JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2006 | Volume:11 | Issue:3|Papers Count:18

BACKGROUND: Atorvastatin has been shown to be cardio protective in ischemia-reperfusion (I/R) injury. Inhibition of Fas expression prevents I/R induced apoptosis. However, the influence of atorvastatin on Fas expression in I/R injury was not studied. Therefore, we designed this study to see the influence of atorvastatin on cardiomyocyte apoptosis and Fas expression following acute I/R in vivo. METHODS: Thirty Wistar rats were selected and divided into three groups (n = 10): acute ischemia-reperfusion (I/R) group, acute ischemia-reperfusion and treated with atorvastatin group and sham-operated group. Apoptosis of the cardiomyocytes was observed under electron microscopy and determined by optic microscopy with TUNEL (terminal  deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling) staining. To detect the expression of Fas in the cardiomyocytes, immunohistochemistry method was used. Image analysis system was used to quantitatively estimate the positive metric substances of immunohistochemistry through the mean optic density. RESULTS: Numerous apoptotic cardiomyocytes were found in ischemic fields in ischemia-reperfusion groups and weren’t observed in the sham-operated group. Fas expression was significantly higher in the ischemia-reperfusion group as compared to sham-operated group, but was decreased significantly in atorvastatin treated group as compared with I/R group. CONCLUSION: Up regulation of Fas expression in myocardial ischemia-reperfusion can induce cardiomyocyte apoptosis, and atorvastatin can significantly inhibit cardiomyocyte apoptosis by inhibiting Fas expression.

BACKGROUND: Long term success of dental implants directly depends on marginal bone resorption. The aim of this study was to determine the annual average bone loss on the mesial and distal aspects of implants following the first year of implantation. METHODS: This was a descriptive analytical study of patients treated with ITI (International Team of Implantology) implants at the Dental School of Isfahan University of Medical Sciences from 1998-2002 (1377-81). A total of 15 patients with 41 implants were selected by convenience sampling method. The height of the alveolar bone was measured using panoramic radiography before and after loading with calipers to determine the average bone loss. Other information such as pocket depth, bleeding index, plaque index, gingival recession, was obtained by clinical examinations. The mean bone loss on the mesial & distal sides was analyzed by ANOVA at 0.05 level of significance. RESULTS: The average bone loss on the proximal sides of ITI implants obtained annually after the first year of loading was 0.084 ± 0.035 mm with slight difference on the mesial (0.092 ± 0.035) and distal (0.072 ± 0.033) sides. There was negligible difference between male and female patients. The average survival rate for thirty three months was 95.1%. CONCLUSION: The average bone loss on the mesial and distal sides of ITI implants compared with other studies was satisfactory. Survival and success rates were acceptable.

BACKGROUND: The aim of this study was to evaluate the efficacy and side effects of tramadol comparing with meperidine on post-spinal shivering in cesarean section. METHODS: In a prospective, controlled, randomized, double-blind clinical trial 73 ASA-I pregnant patients candidates of cesarean section under spinal anesthesia who had shivering ostoperatively were selected and classified into two groups receiving tramadol or meperidine to control  ostoperative shivering. Spinal anesthesia was done by injection of epinephrinized 5% lidocaine at L3-L4 or L4-L5 segment. Pruritis, somnolence, dizziness, nausea, vomiting and the duration of shivering control were evaluated and recorded. All data were analyzed by using Fisher and Chi-square tests.RESULTS: There were no significant differences between two groups in age (P = 0.1) and weight (P = 0.8) of patients. There was no significant difference in response rate after injection of both drugs (P = 0.3). The time elapsed from treatment to ceased shivering was significantly less (P = 0.001) but frequency of somnolence (P = 0.001), nausea (P = 0.001) and vomiting (P = 0.005) were significantly more in tramadol group. Dizziness was significantly more common in meperidine group (P = 0.001) and pruritis was not seen in any group.CONCLUSION: Tramadol is more effective in controlling post-spinal shivering but results in more frequent nausea, vomiting and somnolence in comparison with meperidine.    

BACKGROUND: Many different methods have been used in an effort to provide adequate analgesia after knee arthroscopic surgery. In this study analgesic effect of intra-articular fentanyl, pethidine and dexamethasone was compared. METHODS: In a double blind randomized study 48 male patients undergoing knee arthroscopic meniscectomy were allocated to groups receiving intra-articular fentanyl 50 μg or pethidine 20 mg or dexamethasone 8 mg at the end of arthroscopy during general aesthesia. Postoperative pain scores using visual analogue scale were measured and also analgesic requirements and the time of ability to walk were recorded. RESULTS: Pain scores at one, two, six and 24 h after intra-articular injection were not  significantly different for fentanyl and pethidine but were higher significantly for dexamethasone at all four mentioned times. The mean average time of ability to walk was significantly longer for dexamethasone. The analgesic requirements during the first 24 h after intraarticular injection were significantly greater only for dexamethasone too.CONCLUSION: Better postoperative analgesia, less pain score and shorter time to walk were achieved by fentanyl and pethidine in comparison to dexamethasone but the results were not significantly different between fentanyl group and pethidine.

BACKGROUND: In this study we compared the sedative and amnesic effects of propofol with midazolam in cystoscopy examination.METHODS: This prospective clinical trial was done on 44 adults, with American Society of Anesthesiology physical status I, II, III, who were candidate for cystoscopic examination. Patients were recruited according to convenience sampling method and randomized into two equal groups. In study group, propofol plus fentanyl and in control group midazolam plus fentanyl were given intravenously. Vital signs and SaO2, the number of patients movements, presence of eyelid movements and verbal contact all at the first and 10th minutes after beginning the procedure were recorded. Also, frequency distributions of patients recalls, VAS (visual analog scale) for pain and VAS for satisfaction scores were evaluated in recovery room. RESULTS: Frequency distribution of patients movements, frequency distribution of verbal contact and eyelid movements at the first and 10th minutes were higher in midazolam group (P<0.05). There were a lower VAS pain score and higher VAS satisfaction score in propofol group (P = 0.009 and P = 0.041 respectively).CONCLUSIONS: Propofol was more effective than midazolam in inducing deep sedation and immobility in patients undergoing cystoscopy examination, without interfacing patients with additional danger.

BACKGROUND: To assess demographic variables and the incidence of keratoconus in patients with VKC and to evaluate the characteristics of Vernal Keratoconjunctivitis (VKC) associated with keratoconus. METHODS: One hundred and fifty patients with VKC were studied at Ophthalmology Department of Shaheed Sadoughi medical center between October 2004 and June 2005. Both eyes of VKC patients were evaluated by Orbscan topography for the diagnosis of keratoconus. Corneal topography maps were examined with modified Robinowitz-McDonnell test. The characteristics of VKC were recorded in keratoconus patients.RESULTS: The study included 93 male and 57 female subjects. The patients mean age was 13.07 ± 4.71 (range 8-24) years. The clinical forms of VKC were as follows: 45.2% mixed, 38% palpebral and 16.7% limbal types. Fifty four (36%) of 150 subjects with VKC had complications of pseudogerontoxon, punctate keratitis and shield ulcer. Eightyfour eyes (42 subjects) of 150 patients with VKC were detected as having keratoconus by videokeratography maps (28%). There were 27 males and 15 females in keratoconus group. 16.7% of the eyes had mild, 33.3% had moderate and 50% had severe keratoconus. Eyes with severe keratoconus presented at younger age (12.7 ± 3.35 years) than moderate keratoconus (18.3 ± 2.15 years). Keratoconus was more common in male gender, long-standing disease, mixed and palpebral VKC. CONCLUSION: Screening of keratoconus subjects with corneal topography allows early detection and management of keratoconus. The higher incidence of keratoconus in our study is due to videokeratography study of early keratoconus.    

BACKGROUND: As, acid negatively affects duodenal and gastric mucosal defense, we designed this study to investigate if fasting during Ramadan can promote peptic ulcer and its complication, acute upper gastrointestinal bleeding. METHODS: All patients files who had admitted to hospital with acute upper gastrointestinal bleeding from 10th day of Ramadan till one month later, in 2002 to 2004 were reviewed. Patients were divided into two groups: fasting group who were fasting, at least 10 days before admission and non-fasting group.RESULTS: A total of 236 patients were included in the study; fasting group involved 108 subjects and non-fasting group 128 ones. Both groups were matched regarding sex, predisposing factors and underlying diseases. Fasting group showed more frequent duodenal ulcer (38%) compared to non-fasting group (19.5%) (P = 0.002). The frequency of esophageal varices was significantly higher in non-fasting group. There was no correlation between fasting and other causes of gastrointestinal bleeding. In fasting group 38%, and in non-fasting group 18.9%, had previous  dyspeptic symptoms (P = 0.001). Two groups were similar regarding prognostic factors. CONCLUSION: It seems Ramadan fasting can increase acute upper gastrointestinal bleeding due to duodenal ulcer, but it does not make its prognosis poorer than that in non-fasting patients. Dyspeptic symptoms could be considered as alarming signs for patients who want to fast during Ramadan.

BACKGROUND: Minor head injury is the most common type of head injury. Despite its high prevalence and a lot of studies, there is much controversies about the management of these patients. We performed this study to find indications for brain CT scan according to clinical signs and symptoms. METHODS: We did this prospective cohort study in two university hospitals (Alzahra and Kashani) for one year enrolling 682 consecutive patients with minor head injury (GCS = 15) and recording all clinical signs and symptoms to find which could be used as predictors for brain injuries. X2 and logistic regression with 95% confidence interval were used for analysis. RESULTS: Of 682 patients, 46 (6.7%) had brain injuries in CT scan. All patients with abnormal CT scans had at least one of the following risk factors: post traumatic amnesia, post traumatic unconsciousness, post traumatic seizure, headache, confusion, vomiting, focal neurological deficit, skull fracture, coagulopathy or history of taking anticoagulants and age more then 60 years. We didn't find any abnormality in brain CT scan of patients who did not have any of these factors on admission. Confusion, Vomiting, skull fracture and age > 60 years had significant  correlation with brain injuries. We also found those patients who had more than one risk factor had more abnormalities in CT scan. CONCLUSION: Not all patients with minor head injury need brain CT scan. Clinical factors can be used as indications for brain CT scan in these patients.

BACKGROUND: Opioid agonists such as methadone have been used widely in controlling opioid withdrawal symptoms. Tramadol, a partial opioid agonist, also has been prescribed to manage acute and chronic pain. We sought to compare the efficacy of tramadol and methadone in reducing the severity of opioid withdrawal symptoms. METHODS: In a double blind clinical trial 70 opioid dependent patients who used daily opium equal to 15 mg methadone randomly were assigned in two groups. In one group, methadone was started at 15 mg/day while in the other group 450 mg/day tramadol was prescribed. Both drugs were tapered in a week and placebo was prescribed in the 2nd week. The severity of withdrawal symptoms were assessed five times by short opioid withdrawal scale (SOWS). Data were analyzed by Repeated Measures Analysis of Variance, Mann-Whitney U, and Wilcoxon tests.RESULTS: There were statistically significant differences between two groups in the severity of anxiety (P = 0.015), irritability (P = 0.044), palpitation (P = 0.018), agitation (P = 0.037), and dysphoria (P = 0.044) that all were more common in methadone group. Comparison of side effects revealed statistically significant differences in sweating (P = 0.003) and drowsiness (P = 0.019) between two groups that were more frequent in methadone group. DISCUSSION: Tramadol was more efficacious in controlling opioid withdrawal symptoms with lower side effects.

BACKGROUND: Major Depressive Disorder (MDD) is a common disorder, with a lifetime prevalence of about 15 percent, perhaps as high as 25 percent for women. The etiology of MDD is too complex to be explained totally by a single social, developmental, or biological theory. A variety of factors appear to work together to cause or precipitate depressive disorders. Various functions have been reported for trace elements such as zink in recovery or exacerbation of depression. METHODS: In this experimental study, we studied 46 patients with MDD based on DSM IV criteria, among the patients referred to mental disorders clininc of Noor Hospital. Twenty Patients were men and 26 were women. Thirty two volunteers of general population were evaluated for depression with Beck depression test who did not show any depressive symptoms with this test. A blood sample of 5cc was obtained from each person and the serum zinc concentration was measured. Data gathered and analyzed with SPSS, logistic regression and chi-squar tests. RESULTS: Serum zinc concentrations were 74 to 130 mg/dl in men and 60 to 128 mg/dl in  women of control group. Serum zinc concentration was 30 to 60 mg/dl in depressive patients that it was lower in women than men. The difference between serum zinc concentrations of normal and depressive persons was meaningful (P = 0.02). CONCLUSION: In our study, the serum concentration of zinc was about half of normal value. This study replicates previous findings that major depressed subjects show significantly lowered serum zinc concentration.

BACKGROUND: At least one half of all patients who admitted to general hospitals, suffer from psychiatric comorbidities.Management of mental disorders in these patients, significantly, improves the course and outcome of medical diseases. The aim of this survey was to answer the following questions: 1) what is the rate of diagnosable psychiatric symptoms among medical and surgical inpatients? and 2) what proportion of them undergo psychiatric consultation? METHODS: Three hundred and ninety two patients admitted to medical and surgical wards of Alzahra hospital (Isfahan) from January 2005 until March 2005 were evaluated by the revised form of psychiatric symptoms checklist (SCL-90- R). The total referral records were also aintained and compared with the data of morbidity.RESULTS: One hundred and fifty six (42.7%) of the evaluated subjects had psychiatric co-morbidities. The most prevalent psychiatric symptoms determined in this group were depression, somatization and anxiety. Only 84 (3%) of these patients had undergone psychiatric consultation.CONCLUSIONS: This study demonstrates that many of the patients, who are admitted to general hospitals, may have psychiatric co-morbidities but only a very small percentage of them receive appropriate mental cares.

BACKGROUND: Bilateral vasectomy is the most effective method of male contraception but there are still some reports on its failure. This study was undertaken to determine the failure rate of the no-scalpel vasectomy in Shiraz Vasectomy Center, Southern Iran. METHODS: From 2001 to 2003, 3900 no-scalpel vasectomies were done in Nader Kazemi Health Center. The records were studied for any failure in the method. Presence of any live sperm 6 months after surgery or any report of pregnancy post-vasectomy were considered as vasectomy failure. RESULTS: Among 3900 cases, 2928 patients had a complete follow up file while failure in the method was visible among 109 (3.72%) cases. CONCLUSION: The low failure rate of no-scalpel method indicated its high efficacy to control the fertility in males but there is still need of performance by expert surgeons in well organized centers.

To evaluate the physical and health growth of children, measurements such as height and weight are used 1,2. This study determins the weight and height of 0-2 year old children in Jahrom, Southeastern Iran. A total of 597 (391 boys, 206 girls) children born in Jahrom entered our study from April 2001 to December 2002. The height and weight of these children were recorded 18 times from one month to two years of age. In order to fit appropriate models for infant growth, Healy, Rasbash and Yang (HRY) method was used to estimate age related smoothed centiles. This method was implemented for the World Health Organisation as GROSTAT computer package.  

We would like to point out that the variety of histopathological patterns that observed in pediatric brain tumors are not likely to occur in adults, and contrary to adults, infratentorial area is the most common site of involvement among pediatric brain tumors. In our experience, we evaluated 398 patients with primary brain tumors.