Avicenna Journal of Clinical Medicine
Year:2006 | Volume:13 | Issue:2 (SN 40)|Papers Count:15

Introduction & Objective: Electrolyte disturbances are frequently observed during the acute period after spontaneous subarachnoid hemorrhage (SAH). Hyponatremia and hypernatremia are the most common electrolyte disturbance in acute period of disease, and these disturbances may worsen cerebral edema and mass effect. We performed this study to determine the prognostic significance of serum sodium concentration abnormalities.Materials & Methods: This study was performed as prospective analytic cross sectional in Kashani and Alzahra Hospitals of Isfahan during 2003-2004. The presence of hypernatremia (serum sodium concentration of>145m mol/L) and hyponatremia (serum sodium concentration of<135mmol/l) was determined with serum sodium measurements at admission and 3, 6 and 9 days after SAH, then the effects of hypernatremia and hyponatremia on three-month outcomes were analyzed after adjustment for age, sex, preexisting HTN, admission GCS score, initial mean arterial pressure and finding of Brain CT Scan and Brain angiography. Patients with symptomatic vasospasm were excluded.Results: The analysis of data showed that from 100 participated patients in this study 18% developed hypernatremia and 42% developed hyponatremria. Hypernatemia was significantly associated with poor outcomes compared with hyponatremia (odds ratio, 2.63- CI 95%).Conclusion: Hyponatremia seems to be more common than hypernatremia after SAH. Hypernatrenia after SAH associated with poor outcome and this association is independet of previously identified outcome predictors, including age, sex, admission GCS Score, and X.Ray finding.  

Introduction & Objective: Diabetes mellitus (especially type I) is accompanied with disturbances in learning, memory, and cognitive skills in the human society and experimental animals. Considering the potential anti-diabetic effect of the medicinal plant Withania somnifera (ashwagandha) and the augmenting effect of its consumption on the memory and mental health, this study was conducted to evaluate the effect of chronic oral administration of ashwagandha root on learning and memory in diabetic rats using passive avoidance test.Materials & Methods: For this purpose, male Wistar diabetic rats were randomly divided into control, ashwagandha-treated control, diabetic, and ashwagandha-treated diabetic groups. Ashwagandha treatment continued for 1 to 2 months. For induction of diabetes, streptozotocin was injected i.p. at a single dose of 60 mg/kg. Serum glucose level was determined before the study and at 4th and 8th weeks after the experiment. In addition, for evaluation of learning and memory, initial latency (IL) and step-through latency (STL) were determined after 1 and 2 months using passive avoidance test.Results: It was found that one- and two-month administration of ashwagandha root at a weight ratio of 1/15 has not any significant hypoglycemic effect in treated control and diabetic groups. Furthermore, there was a significant increase (p<0.05) in IL in diabetic and ashwagandha-treated diabetic groups after two months compared to control group. In this respect, there was no significant difference between diabetic and ashwagandha-treated diabetic groups. In addition, STL significantly increased in ashwagandha-treated control group after 1 (p<0.01) and 2 (p<0.05) month in comparison to control group. On the other hand, STL significantly decreased (p<0.05) in diabetic group and significantly increased (p<0.05) in ashwagandha-treated diabetic group as compared to control group after two months.Conclusion: In summary, chronic oral administration of ashwagandha root could enhance the consolidation and recall capability of stored information in control and diabetic animals.

Introduction & Objective: There are several studies showing the intra tissue anesthetic infiltration is effective to relief the post operative pain, whereas this effect is not observed in some other studies. The aim of this study was to evaluate the effect of intra tissue Bupivacaine infiltration in peritoneum, fascia and subcutaneous tissues on severity of pain, analgesic consumption, nausa and vomiting after cesarean section.Materials & Methods: In this double blind clinical trial, fifty candidates of cesarean under spinal anaesthesia were divided randomly into placebo (n=25) and intervention (n=25) groups. 20 ml of 0.25% bupivacaine and 20 ml of 0.9% saline was injected into parietal and visceral peritoneum, fascia and subcutaneous tissues in intervention and placebo subjects respectively. Severity of pain was measured according to visual analoge scale (VAS). Analgesic need was recorded during recovery and 2, 4, 8, 16 and 24 hours after surgery. Nausa and vomiting was also recorded during, immediately- and 24 hours after surgery and overall satisfactory of subjects in two studied groups were compared.Results: Mean of pain score exactly in 4 hour after surgery was significantly less in bupivacaine group (P=0.042). 24% of patients in intervention group and 12% of subjects in placebo group did not need analgesics. 20% of intervention patients and 52% of placebo subjects requested analgesic twice in 24 hours (P=0.07). Mean of analgesic consumption in 24 hours was significantly more in placebo group (P=0.048). Vomiting was similar in two groups. 76% of bupivacaine group and 60% of placebo group were overall satisfied (without statistically significance) Conclusion: Intra tissue bupivacaine infiltration during cesarean section reduces analgesic consumption in 24 hours after surgery and nausa episodes. Pain in peak of drug efficacy (4 hours after usage) was reduced significantly.

Introduction & Objective: The province of Hamadan was one of the regions with endemic goiter in Iran. Following initiation of the program of control of iodine deficiency in 1989, production, distribution and consumption of iodized salt were begun.Materials & Methods: In 2001, as part of a national monitoring survey, 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Hamadan, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren.Results: Total goiter rate was 18% (15.8% in girls and 20.2% in boys). Median urinary iodine was 15.3μg/dl. Urinary iodine was above 10μg/dl in 78.3% and less than 5 μg/dl in 8.7% of subjects; no one had urinary iodine below 2μg/dl.Conclusion: It is concluded that the rate of goiter in Hamadan has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake; Hamadan province therefore can be considered a “iodine deficiency free” zone.

Introduction & Objective: Fascioliasis is a zoonotic parasitic disease, caused by the liver fluke, Fasciola spp. Human is occasional host when ingesting the metacercaria by eating contaminated aquatic vegetable. In the two past decades, human fasciolasis was emerging as a problem of public health in the Guilan province; in Anzali city. Triclabendazole is a novel anti-helmenthic that during recent years has been used for fascioliasis treatment in this region. The aim of the present work is to study alteration in hematological and liver function indices during human infection with Fasciola spp. pre and post treatment with triclabendazoleMaterials & Methods: The present work is a longitudinal clinical trail. In this regard, fifty confirmed fasciolasis patients, were chosen for parasitological, hematological and biochemical examinations pre-therapy as well as 1 and 6 months post-therapy. Formalin-ether and modified Telemann methods were used for stool examination. For Fasciola antibody detection ELISA technique was employed. Hematological and biochemical tests were performed by standard methods.Results: Results indicated that, triclabendazole efficacy was 74% after usage as one dose of 20mg/kg and reached to 88% after repeating in the next month. Before triclabebdazole therapy the Hb and HCT of the patients were slightly found lower than normal ranges, meanwhile the ESR and eosin Phil percentages were higher. However following receiving the drug, in the cured individuals, the indices returned to the normal ranges but in the non-cured individuals were not shifted to the normal. On the other hand liver function indices of the patients mostly were at normal ranges before and following drug therapy.Conclusion: In conclusion hematological indices could be valuable indicator for successful therapy of patients treated with triclabendazole.

Introduction & Objective: Some investigators reported significant effect of garlic on serum cholesterol reduction. In addition, Iranian culture has specific belief on herbs and garlic in this regard. Our goal in this study was to evaluate the effect of garlet tablets on serum lipid profile.Materials & Methods: Sixty patients were randomly divided into two groups for evaluation of the effect of garlic on their lipid profile. The first group was low fat regimen group and the second was garlet tablet regimen group. Total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured in both groups. Then, after two months of these regimens administration, these items were measured again and were compared.Results: Mean age, sex and baseline initial lipid levels were similar in both groups. Total cholesterol and LDL cholesterol levels were decreased significantly in the garlic regimen group (in spite of non significant reduction in the other group). Triglyceride and HDL levels were not changed significantly in both regimen groups.Conclusion: Garlet tablet administration has more significant reductive effect on cholesterol level than low cholesterol diet.

Introduction & Objective: Despite of many studies on cerebral palsy (CP), the impacts of this disease on musculoskeletal function especially on the dynamic balance of the CP patients is not well understood. This information can improve the quality of the treatment. The objectives of this study were to evaluate the differences between the dynamic balance performance of normal and CP children in different conditions.Materials & Methods: Ten children with spastic diplegia cerebral palsy between 8 to15 years of age and with mean weight and height of 30.8±5.7kg and 1.35±0.09m respectively, underwent an exercise therapy program for 12 weeks. A stability platform system was used to measure the deviation on the mean point of the application of the center of gravity (COG) from the center of base of support (COBOS). The balance tests were repeated on stable and unstable base of support as well as with and without shoes.Results: It was shown that the mean deviation of COG of the CP children improves about 25% after exercise therapy (p=0.001). The most improvement was in mid-stable and unstable of base of support as well as in AP direction. Mean deviations of COG was near to natural patternConclusion: The mean deviation of COG of the CP patients was significantly increased in dynamic standing which shows the poor function of the proprioceptive system in these children. Exercise therapy improves the mean deviation of COG in dynamic standing. These results show the importance of the shoes on the treatment procedures of the spastic CP children.

Introduction & Objective: Benzene is a light yellow liquid with aromatic odor and has effects to human body. The main and dangerous health effect of chronic exposure to benzene in workplace is hematopoetic system disease or blood cancers that it's primarily clinical figures are anemia, leucopenia, and thrombocytopenia. The objective of this study was evaluation of benzene exposure by analysis of urinary trans, trans-muconic acid (t,t-ma) in post shift of workers.Materials & Methods: A case-control study was conducted. The urine samples were collected from 42 workers exposed to benzene at a cokery plant and it’s by –product refinery site and 40 non exposed villagers from rural areas without nearby factories. The t,t-ma was extracted from urine by solid phase extraction (SPE) and analyzed via high performance liquid chromatography (HPLC). The urinary creatinine level was measured by Kone – Pro autoanalyzer.Results: The mean urinary t,t – ma level was 3.33 mg/g creatinine for exposed workers and 0.1007 mg/g creatinine for non exposed workers. The urinary levels in exposed group differed among workplaces, and were higher for subjects that worked in cokery plant (cookery plant, 3.68 mg/g creatinine; it's by product refinery site, 0.64 mg/g creatinine).Conclusion: The results showed that the mean level of urinary t,t-ma was about 6 to 7 times more than biological exposure index; thus, there is a high risk of hematopoetic damage and other adverse effects in these workers. We suggest that the company must decrease benzene exposure via engineering and management controls to lower than threshold limit value.

Background & Objective: Caudal block with local anesthetic agents has been extensively used in pediatric patients to provide intra and postoperative analgesia for surgical procedures such as herniorrhaphy or orchidopexy. Various additives to local anesthetic solutions have been used to prolong and enhance analgesia after caudal block. The aim of this study was to evaluate effectiveness of bupivacaine 0.25% with the addition of fentanyl or neostigmine for caudal block in children undergoing inguinal herniorrhaphy.Materials & Methods: This study was clinical trial and seventy five children were randomly allocated to three groups to receive a caudal block with either 0.75 ml/kg of 0.25% bupivacaine with 1μg/kg neostigmine (group BN) or 1μg/kg fentanyl (group BF) or 0.75ml/kg of 0.25% bupivacaine alone (group B). Haemodynamic variables, degree of pain and sedation, additional analgesic requirements and side effects were evaluated. Mean age, weight and duration of anesthesia and surgery were similar in the three groups. Baseline systolic arterial pressure and heart rate were similar in the three groups.Results: Mean intra-operative systolic arterial pressure and heart rate was higher in group B than the other groups but this was not statistically significant. Adequate analgesia was obtained in 21 patients (84%) in group B, and 23 (92%) in BN and BF groupd. This difference was not significant. There was no difference in degree of sedation and analgesia between the groups. The incidence of vomiting was similar in the studied groups. No other side effects were seen.Conclusion: We found that addition of 1μg/kg fentanyl or 1μg/kg neostigmine to 0.75ml/kg of 0.25% bupivacaine provide no further analgesic advantage to 0.75ml/kg of 0.25% bupivacaine alone in caudal block in children undergoing unilateral herniorraphy.

Introduction & Objective: Acute appendicitis is the most common cause for acute surgical abdominal pain, as soon as the diagnosis is documented, so appendectomy is necessary. Therefore it is important to demonstrate the specific and sensitive laboratory test for rapidly diagnosis or exclusion of disease. The purpose of this study is was evaluation of specificity and sensitivity of quantitative CRP and WBC and comparing them in diagnosis of acute appendicitis.Materials & Methods: The method of this study was cross sectional descriptive over 185 patients who underwent operation with primary clinical diagnosis of acute appendicitis. Pathology study revealed appendicitis in 50 cases and 135 did not have pathologic abdominal problem.Results: We showed that the specificity and sensitivity of CRP were 94.4% and 88.1% respectively and for WBC these were 98.1% and 37.1% respectively.Conclusion: Negative CRP in the patients who admitted with abdominal pain with suspicious to acute appendicitis highly probable could rule out impression.

Introduction & Objective: The bioaerosol is one of the operating room (OR) hazards that can be threaten of personel health and capable to creating of postoperetive infection in the patients. Because of the hospital infection rate has correleted to bioaerosol concentration, therefore, it is important to determine of type and concentration of these microorganisms as the main goal of this study.Materials and Methods: In this research, 23 operation rooms in the 4 educational hospitals of the Hamadan City were studied. 115 air samples were collected in the various locations and conditions according to filtration method suggested by bioaerosol committee of ACGIH. The samples were transported to blood agar and cultivated immediatedly. The type and number of colonies were determined in the laberatory then, the bioaerosol concentrations were calculated in terms of cfu/m3. The data of physical conditions of ORs, ventilation specifications and other environmental parameters have been recorded in the work sheet.Results: The results have demonstrated that the mean of total bioaerosol and pathogen bioaerosol concentration were 136 cfu/m3 and 4.01 cfu/m3 respectively. The concentration of 25.3% of the total pathogen samples is exceeded of recommended limit. It is apeared that have been correlation between concentration of bioaerosols and duration of surgry (P<0.05), also the concentration of morninig shift were higher than the other shifts (P<0.05).Conclusion: According to the detected bioaerosols pathogens in the samples, high cleaning class in the operating rooms is necessary. It is necessary to design and administrate the ventilation systems according to standards because of the absence of appropriate ventilation system in the three hospitals of four investigated hospitals.

Introduction & Objective: Despite mild and self limited manifestation of rubella, involvement of fetus as a consequence of prenatal infection is very important and can lead to congenital rubella syndrome (Cs). The aim of this study was the evaluation of immunity rate against rubella virus in women who were in child bearing ages.Materials & Methods: This survey was performed with cooperation of health center on 248 cases of women who are offered for pre marriage serologic test and their titer of IgG antibody against rubella with Elisa method was measured.Results: Out of 248 specimens, 41 (16.5%) were non immune against rubella and 207 (83.5%) were immune. The frequency of immune serologic titer was highest in the age group of 18-23 years and was lowest in the age group of 30-34 years. Of 138 cases that lived in the urban area, 121 cases (87.7%) were immune and 17 cases (12.3%) were non immune and out of 110 cases that lived in rural areas, 86 cases (78.2%) were immune and 24 cases (21.8%) were non immune. Education levels of most women were graduated from high school (50.8%), whereas the rate of illiterate women was least (1.6%). In this study nobody had a history of vaccination against rubella and 16 cases (6.5%) had a history of rubella infection.Conclusion: On the basis of this study 83.5% of subjects in studied group were immune against rubella and 16.5% were non-immune. This study showed that women in child bearing ages should be checked for rubella and vaccinated against it, if they are non immune.