Journal of Shahid Sadoughi University of Medical Sciences
Year:2009 | Volume:17 | Issue:3 (66)|Papers Count:15

Introduction: Control of post thoracotomy pain is particularly important in prevention of post operative respiratory complications. Several methods are proposed for control of postoperative pain. Cryoanalgesia by freezing of intercostal nerves is able to providing long term pain relief in post operative period which probably results in cutaneous sensory changes.Methods: This clinical trial study was done on 124 patients who underwent CABG surgery. Patients were randomly divided in two groups; control group (group I) and study group (group II). In study group cryoanalgesia was applied intraoperatively on the intercostal nerves. All of the patients received appropriate analgesia on demand in postoperative period. Pain in LIMA harvesting site and sternum was measured by visual analogue pain score before discharge, one and three months following cryoanalgesia. In all of the patient’s, presence of paresthesia was evaluated. The amount of administered analgesics (narcotic, opium, indomethacin) was noted daily. Data of this investigation was analyzed and evaluated using SPSS 11.5 software.Results: Pain score of sternum was higher in study group before discharge and was lower at one and three months after operation than the control group that was statistically significant (P=0.01). Pain score of LIMA region before discharge was higher, at one month post operation was equal and at three months post operative was lower than the control group (P=0.045). Use of morphine and opium was lower (P=0.017) and use of indomethacin was higher in the cryoanalgesia group that was statistically significant (P=0.001). Incidence of paresthesia was lower in the study group (P=0.001).Conclusion: It is proposed that cryoanalgesia is a safe and effective method for reduction of pain and paresthesia and need for analgesics following CABG operation.

Introduction: Infertility is a common complication present in 10-15% of the population. It causes serious  problems for the family. There are different methods for evaluation and treatment of infertility. One of the routine tests is hysterosalpingography that was first used in1922 and with changes in types of contrast media and its techniques, it is the primary test for simultaneous evaluation of tube, uterus body and cervix. Methods: This descriptive clinical outcome study was carried out on the base of a case series study. The study was performed on 117 patients who referred for HSG procedure and were followed for 2 years for detection of pregnancy. Data was analyzed by SPSS.14, and statistical tests included student’s t-test, chisquare and Fisher exact test.Results: The mean age of patients was 26±4.7 years. Duration of infertility was 6 years. Of the total, 98(83.8%) cases had one or both patent tubes on HSG. They didn’t have any established causes of infertility after scrutiny of other findings and 51(43.6%) cases became pregnant during 2 years (CI=95%, 34.6-52.6%).Notable point was that 86.3% of pregnancies occurred in the first 6-months after HSG procedure. Conclusion: HSG plays a significant role in infertility diagnosis and treatment in spite of the new techniques and methods for infertility diagnosis and treatment; so follow up and control of patient for 6 months after HSG is recommended. If HSG fails, other procedures such as laparoscopy can be done.

Introduction: Genetic and health factors along with ethnicity and geographic location are factors that affect the time of puberty onset. The aim of the present study was to evaluate the mean age of onset of puberty and its stages in boys of Yazd.Methods: This cross- sectional study with random clustering sampling method was conducted on 1018 healthy 9-16 years old male students of Yazd. All cases were examined and evaluated for onset and secondary characters of puberty with inspection of the genital region for pubic hair and scrotum and testicular size according to Tanner classification.Results: The mean age of G2 (onset of testicular growth) and PH2 (onset of pubic hairs growth) was 11.57±1.54 and 12.43±1.07 years. The mean age of G5 (final stage of testicular growth) and PH5 (final stage of pubic hairs growth) was 15.43±0.8 and 15.69±1.1 years. The mean BMI in the early stages of puberty (G2) was 16.32±2.02.Conclusion: The mean age of onset of puberty (G2) in boys of Yazd was 11.5 years that is similar to other researches in other countries.

Introduction: It is generally assumed that 50% of the cases of anemia are due to iron deficiency. The most severe consequence of iron depletion is iron deficiency anemia (IDA), and it is still considered the most common nutrition deficiency worldwide. The main risk factors for IDA include: inadequate iron intake, impaired absorption or transport, physiologic losses associated with chronological or reproductive age, or acute or chronic blood loss, parasite infections such as hookworms, acute and chronic infections, including malaria, cancer, tuberculosis, HIV and other micronutrient deficiencies, including vitamins A and B12, folate, riboflavin, and copper deficiency.Methods: This work as a cross-sectional study was done in 2007-2008 in Yazd. Two hundred girls who participated in the study were selected randomly from eight girl high schools. Five ml venous blood was collected for determination of serum ferritin and cell blood count (CBC). Serum ferritin was determined by using ECLIA method and CBC by cell counter SYSMEX KX21N. Iron deficiency was defined as having serum ferritin values below 12 m/l. Anemia was defined as having Hemoglobin levels below12 g/dl. Irondeficiency anemia was considered to be the combination of both.Results: The3 mean age(years) and body mass index (kg/m2) were 15.19±0.7years and 21.5±4.2, respectively. Distribution in the 14, 15 and 16 years and more age groups were 13, 58.5 and 28.5 percent, respectively. Mean of Hemoglobin(g/dl), Hematocrit(%), MCV (fl), MCH (pg), MCHC (g/dl) and ferritin(m/l) were 12.8±0.9, 38.9±3.0, 80.7±4.3, 26.6±1.8, 33.2±3.6 and 23±18.2, respectively. Of the total, 13.5% were anemic, 68% of which had Iron Deficiency Anemia (9.3% of the total). Iron deficiency was present in 34.7% of the population under study.Conclusion: According to world health organization criteria, anemia is a mild public health problem in this region, but iron deficiency is a significant problem and suitable measures for control and prevention of it should be undertaken.

Introduction: Investigation of job stress among people who have experienced accidents could help to recognize causes of events in workplaces. The objective of this study was to measure frequency and severities of work stressors among staff employed at the Hormozgan Ports & Sailing Organization, and determine its relationship with accidents. Methods: This cross-sectional study included 320 Hormozgan Ports & Sailing Organization staff that completed 3 questionnaires including demographic characteristics, stress frequency and stress reaction. Statistical analysis was performed by One way ANOVA and Chi square test.Results: The averages scores from frequency and reaction stressor questionnaires for all of the study population were 88.9 and 16.1 respectively. The scores of stress frequency questionnaire of 78% with history of accidents were more than median, but only 34% without history of accidents had scores more than the median. The Odds Ratio of people with positive history of accidents in stress frequency questionnaire was 6.48.Conclusion: As seen in the results of this study, stress plays a role in non fatal accidents and therefore, quality management for the control of stress in workplaces is a necessity.

Introduction: DNA extraction methods are very important for genetics research and diagnostic tests. In These methods are also important for detecting genetic diseases or in cancers for investigating genetic changes during cancer progression or treatment. Therefore, selection of the best method for DNA extraction from different samples such as bone marrow (BM) or peripheral blood (PB) and their slides is very important. Methods: In the present research, DNA was extracted from 5 different samples including; 1-PB, 2-BM slides stained by Gimsa method, 3-Gimsa stained PB slides from archives, 4-new Gimsa stained PB slides and 5- non stained new PB slides by 3 different methods; salting-out, boiling and phonal chloroform method. In all of the groups, three DNA parameters were investigated; 1-OD (Optimal Density), 2-DNA concentration and 3-Outcome (PCR results).Results: The best DNA quality was achieved by salting-out method (OD=1.74), while the worst quality was by the boiling method (OD<1.0). The DNA quality of all the samples was similar in the salting-out and phenol chloroform methods. Regarding DNA quantity, the best result was from boiling method (6.7mg / ml). The least amount of DNA was obtained by the phenol chloroform method and salting-out method also resulted in the least quantity of extracted DNA. Regarding the outcome of DNA extraction or the PCR results, all the three methods showed 100% positive results for peripheral blood samples, while boiling method had the best outcome for BM slides, archive stained PB slides, new stained PB slides and nonstained PB slides (100%, 88%, 84% and 72% respectively).Discussion: The present research indicated that except non stained PB slides, the DNA extraction from all other samples showed very good results. In addition, the research showed that there is no difference in DNA extraction of new or archive slides.

Introduction: The purpose of this study was to assess prevalence and possible variables on the change of diagnosis in mood disorder patients to schizophrenia.Methods: This study was a retrospective and comparative analytic research that was performed in 2006 at Razi psychiatric hospital. The study included all of the 176 patients who were hospitalized in 2000 with diagnosis of a mood disorder. The patients were divided into two subgroups; the stable group with a persistent mood disorder diagnosis and the changed group with a changed mood disorder diagnosis to schizophrenia. Data was analyzed by statistical chi-square and t student test.Results: Findings showed that 31.3% of all of the patients shifted toward schizophrenia. 23.3% and 32.9% of patients with major depressive disorders and bipolar disorders shifted toward schizophrenia, respectively. There was no statistical difference between groups in demographic variables, but there was statistical difference in some of the clinical variables such as psychotic features (Pvalue=0.001), severe clinical features (Pvalue=0.016), and gradual onset of disorder (Pvalue=0.027) with change of diagnosis to schizophrenia. Conclusion: Recognition of clinical variables associated with change of diagnosis to schizophrenia such as psychotic features, severe clinical features and gradual onset of disorder will help clinicians in better management of these patients than the past.

Introduction: Hepatic hydatid cyst is caused by echinococcosis granulosis. It is a major health problem in endemic areas. The modern treatment of hydatid cysts of the liver varies from surgical intervention to percutaneous drainage or medical therapy. A high rate of complications following percutaneous drainage, and ineffectiveness of medical therapy have shown not to be the definitive treatments for the disease. Thus, surgery is still the best choice for the treatment of hydatid cyst of the liver. Surgical treatment methods can be divided into radical and conservative approaches. There is controversy regarding efficacy of the two surgical methods. In this study, we aimed to present a retrospective evaluation of the two surgical methods in patients treated for the hepatic hydatid cyst.Methods: This retrospective study reviewed medical records of 135 patients who underwent surgery for hepatic hydatid cyst from 1997 to 2007. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers) and radical methods (total excision of the cyst and removal of its outer layer).Results: One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%), whereas, the remaining 64 patients (47%) underwent radical surgery. Postoperative complications were 28% and 19%, respectively. Recurrence of the cyst in the conservative and radical surgery groups was noted to be 12.5 and 1.5%, respectively. The mean length of hospital stay was shorter in the radical surgery group (5 vs. 15 days).Conclusion: Radical surgery may be the preferred treatment for the hepatic hydatid cyst because of its low rate of postoperative complications and recurrence, as well as short hospital stay. Selection of the most appropriate treatment depends on the size, number, and location of the cyst(s), and presence of cystobiliary communications, and the availability of an experienced surgeon.

Introduction: There are a lot of fungi in the air and our environment that grow and reproduce if the temperature and humidity are suitable. Aspergillus flavus and parasilicus are among the most important food contaminants which have a role in food poisoning. These fungi secrete poisons which contaminate animal feed as well as the milk we get from the animals fed with these foods.Methods: In this study, a total of 428 samples of raw, pasteurized milk and animal feeds were examined in different seasons of the year using ELISA or TLC method.Results: The results revealed that in 43.36% of the animal feed samples, the contamination level was above the permissible level of aflatoxin B1 (20ppb). In 38.03% of raw and 14.42% of pasteurized milk samples, the contamination level was above the permissible level (0.5 ppb). It was also found out that the contamination level was higher in summer and autumn than that in winter and spring. This could be due to higher humidity in autumn and higher temperature in summer. This study also showed that the percentage of contamination in corn was higher. A high percentage of contamination was also found in recycled bread in the samples of AL. The contamination level was low in Fal. Fa, bran and straw samples.Conclusion: Based on these findings, there seems to be a pressing need for controlling aflatoxin contamination in animal feeds and prevention of the use of contaminated animal feeds such as corn and recycled bread. Also rotten analysis of milk and its products is necessary to be performed periodically for detection of aflatoxin contamination.

Introduction: Delayed Onset Muscle Soreness (DOMS) is a common strain resulting during therapeutic exercise with eccentric contractions. This pain can result in loss of interest by the patient and eventually in cancellation of the routine. The purpose of the present study was to determine whether vibration could have an affect on delayed onset muscle soreness. We hypothesized that the vibration training would decrease DOMS.Methods: Subjects comprised of 30 male athletes aged 18-26 years. The athletes were involved in regular sports activities since at least three years. Subjects were assigned randomly into two VT (n=15) and Non-VT (n=15) groups. The measurements included the flexed knee angle (FANG), pressure pain threshold (PPT), muscle soreness (SOR) of right quadriceps muscle and maximal isometric force (MIF) of both quadriceps muscles together (Base-line). A vibrator was used to apply 50 Hz vibration on the left and right quadriceps muscles for 1 min in the VT group. Then both groups trained eccentric exercise. All parameters were determined again 24 hours post-exercise (After- activity).Results: All subjects showed a loss in MIF, decrease in PPT, FANG and increase in SOR 24h after eccentric exercise (p=0/000). But the parameters were statistically significantly different in the VT and Non-VT groups [MIF (p=0/000), PPT (p=0/001), FANG (p=0/02), SOR (p=0/003)].Conclusion: Therapeutic exercise with eccentric contractions results in DOMS, but vibration training before exercise is effective and beneficial in decreasing DOMS.

Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities.Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.