JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2001 | Volume:6 | Issue:2|Papers Count:26

Introduction. In a time that economic classification of nations is largely dependant on their scientific output, our country "Iran" in comparison to it"s facilities, has fewer scienilfic producilon than accepted. For programming to increase quantity and quality of research, at first, should carefully recognise the present condition. This study was done to survay attitiude, knowledge and practice of students in Isfahan University of Medical Sciences and Health Services (IUMSHS) about research. Methods. Questionnaires were distribiuted among interns (n=234) who their names and sites had extracted. Students enterance year to university was between 1992 to 1994. So, they were at the end of their staying in university. Results. Average grade of knowledge was 2.92±2 (from whole grade= 10). This grade did not depend on stage of preparing thesis. The most true answer was in writing of purpose and the least was in sampling, medline and role of variables in study. Attitude in 78.2 percent, indicate agreement with necessity of learning research concept. 54.2 percent agree with necessity of participailon in at least one research project in educational period in university, but 41.8 percent believe that research activity in present condition is wasting the time. The answerers who at least had parilcipated in one research project were 11.9 percent and the highest knowledg"s grade was in these students. Discussion. Despite the positive attitude of interns to learn the research concept, their knowledge level in comparison with other Iranian univercities and other univercities" students in the world, was very low. Although more than half of them have positive attitude to participation in research project, their practice was insignificant. Radical changes in education system and management seems to be necessary.

Introduction. Diabetic control and its acute and chronic complications needed to investigate the characteristics medical and self care in diabetics. This evaluation can detect conflicts in this field and provide the possibility of better planning to arrive the ideal control of diabetes. Methods. This study was a cross sectional survey. Samples were 344 diabetic patients who were living in Isfahan. Data was collected by a questionnaire described diabetics contextual characteristics, position of medical services use, position of diabetic education, self blood glucose monitoring (SMBG), attendance to diet regimen and so on. Questionnaires were cmpeleted through interview. Results. Mean age of patients was 56.5±13.6 years. More than fifty percent (57.7 percent) were female. More than one third (57.6 percent) were illiterate. Patients had 1 to 40 years history of diabetes. More than one forth (27.4 percent) did not seek medical advice and 61.2 percent had referred to physician only when they were encountering with a problem for example lack of insulin or oral hypoglycemic agents. Over eighty percent never had foot examination by their physicians. Only 7.4 percent, had heared about glycosylated hemoglubine. This test had not been accomplished for 95.9 percent of patients. 46.2 percent had not performed self foot examination till study time. More than eighty percent of interviewers had reported their lost blood glucose value above 130 mg/dl. Only ten percent of the study population had performed 5MBG. About fifty percent (45.3 percent), did not educated about diabetes. Only 26.8 percent reported that they always follow their dietary regimen. Discussion. Results of this survey showed irregular calls to physicians, poor blood glucose control, high rate of hospitalization due to acute and chronic diabetes complications, irregular blood glucose monitoring. Diabetes management needs more attention in our city.

Introduction. Defining reference values is a priority in medical research for any community. The importance may be stressed when we look to platelet indices in which a few researches were performed. Methods. Sampling was done on a non probability convenience basis to select 19993 persons during a 6 month period. Platelet indices were measured automatically using H-1 cell counter. Results. After analysing the data, 2.5 and 97.5 percentiles of platelet count were 145 and 356 (×103/mm3), of POW were 40.2 and 57.4, of PCT were 0.13 and 0.32, and of MPV was 7.4 and 10.7. For the first three variables the difference was significant between males and females. Discussion. The reference values of platelet indices in Iranians are different from international data, although it may be due to burden of disease in this population.

Introduction. The light waves stimulates the retinal cell and eventually the brain cortex will interpret it to a color vision. Color vision defects can be congenital or acquired. Congenital types have a lifelong constant state (Severity). These patients almost always have red-green defect. These types are sex-linked, and according to the existing data have a prevalence of 8 percent in males and 0.5 percent in females. Acquired color vision defects are frequently of blue-yellow type and have an equal prevalence in males and females. Methods. This is a descriptive study and includes 1500 male and 1500 female students of 34 Isfahan high schools, in 1378. We used the "lshihara test" for the evaluation of color vision in these cases. Results. Prevalence of color blindness was 4.2 percent in males and 0.33 percent in female cases. Discussion. These findings are very different from what are registered in our references; so we recommend to perform the "Ishihara test" (which has a low cost) and job consultation for all males before entering their occupational field. This can help them to have a better selection, more suitable job and less problems because of their probable color vision defects.

Introduction. Hematuria is a clue to the diagnosis of renal and extra renal diseases. In this survey we evaluated the prevalance of hematuria in asymptomatic adults. Methods. Non - probability convenience sampling method was applied to choose 1000 subjects among the medical staff and patients" relatives in Noor and AI-Zahra Hospitals affiliated with Isfahan University of Medical Sciences (IUMS). On the basis of inclusion criteria, urine samples of subjects were tested with dipstick and some were crossed out based on exclusion criteria. Remaining samples were centrifuged and urine sediments were examined with light microscope. Hematuric samples were divided in to glomerular and non-glomerular groups. Data analysis was performed with SPSS software package and results were statistically compared with X2 method. Results. The relative prevalance of hematuria in this study was 2.6 percent. Glomerular and non-glomerular hematuria accounted for 1 percent and 1.6 percent of cases, respectively. The origin of hematuria in younger age groups was glomerular in most cases (66.6 percent) and non-glomerular in older age groups (90 percent). There was significant difference between the prevalance of non-glomerular disease (1 percent) and those with non-glomerular origin (P<0.001). In subjects with non glomerular hematuria who underwent urological workup, 62.5 percent were diagnosed with a specific disease. Given their normal hematologic and serological test resultes, kidney biopsy was not indicated for subjects with glomerular hematuria. All of these subjects had isolated hematuria. The pre valance of hematuria evaluated with dipstick was significantly different from the results obtained from microscopic examination of urine specimens (P<0.001). Discussion. Most cases of hematuria were non-glomerular origin in patients older than 50 years and glomerular in younger age groups. The diagnosed diseases did not affect, the subjects prognosis and this way of patient screening do not seem to be cost-effectiveness. More extensive evaluation are essential in high risk groups and individuals older than 50 years.

Introduction. Laryngoscopy and tracheal intubation cause sympathetic and parasympathetic stimulation that in turn, result in dangerous cardiovascular signs like elevation of systolic and diastolic blood pressure and heart rate. Verapamil and lidocaine have been compared with each other in control of these changes. Methods. In a double blind clinical trial study was done over three groups, each containing so persons, 90th second before intubation, each of which recived verapamil, lidocaine and placebo, respectively. Systolic and diastolic pressure and heart rate were measured and compared together one, two and five minutes after intubation. Results. Mean of systolic blood pressure was decreased 3.9 and 6.1 percent in verapamil and lidocaine group after laryngoscopy, respectively but it was increased about 2 percent in placebo recipients (P<0.05). Mean of diastolic blood pressure was decreased in verapamil and lidocaine group 2.1 and 3.9 percent, respectively but increased 2.1 percent in placebo recipient (P<0.05). Mean of heart rate was decreased 3.1, and 1.8 percent in verapamil and lidocaine group, respectively but increased 5.7 percent in placebo recipient (P<0.05). Discussion. Lidocaine seems to be more effective than those for prevention of hypertension after laryngoscopy and tracheal intubation. With regard to lower percent of tachycardia in the verapamil groups versus lidocaine and placebo groups, verapamil group is more effective than those about the prevention of tachycardia after laryngoscopy and intubation.

Introduction. There are few studies about intravenous fentanyl infusion for reduce labor pain. This study evaluate the usefulness of intravenous fentanyl infusion for labor analgesia. Methods. Seventy seven healthy pregnant women were randomized to recive 1.5-2.5µg/kg/hr intravenous fentanyl infusion (interventional group) or placebo (control group). Maternal labor pain intensity, systolic, diastolic and mean arterial blood pressure, pulse and respiratory rate, frequency of nausea and vomiting were monitored. Fetal heart rate (FHR) and neonatal APGAR score also monitored. Results. Maternal intensity of labor pain, frequency of nausea and FHR changes were significantly lower in interventional group. There was no significant difference between groups about maternal frequency of vomiting, systolic, diastolic and mean arterial pressure, pulse rate and neonatal 1 and 5 min APGAR score. Discussion. Intravenous fentanyl infusion (1.5-2 µg/kg/hr) during active phase of labor can diminish labor pain without any side effects of neonate and mother.

Introduction. Tissue expander is a new method in plastic surgery. This technique was used as a practical method from 1976. Tissue expander is made from silicone elastomer and is placed in subcutaneous and gradually expanded with saline solution Methods. This is an analytic study on 101 (72 female and 29 male). All patients were operated in Isfahan from 1995 to 1999 all patient followed for six months after operation. Results. Seventy two cases were in 20-29 age group and 29 cases were in 30-39 age group. Tissue expander was used in head and neck (86. 1 percent), trunk (1.9 percent), and extremities (5.9 percent). Flap contracture (13.9 percent), flap hyperpigmentation (5.9 percent), hyposthesia (5.9 percent) and hyperesthesia (2 percent) were obsereved in patients. We detected temporary hair loss in 20 percent of patients operated for alopecia. Discussion. Tissue expander method is ideal method for repair of skin defect because complication is low and in near 90 percent color is normal. Between flap pigmentation and sex is not any relation but between scar and age was some relationship.

Introduction. Good results of foreign made Hydroxyapatite in human orbit, expensive American and Europian made hydroxyapatites, the possibility to make this material from coral by hydrothermal method and good source of coral in Persian Gulf made us start this study. Methods. The left eye of 21 male rabits weighing 200-270 grams were enucleated and implanted by 14mm coralline spheres being covered by preserved rabits sclera (11 with pure coral and 10 with Iranian made hydroxyapatite). The implants were removed for pathologic study after an average time of 79.4 days of clinical evaluation. The type of coral was acropora and the hydrothermal Ion exchange form carbonate to phosphate was performed in chemistry department of Isfahan University. Results. No evidence of extrusion was seen in implants. Exposure phenomena was seen 55 and 12 percent in coralline and hydroxyapatite implantation, respectively (P<0.05). Tissue inflammation was detect 89 and 25 percent of coralline and hydroxyapatite implantation, respectively (P<0.05). Discussion. The tissue tolerance of rabits orbit to Iranian made hydroxyapatite was almost fair and it"s use in human"s orbit could probably be tried safely. Orbital implantation of natural coral in rabits" orbit is accompanied by moderate to sever tissue inflammatory response and tissue necrosis, creating more clinical complications.

Introduction. Suramin, as a selective P2x-Pourinoceptor antagonist can inhibit the sympathetic excitatory junction potentials (SEJPs). Experiments have shown that the biphasic contractile responses (bcr) in smooth muscles of vascular and vas deferens (vds) is evoked by cotransmission of ATP and neuradrenaline. Therefore, vds is considered as a model for studying the role of A TP and antagonizing its effect. By using different concentrations of Suramin, its antagonistic effect in phase one of bcr is observed To confirm the purinergic origin of SEJPs, some experiments should be performed electrophysiologically at different concentrations of Suramin. Methods. Suramin was dissolved in distilled water and after diluting with physiological salt solution freezed as a stock solution at concentration of 10-1M. After killing and dissecting the albino male guinea pigs (weighing 2S0-300 gm), both testes were pushed up to give out the whole vds. The vds was cleaned from surrounding tissues and cut from epididymic and prostatic ends. vds was maintained at 3SC in physiological salt solution bubbled with 9S percent O2 and 5 percent CO2. Intracellular microelectrodes (with resistance of 20-40 MQ) recordings were made from prostatic end of vds. Results. The resting membrane potential of the control smooth muscle cells was 67.4±.0.7 mV (n=48). Electrical stimulation at frequency of 0.5 Hz evokes SEJPs which are magnified consistently due to facilitation. Mean magnitude of fully facilitated SEJPs which were evoked from control cells was 8.5±0.8 mV (n=23). Further facilitation was evoked at frequencies of 1 Hz or 2 Hz, because SEJPs were obtained at the threshold limit to begin the action potentials which were 55 mV in most cells. It was difficult to estimate correctly the threshold potential in a cell because disseminated potential might conduct to the other cell and the penetration of microelectrode into cell was impossible due to contraction of smooth muscle cell. All control experiments were performed by using stimulation at frequency of 0.5 Hz and the effects of drug in fully facilitated SEJPS were tested. Suramin produced the dose dependent reduction in SEJPs. Discussion. SEJPs are inhibited by Suramin in guinea pig vds. The mean magnitude of SEJPs is not reduced even at frequencies until 8 Hz by using selective a1-adrenoceptor antagonists (prazosin). The addition of Suramin does not change the resting membrane potential of smooth muscle cells during exposures of over one hour and further reduction in SEJPs. Suramin can block the SEJPs in vds and the role of A TP to evoke the bcr is indicated by it.

Introduction. Mutagenesis, carsinogenesis and cytotoxicity effects on body tissues are side effects of sulfur mustard which in turn, causes the bone marrow and lymphoid system dysfunction. Previous investigation in 31 Iranian chemical casualties, indicated the presence of persistant atypical lymphocytes and the decrease of T lymphocyte subsets and surface markers. The present study was performed to evaluate the changes of B lymphocyte surface markers in the above mentioned group and compare the changes with two other control groups. Methods.The first control group consisted of 30 chemical casaulities with the same clinical conditions and the same history of exposure to mustard but absence of atypical lymphocytes in their blood, and the second control group were consisted of 30 completely normal indivduals. Monoclonal antibodies congugated to fluoroscein isothiocyanate were used to determine B lymphocyte markers.The monoclonal antibodies used in this study were against human immunoglobuline δ and µ heavy chain, λ and κ light chains, anti human HLADR and anti human CD10. The tests were performed on 100 ml of peripheral blood, using flow cytometer model EPICS®XL.Results. In comparsion with normal controls, k and λ light chains showed a significant decrease (P<0.001) while HLADR showed a significant increase (P<0.001) in the two groups of poison gas injury. No significant difference could be seen in µ and δ chain. Two patients of victims group with atypical lymphocytes were CD10 positive. Discussion. Results of this investigation on B lymphocyte markers, suggests the increasing risk of neoplasuc or Iymphopro fife rative disorder with B cell origin, in chemical casaulties with mustard gas.

Introduction. Familial hypertrophic cardiomyopathy (HCM) occurs as an autosomal dominant mendelian inherited disease in about 50 percent cases. abstractive and nonobstractive were two forms of HCM. The most common treatment modalities include drug therapy, mitral valve replacement, installation of dual chamber DD pacemaker and surgical excision of a portion of the hypertrophied septum. Methods. One of the newest methods used in recent years for the treatment of HCM unresponsive to common medical procedures is to inject alcohol into septal artery (septal ablation). We used a modified version of this procedure which consisted of using transesophageal echocardiography evaluation of mitral regurgitation and the diagnosis of septal artery during alcohol injection in a HCM patient. Results. The short term (immediately after procedure) and the long term (after 3 months) evaluation indicates complete improvement of clinical symptoms in the patient. Discussion. Considering the clinical improvement of symptoms, increased tolerance for activity and reduced gradient in LV outflow tract, this procedure is an effective method for the treatment of HCM resistant to common medical therapy.

Infection with echinococcus has a world-wide distribution. This parasite affection almost all body organs (such as brain, lungs, spleen, billiary tract, liver, thyroid, parotid, tongue, bone, prostate, bladder, tonsile, pulmonary arteries and inferior vena cava). The other important body organ which also is infected by this parasite is the heart. The patient is a 32 year old man without any symptoms who referred for the evaluation of incidental cardiac murmur on physical examination. All findings in ECG and Chest X ray were normal. Echocardiography showed a large moblie cystic mass in left ventricular outflow tract. Because of the dangerous site of the cyst and probability of rupture and anaphylaxis, he was operated emergently and the cyst was removed successfully. He was discharged from the hospital without any residual LV dysfunction, heart block and cardiac problems.  

Introduction. Human T Iymphotropic virus type I (HTL V-I) was itroduced in 1980. It is suggested that HTL V-I may have the etiologic role in adult T-cell leukemia (ATL) and spastic paralysis. This lymphoproliferative malignancy occures in the high endemic areas for HTLV-I (such as Japan, Caribbean, South America, parts of Africa and Iran). The retrovirus is transmitted mainly by blood transfusion and body fluid (e.g. sexual contact, breast feeding). Methods. This study was performed in Fars province (Shiraz). Blood samples of 100 leukemia/lymphomatic patients, 200 thalassemic patients and 500 blood donors (as control) were examined by ELISA method for detection of HTL V-I infection. Results. Antibody to HTLV-I was not detected in any case of leukemia/lymphoma. Among the thalassemic patients with more than 10 times history of blood transfusion, six (3 percent) patients had antibody to HTLV-I and 7 patients were suspected to positive antibody. Discussion. The prevalence of HTL V-I in Shiraz is low and the screening test is not necessary.

Introduction. Central nervous system infections are among the most serious conditions in of medical practice. C-reactive Protein has recently been evaluated in terms of its ability to diffeccentiate bacterial from nonbacterial central nervous system inflammations. Methods. We studied the frequency of positive CRP in 61 patients who had signs of meningitis. All the specimens referred to one laboratory and were examined by Slide method. Results. Positive CRP was found in 97.6 percent of those who were finally diagnosed as bacterial meningitis. The frequency of CRP for other types of meningitis was 16.6 percent (P<0.05).Discussion. In the absence of infection, CSF is free of CRP. Positive CRP may help to the differentiate the different types of meningitis.

Introduction. Tuberculosis is a wide spread disease in the world. It is a health problem in every where. The prevalence of tuberculosis have been increased since several years ago due to some factors such as AIDS. For management of this problem, we need to data about our identified patients. Then we can have a solution for disease control. We demonstrate the patients demographic characters in our province. Methods. All of 164 identified patients under treatment for tuberculosis in Isfahan province were studied (1998-1999). Demographic data such as age, sex, nationality and gender and some characters about their discase was collected. HIV screening was done for all patients by ELISA method and documented in suspicious patients by western blot test. Results. Male to female ratio was 21:20. About 70 percent of patients had primary lung tuberculosis. Skeletal TB was the most common type of extrapulmonary invasion. Seventy four patients were Afghanian and 90 patients were Iranian. Only one patient (a 14 years old boy) was positive for HIV infection. He was a hemophilic patient with history of infected blood transfusion. Discussion. Compared to developed and far east countries, in our country, HIV infection is not a frequent infection in tuberculosis patients. This study shows that migration from Afghanestan to Iran is a very important affecting factor in tuberculosis epidemiology in our region.

Background. Cervical cancer is a common female malignancy in developing countries. In our health care system, the screening program is performed by doing pap smears with the interval of three years. This study was designed to determine the prevalence and frequency disturbation of abnormal smears. Methods. This is a cross sectional study was done in 1997-1998. Sample group were all the under coverage married women aged 20-65 years who have a factor of referal criteria. Papsmears samples were interpreted by a pathologist. Papsmear results were documented by colposcopy and biopsy. Results. The prevalence of abnormal smears in under coverage women is 0.05 percent. Results of abnormal papsmears due to more investigations (colposcopy and biopsy) were: Normal 25 percent, ASCUS 57 percent, CIN 14 percent, CIN 2 1 percent, CIN 3 1 percent invasive cancer 2 percent. Conclusion. Refering of women with abnormal signs such as leukoplakia, cervical erosion, and history of contact bleeding is necessary. The number of false positive results in cytotechnologlsts diagtlosfs is high. This result shows that on-job-training for cytotechnologists is important.

Introduction. Retinal detachment is a serious complication after lensectomy in traumatic cataract. It is due to traumatic retinal breaks or vitrous traction that occur after sharp and blunt trauma. Methods. Prophylactic effect of encircling band was evaluated. 247 patient"s who had undergone lensectomy due to traumatic cataract were divided in two groups. In the case group (52 patients) encircling band was used intra operatively and in the control group (195 patients) were operated on without using encircling band. Results. After follow up for at least one year, retinal detachment was not seen in any case of interventional group but was seen in 6.66 percent of the control group (P<0.05). Discussion. It is advised that this prophylactic technique be applied for traumatic cataract surgery.

Neurogenic tumors are common in the mediastinum. Two cases (A 35 years old woman and a 45 years old man) presented with non specific clinical signs and worked up, According on imaging (Chest X-Ray, CT Scan, MRI) they have mediastinal tumor near thoracic spine. Two tumors were removed completely (about 1 kg) with thorcotomy. Pathology of both were schwannoma. The importance of knowledge about this tumor is its relation with thoracic spine and the spinal cord. Therefore all surgeons must noticed that this surgery (posterior thoracotomy and laminectomy) is done with the cooperation of neurosurgical team.