82% of the S. aureus were MRSA. There was a significant difference between the prevalence of among the personnel working in the orthopedics' ward, operating room and the rest of the staff in other departmens (p<0.05). All MRSA strains were susceptible to vancomycin. No significant differences were found between resistant to methicillin and host factors such as sex, age and duration of occupation.Conclusion: In conclusion with regarding to the high prevalence of carriage state in hospital staff, identification, treatment and eradication of S. aureus can prevent transmission this organism to patients and provide a good measure to control nosocomial staphylococcal infection in hospitalized patient.

Objective: Depression is one of the most important psychiatric disorders that may be due to a general underlying chronic medical condition such as diabetes mellitus. The aim of this study was comparie depression in diabetic patients and non-diabetic patients.Subjects and Methods: 309 diabetic out-patients referred to Ahwaz Golestan hospital Diabetic Clinic in 1382, were selected by convenient sampling and compared with nondiabetic group (n=289), that were matched for age, sex and education. Both groups were requested to answer the Beck Inventory standard test and a self made questionnaire for demographic variables.Results: The results showed a high prevalence rate of depression in diabetic group (72/2%) comparison with non diabetic group (37%). This study shows a significant relationship between diabetes and severity of depression (p<0.001). A significant relationship between depression and type of diabetes mellitus, and also between depression and insulin therapy was found (p<0.001). Conclusions: In order to prevent complications associated with depression, patients suffering from diabetes need psychiatric evaluation and consultation for early diagnosis imd if required appropriate treatment may be initiated.

Objectives: Hip fracture in the elderly creates a lot of problems for the health system and has a high mortality rate. Depending on the age, background disease and quality of the bones, conservative treatments, fixation of the fractures treatment (ORIF), unipolar and bipolar hemiarthroplasty and total hip arthroplasty are among various treatment options that can be considering.Subjects and Methods: In this study, 61 patients with femoral neck fracture, who were under treatment by bipolar arthroplasty, were examined retrospectively for 23 months.Results: The average Harris Hip Score of the patients was 80 and 91% of them had little or no pain. Conclusions: Considering the conditions of bipolar prosthesis with adjustable stem diameter, length of neck and the size of its head. Furthermore, the possibility of changing it into THA prosthesis. In addition, knowing that the two main consequences of Moore and Thompson's prosthesis, are respectively acetabullar erosion and protrusion, which have ,lower rate in bipolar prosthesis. The findings of this study suggest that the use of this prosthesis is more preferable in treatment of femoral fractures in the elderly.

Objectives: Castor oil was first noted to have oxytocic properties by ancient Egyptians. Derived from the castor plant Ricinus communis, castor oil may possess properties that are useful in post term pregnancies. The purpose of this study was to determine the safety and efficacy of castor oil for cervical ripening and labour induction.Subjects and Methods: This study was performed at Khatam-Al-Anbia hospital, Shoushtar, in 1381. In this clinical trial 80 pregnant women, were randomly assigned to the study group (n=40), to whom a single 60 ml, diluted in orange juice, oral dose of castor oil, or assigned to a placebo group (n=40). Inclusion criteria were post-term pregnancy, singleton with vertex presentation, Intact membranes, Bishop score of 4 or less, no evidence of regular uterine contractions and gravity 1-2. Exclusion criteria were placenta previa, previous caesarean section or hysterectomy and maternal medical complications. After the initial 12 hours of castor oil administration a repeated Bishop score assessment was made by the same initial examiner. All patients were observed for labour onset for 12 hours after castor oil administration. If labour did not occur during this time, the patients were placed on a standardized oxytocin induction regimen. Both groups of women did not differ in maternal age, parity, initial Bishop score or gestation age.Results: Following the administration of castor oil, 25 out of 40 woman (62.5 %) on caster oil regimen began active labour, compared to 3 of the 40 woman (7.5%) receiving placebo (p<0.001). The mean change in the Bishop score was significantly higher in those receiving castor oil (2 vs. 0.5, p < 0.001). Fewer patients on the castor oil group required oxytocin augmentation (37.5% vs 92.5%, p=0). There were nearly three times as many caesarean section in the control group (22.5%) compared to the castor oil group (7.5%), but the difference was not significant. The incidence of meconium - stained amniotic fluid, Apgar scores, and birth weights was similar in both groups. All newborn neonates had a 5- minute Apgar score greater than 7. In the castor oil group, there was a case of uterine hypertonicity, but this was not problematic. The expected maternal side effects of castor oil, which includes liquid stools and nausea, did occur in almost patient.Conclusion: Woman who receive castor oil have an increased likelihood of initiation of early labour within 12 hours compared to woman who receive placebo.

Objectives: this semi-experimental research was conducted in order to determine the effect of educational programs on educational staff of primary schools in handing a child with asthma. Subjects and Methods: For this aim, 195 educational staff stuff including, teachers, managers and hygienists in primary boy schools in Ahwaz, were questioned at two stages before and after instruction on asthma. The method of research was based on a questionnaire, that were previously analyzed and validated for reliability, containing information about the biography of the person and 20 scientific questions on symptoms and pathophysiology as well as the effects of asthma on growth and development, methods of control of attacks, prevention long term treatment and support of a child with asthma. After analyzing of the preeducational results educational plan was made and implemented for two weeks. After two weeks, the same questionnaire was distributed among school stuff. Results: The obtained results showed that after the necessary educational instructions, the level of awareness was considerably promoted and all the participants obtained acceptable scores that were singificnalty improved relative to before education (p<0.001). Conclusion: In conclusion that proper instruction could highly increase the level of knowledge of school stuff on asthma.

Objective: Bone defect that is created by trauma, fracture and tumor removal or cysts is a major problem in orthopaedic surgery. Cancellous bone auto grafts and recently bone marrow have been considered as a material for promoting bone formation. The purpose of this study was pathological and paraclinical evaluation of autogenous cancellous bone graft and autogenous bone marrow for filling a 2.5 cm segmental bony defect. Materials and Methods: Fifteen adult dogs with an average age of 37.2 month and weight of 19.42 kg were surgically treated to create diaphyseal defects in the right ulna. The defects were filled with autogenous bone marrow in group 1, were grafted with autogenous cancellous bone in group 2 and were not filled in group 3 as control group. Cancellous bone was harvested from iliac crest by a chisel and a curret. Autogenous bone marrow was obtained by aspiration with a needle through the tip of the greater trochanter into the medullary canal of femur. The animals were under observation for 13 weeks and then. euthinized and tissue sections prepared for pathological study. All the animals were followed paraclinically for 5 weeks, Results: The study showed no significant difference among three groups based on the parameters of R.RC, P.CV. and Hb. There was significant difference among three groups based on the parameters of W.B.C., neutrophil, lymphocyte, eosinophil, monocyte and band cells in all postoperative days. Calcium, phosphorous and magnesium showed no significant difference among three groups and among post and preoperative days. Alakaline phosphatase slightly increased after operation (that can be related to osteogenic activity of osteoblasts) but the difference among three groups and difference among post and preoperative days was not significant. In pathological assessment compact bone, mature haversian systems and a little spongy bone were observed in group 2. The similar results were observed in group 1, but the haversian systems were not mature as in group 2. New bone was formed by intramembraneous ossification in the cancellous bone group and by intramembraneous and endochondral ossification in the bone marrow group. Connective tissue and a little immature bone formation were observed in group 3. Conclusions: The results of this study showed that the autogenous bone marrow as well as cancellous bone graft can be used for filling segmental bone defect but the rate of osteogenesis is slightly lower.

Objectives: GI bleeding is accompanied with high mortality rate which can be especially massive in the elderly. There are various causes of lower GI bleeding with colorectal source that depends on the age of the patient, colorectal cancer, polyps, infections, diverticulosis and vascular ectasis are common causes. In this study we report the epidemiologic pattern of rectorrhagia with colorectal causes with regarding to age, and sexes and etiology among patients who were admitted, due to GI bleeding, to our hospital over five years in our patients.Subjects and Methods: This is a retrospective and cognitive study from 1379 to 1383 over 5 years. This study was evaluated 100 patients that referred to surgery ward of Imam Khomeini hospital with chief complain of rectorrhagia due to colorectal source and we evaluated the incidence in relation to age, sex and causes of bleeding.Results: In this study 62% patients were male. The maximum incidence was in sixth decade of life. The most common cause was amebiasis (32%) and second most common cause was cancer of rectum (23%) and then polyps (22%). The most common age for colorectal cancer was in the fifth and sixth decade of life and most common age of patient with polyps was first decade of life. Amebiasis was more common in the 2nd and 4th decade of life. In this study there was no patient with vascular angiodysplasia. Conclusion: Rectorrhagia with colorectal source must be considered in relation to the age of the patient. In childhood age, the most common cause is polyp and in adolescents and young adult amebiasis and colorectal cancer and then diverticaulitis are more common causes. In our patients there was lower incidence of IBD and diverticulitis than West Country. In elderly patients, malignancy are common causes in elderly patients.

Objective: Kidney transplant recipients are more predisposed to malignancy. Malignancies are the important causes of mortality in this group. Prevalence of malignancy in transplant patients is 100 times more common than general population. Genitourinary malignancies especially women genital tract are among the most prevalent after transplant. The purpose of this study is evaluation of cervical cancer prevalence in kidney recipient patients. Subjects and Methods: All of the married female patient undergoing kidney transplant from 1988 to 2003 are accounted in this study. 81 patients were under triple immunosuppressive regimen and 4 were treated with two agents. With maintaining the necessary criteria, after taking history and GV tract physical examination, papsmear was prepared. Cytology results were reported according to Bethesda system. Results: 85 patients with mean age of 39 years and average of 5 years after transplant were accounted in this study. No tumoural lesions of vulvovaginal region was seen in physical examination. In 50 patients cervix was normal and there was atrophy in 18, acute cervicitis in 5 , polipoid lesion on exocervix of one patient and the remainders had some evidence in favor of chronic cervicitis. Pap smear was normal in 53 and benign reactive changes was seen in 32 and there was not any low or high grade intraepithelial lesion or malignancy. Conclusions: These findings suggest that there is a significant difference in the prevalence of cervical malignancy relative to other studies. This may be due to several reasons including fewer number of cases, shorter follow up, less general risk factors than general population and different environmental, ethnics, genetic factors and viral carcinogens.

Objective: The blood supply of the heart is provided by the right and the left coronary arteries. The right coronary arises from the anterior aortic sinus and the left coronary arises from the left posterior aortic sinus of the ascending aorta. These arteries and their branches anastomose with each other but the anastomoses are not sufficiently large to maintain a collateral circulation. Variations of these branches do not have a determinable pattern, so this investigation was done to establishing and recognizing the variations of coronary arteries. Methods: This investigation was carried out on 40 adult human hearts of fixed Iranian male cadavers, with approximate age of 40-80 years. Dissecting tools used to remove the pericardium in order to expose the coronary arteries and their branches, for observing any kind of variations. The origin of both right and left coronary arteries had no variation. Results: In 2 cases (5%), the right marginal artery was absent. The blood supply of the heart in 92.5% of cases was right dominant, but in only7.5% was left dominant. We observed that in 90% of cases the anterior interventricular artery ran on the diaphragmatic surface to anastomose with the posterior interventricular artery, in only two cases, the left marginal artery was absent, however in these cases the diagonal artery had more branches than the others.Conclusion: Variations of coronary arteries do exist, but they are generally asymptomatic, there is no official reference offered and no acceptable pattern of such variations presented either. In spite of the technological development in dissection and study of angiography and surgical myocardial revascularization, the variations of the coronary arteries must be taken under consideration.

Introduction: To deal stress, people use coping styles which are adaptive or maladaptive. Drug use has been conceived as a maladaptive means of coping utilized by individuals unable to deal with stress in more adaptive ways. The present study has been investigated stress, coping styles and theirs relationship with general health in opium dependents and non- opium dependents.Method: In the case-control study, subjects were 63 opium dependents and control group were matched in number, age and sex with case group. The instruments used were the Coping Style Questionnaire (CSQ), General Health Questionnaire (GHQ) and Life Experience Survey (LES).Results: The results show, statistically significant associations between two groups of stress (P<0.01), coping styles (P<0.01) and general health (P<0.028). Also relationship between stress, coping styles and general health in opium dependents has been significant (P<0.002), but we found no significant relationship in non- opium dependents.Conclusion: Findings of this study represents opium dependents have maladaptive coping styles which are related to more stress and loss of general health. These results suggest that coping style is a key factor in assessing the relationship between stress and general health in opium dependents.

Traumatic hip dislocation is seen most commonly as a posterior type, in which the femoral head is displaced in the posterior aspect of the acetabulum. Although the anterior type has been reported in 10% of the case, bilateral traumatic dislocation is a rare condition and most of the reported cases have been associated with other skeletal and soft tissue injuries. The combination of an anterior and posterior, traumatic dislocation of the hip joints in one patient is a very rare occurrence. In this case report, a 26 years-old patient with this event who was treated successfully by closed reduction.

objectives: Splenectomy sometimes needed in the path of longterm treatment of Thalassemia disease.Post SpleneetoiPortal vein thrombosis is a complication of splenectomy, one of the interesting cases with the aim faster diagnosis and management have been discussed here.Case Report: The patient is a 23 years old female with B-thalassemia major, who was admitted in Thalassemia ward, with complaints of fever, limb and, abdominal pain, dysuria and diarrhea. She had history of splenectomy (2 years ago), cholecystectomy (1.5 years ago) and diabetes mellitus.In the first and second gray scale ultrasonography which performed in the first and second weeks of admission except hepatomegaly due to iron deposition otherwise was unremarkable Portal and splenic venous thrombosis with cavernous fonnation with extension to superiormesentric vein was noted, in third grayscale ultra -sonography which performed 3 days after second ultrasonography. These findings were confinned with colour Doppler ultrasonography.In MRA , vascular network around stomach (endoscopy showed gastric fundal varices) in addition to extensive cavernous formation around portal vein was seen.For primary prevention of bleeding due to gastric varices propranolol equivalent to Img/kg/day was started.Discussion and conclusion: In major B-thalasemia patients, portal vein thrombosis have been seen after splenectomy, as two distinct acute and chronic forms.Due to hypercoagulability state(thrombocytosis,leukocytosis and increased rigidity of RBC) and splenic vein ectasia (due to splenomegaly) possibility of portal vein thrombosis in major B- thalassemic patients is high.Abdominal CT Scan with contrast is the best diagnostic method. In acute phase anticoagulative drugs (heparin, warfarin), thrombolytic drugs (t-P A) are useful. But in chronic phase(which is characterize with cavernous formation) a primary or secondary prevention of bleeding due to varices is regarded.