Journal of Shahid Sadoughi University of Medical Sciences
Year:2005 | Volume:12 | Issue:4|Papers Count:19

Introduction: Heparin is only fast acting anticoagulant drug available in the injectable form. Skin discoloration is an adverse and unpleasant outcome of subcutaneous heparin injection that is observed frequently and causes the patient both physical and psychological discomfort thus limiting the further sites for injection. It is therefore important that nurses use an injection technique that minimizes the incidence of adverse outcomes. This research is a quasi-experimental study carried out to determine the relation between duration of injection of subcutaneous heparin and extent of local skin discoloration at the Fatima and Shahid Beheshti cardiac hospitals, Shiraz, 2002 . Methods: 167 patients were selected and sampling was done by selecting consecutive samples. Data collection was done by using a researcher-made check-list consisting of section of demographic characteristics and a section to record the extent of discoloration at 48 and 60 hours after injection. Data analysis was done by distributional index and parametric (paired-t test) and Bi-parametric (Mann witney-U and kruskal wallis). Results: Extent of local skin discoloration was less in 30-second injection technique, so that the mean size at 48 and 60 hours after 10-second injection techniques (82.85 ± 214.3,77.96 ± 206 ,respectively) was more than the mean size at 48 and 60 hours after 30-second injection technique (40.53 ± 148.11,44.41 ± 175.51 respectively).There was a significant relationship between sex and size of discoloration (p<0.001),so that mean size in females in the 10-second and 30-second injection techniques at 48 and 60 hours after injection was more than that in males. Conclusion: On the basis of results of this research, administering subcutaneous heparin injection over longer duration, especially in females reduces injection site discoloration.

Introduction: Invasive diagnostic procedures such as coronary angiography, in most cases, are accompanied by stress and anxiety for patients,which may effect on hemodynamic signs. Materials and Methods:This research, as a quasi experimental study, has the objective to determine the influence of applying methods of relaxation on hemodynamic signs in hospitalized 40 patients, experienciny coronary angiography (CA),, has been studied, in regard to existing conditions and methods of sampling and random allocation to two groups of control and relaxation at 2003 . Data collection tool included demographic and disease related information sheet, as well as record sheets for hemodynamic parameters at intervals of 8-12 and ½ hrs before, during and after the angiography. For relaxation group, the researcher would speak individually about the influence of relaxation, the day before angiography; Then with the aid of client himself/herself, performed relaxation instances in a single bout, and eventually asked client to perform relaxation technique 2-3 times before going for angiography. In control group was attended in the usual manner preangiographically. Homodynamic parameters were measured in both groups 8-12 and ½ hrs, before during and after CA. Afterward, resulted data were analyzed statistically by T-Test Chi-squre. Results With T-Test, respiratory rates½ hrs, beforeAngiography, diastolic blood pressure and Respiratory Rate after Angiography showed statisticaly significant difference between two groups (P<0.05). Other hemodynamic parameters showed no statisticaly significant difference between two groups (P>0.05).but most of parameters showed clinically significant difference between two groups. Conclusion: Therfore it is offered that relaxation method is applied after invasive procedures.

Introduction: Lipoprotein (a) is a particle rich in cholesterol in human plasma and it is known as an independent risk factor for coronary artery disease. In addition to genetic background, other factors such as diabetes affect the plasma concentration of this lipoprotein as a risk factor. The aim of this study was evaluation and comparison of plasma concentration of Lp(a) in type II diabetics and non diabetic individuals. Material and Methods: The study population included 180 diabetic patients who had referred to the Diabetic Research center of Yazd and 180 non diabetic individuals who were matched according to age and sex with the patient group. Blood samples were collected from the study groups in fasting condition. Glycated hemoglobin, glucose, lipids and lipoproteins were measured by routine laboratory methods and Lp(a) assay was carried out by electro immunodiffusion. Results were analyzed with the use of SPSS program. Statistical tests included variance analysis, t-test for comparing lipids and lipoproteins, U-test for comparing Lp(a) in the two groups and Pearson Correlation for determining of the variables with Lp(a). Results: Mean plasma concentratin of Lp(a) in diabetic patients (Mean + SD 41.98+ 34.63 mg/dl) was significantly higher than that of the control group (26.6 + 20.2 mg/dl) (P<0.001). Mean concentration of cholesterol, triglyceride and LDL cholesterol in the patient group was higher but mean HDL cholesterol in control group was higher than patient group. However, no significant correlation was found between Lp(a) and other variables in the patient and control groups. Conclusion: Plasma concentration of Lp(a) in Diabetes Mellitus is increased independently. In diabetic patients, the risk of coronary artery disease may increase with increase in Lp(a).

Introduction: Subconjunctival hemorrhage (SCH) is one of the complaints of patients referring to ophthalmology clinics. SCH can cause red eye and mild irritation, but usually does not have any symptoms. The most significant sign is SCH observation. The etiology of this problem is usually unknown or spontaneous. SCH starts suddenly and usually involves only one eye. The diagnosis is based on observation. Usually, there is no need for therapy and the best way is to reassure the patient. Aim: Evaluation of demography & causes of SCH in patients referring to eye clinics. Material and Methods: This study was descriptive, case- series type that evaluated 80 patients with SCH at the ophthalmology clinics of Shahid Rahnemoon and Shahid Sadoughi Hospitals from Dec 2003 to March 2004. Data was collected by a questionnaire and analyzed by SPSS software and Chi-square test. Results: 80 patients were divided into two groups according to age (<30 years and > 30 years) and each group included 40 patients. The mean age of the patients was 34.13±18.9 years (4-71 years), 34% of patients were female and 66% were male. The most common cause of SCH was trauma (50%). There was a significant relationship between the cause of hemorrhage and the age of patients (P.value=0.001). In the under 30 years age group, trauma was the most common cause of hemorrhage (70%), while in patients older than 30 years, spontaneous hemorrhage was more common (42.5%). There was no significant relationship between the cause of hemorrhage and the sex of patients (P.value=0.425). Trauma was the most common cause of hemorrhage in both sexes. In this study, 87.8% of the cases involved only one eye; 42.5% left eye and 36.3% right eye. The mean duration of the disease was 15.32±2.7 days (range 8-20 days). The majority of the hemorrhages were seen in the temporal area (86%). The most common cause of referral was observation of the hemorrhage by the patient or others, which caused anxiety in the patients. Conclusion: Although SCH with normal visual acuity is benign, it could be a sign of a systemic disease and assuring the patient is the safest approach for treatment.

Introduction: There are multiple reports of Acute Hepatitis B after blood transfusion inspite of good screening for Hepatitis B before transfusion. Therefore, occult hepatitis B is a serious concern for Blood transfusion. There is a lot of evidence that positive HBCAb in seronegative HBSAg blood donors is associated with occult Hepatitis B. Aim: Evaluation of the prevalence of HBCAb in seronegative HBSAg blood donors. Method: In a cross sectional descriptive study, we evaluated the serum of 1230 Blood donors for HBCAb, HCVAb and Aminotranferase levels. HBSAg or AntiHIV Ab positive cases were excluded from the study. Detection of Anti HBSAb was done in HBCAb positive patients and liver biopsy was performed in all HCVAb positive cases. Results: 15.1% of blood donors were positive for HBCAb and 51.6% of them had Anti HBSAb. Aminotranferase levels were normal in all people who were positive for HBCAb ,but about 50% of HCVAb positive persons had elevated aminotransferase levels and liver biopsy of all these patients showed inflammation Conclusion: Prevalence of HBCAb is high in our seronegative HBSAg Blood donors and biomolecular studies such as PCR for HBV DNA is indicated in HBCAb positive people, especially in people with isolated HBCAb .

Introduction: Smoking is one of the main risk factors in various diseases of different systems of the body, including the respiratory system and asbestosis is pulmonary fibrosis due to asbestos inhalation. Aim: This investigation evaluates the effects of smoking on the respiratory function and aggravation of respiratory complications in asbestos workers. This study was performed in August, 2002 at The Haajat Chrysotile Asbestos factory of Nehbandan, Birjand, Khorasan, Iran. Methods: A cross –sectional study was done on 56 Asbestos mine workers, randomly chosen and matched in two groups; smokers (25 individuals) & nonsmokers (31 individuals). Asbestos levels were measured in different areas of the factory and mine. All of the workers were interviewed and underwent clinical examination and spirometery. Results: The mean value of asbestos in the respiratory field of the exposed workers was approximately 80 times over the standard limit (39.75 f/ml; TLV= 0.5 f/ml). According to clinical examination, both groups showed some kind of respiratory dysfunction, but cough & bloody sputum in the smoker group was significant. So, pulmonary function test impairment was seen in both the groups, but obstructive and mixed patterns were significant in the smoker group (P<0.01). Conclusion: The results demonstrate that cigarette smoking results in a significant increase and aggravation of pulmonary complications in asbestos workers. These changes are prominent even in those workers smoking less than 5 p/y. We therefore suggest that smoking and asbestos inhalation aggravate each others complications because smoking, even in low amounts causes respiratory problems in these workers and asbestosis presents itself in smokers much earlier than expected. . In view of the wide use of asbestos in friction industries like manufacture of brakes of vehicles, smoking can produce undesirable effects in those exposed for longer periods to heavy traffic, such as traffic police officers. In order to decrease these personal and social problems, serious thinking needs to be done.

Introduction: Fiberoptic techniques have been used for diagnosis and also for treatment of gastrointestinal disorders very largely. Infection is a complication of endoscopy and fiberoptic endoscopy may serve as vehicle for transmission of infection. Methods: Before doing gastroscopy, all parts of the endoscope were disinfected (as normally done in the ward). Then, samples for culture were taken from the device and at the end of the procedure, again samples from all parts of gastroscope (outer surface, internal canal, water – air pump) were taken and cultured in Blood agar and E.M.B media. Microbiology species and colony count as standard protocol were identified and reported. Results: 954 Samples were prepared before and after upper gastrointestinal endoscopy. In samples from outer surface of the device before procedure, culture was negative in 90.6% and positive in 9.4% (15 cases), while in samples from the same region after endoscopy, culture was negative in 32.7% and positive in 67.3%. Staphylococcus epidermis
was the most common organism. Before endoscopy, sampling and culture from internal canal of device was reported as 88.7% negative culture and 11.3% positive culture with pseudomonas aeruginosa
being the most common organism.
After endoscopy, internal canal culture was 52.7% negative and 47.2% positive culture. Staphylococcus epidermidis was the most common organism. Air

water Canal samples before endoscopy were 51.6% negative and 48.4% positive. Non fermented gram negative bacilli were the most common organisms After endoscopy, these samples were 22% negative and 78% positive. Non- fermented gram negative bacilli were the most common organisms. Conclusion: The microbial contamination of the air-water canal (78%) and outer surface of the device (67.3%) after endoscopy was due to inadequate cleaning and disinfection after completion of procedures.

Introduction: Uroflowmetry is a noninvasive, simple, cost effective test for screening and diagnosis of abnormal urination, but a reference nomogram consisting of maximum urinary flow (Q max) and mean urinary flow (Q ave) is required. There is a significant relationship between Qmax(maximum urinary flow) and Qave (mean urinary flow) and urine volume according to age. Qmax in 150-400cc urine volume is 26 ml/s and the mean Qave with similar volume is 15ml/s. Maximum (Qmax) is seen in patients younger then 30 years old (39 ml/s) that decreases with increase in age. In order to obtain a reference nomogram, this study was done in a sample population with social, cultural and somatic features similar to our population. Material and Methods: This study was done in 350 normal men (15-45 years old) in Tabriz,Iran. Qmax and Qave were compared with urine volume. Nomograms of urine volumes with Qmax and Qave were drawn and these nomograms included a wide range of urine volumes between 25-800 ml. Results: On the basis of results, maximum urinary flow has relation with urine volume and mean urinary flow has a significant relation with urinary volume and age (P<0.000). Qave has a significant relation with increasing age P (0.023). In this study, mean Qmax in urine volume (150-400ml) was 26ml/s and mean Qave in a similar range was 15ml/s. In this study, flow acceleration of urine in males was studied. Also, measurement of initial slope in urinary volume under 150ml showed a significant difference between normal and abnormal cases, which can be used clinically in patients with urinary volume under 150ml. Conclusion: The nomograms obtained in this study can be used for interpretation of urodynamic tests in patients. Uroflowmetry is a simple, cost effective and noninvasive test as compared to cystoscopy and radiology.

Introduction:
Thalassaemia was first explained by Thomas Cooly as Cooly’s anaemia in 1925. The
- thalassaemias are hereditary autosomal disorders with decreased or absent
-globin chain synthesis. The most common genetic defects in
-thalassaemias are caused by point mutations, micro deletions or insertions within the
-globin gene. Material and Methods: In this research , 142 blood samples (64 from childrens hospital of Tabriz , 15 samples from Shahid Gazi hospital of Tabriz , 18 from Urumia and 45 samples from Aliasghar hospital of Ardebil) were taken from thalassaemic patients (who were previously diagnosed ).Then 117 non-familial samples were selected . The DNA of the lymphocytes of blood samples was extracted by boiling and Proteinase K- SDS procedure, and mutations were detected by ARMS-PCR methods. Results: From the results obtained, eleven most common mutations,most of which were Mediterranean mutations were detected as follows; IVS-I-110(G-A), IVS-I-1(G-A) IVS-I-5(G-C)
Frameshift Codon 44 (-C
 codon5(-CT)IVS-1-6(T-C)
IVS-I-25(-25bp del) ,Frameshift 8.9 (+G)
IVS-II-1(G-A)
Codon 39(C-T) Codon 30(G-C)

the mutations of the samples were defined. The results showed that Frameshift 8.9 (+G), IVS-I-110
(G-A) ,IVS-II-I(G-A), IVS-I-5(G-C), IVS-I-1(G-A)

Frameshift Codon 44(-C) , codon5(-CT) , IVS-1-6(T-C) , IVS-I-25(-25bp del) with a frequency of 29.9%, 25.47%,17.83%, 7.00%, 6.36% , 6.63% , 3.8% , 2.5% , 0.63% represented the most common mutations in North - west Iran. No mutations in Codon 39(C-T)
and Codon 30(G-C) were detected. Cunclusion: The frequency of the same mutations in patients from North - West of Iran seems to be different as compared to other regions like Turkey, Pakistan, Lebanon and Fars province of Iran. The pattern of mutations in this region is more or less the same as in the Mediterranean region, but different from South west Asia and East Asia.

Introduction: This study was performed to evaluate the effect of dentine bonding agents and Glass Ionomer cement beneath composite restorations and its resistance on fractures of endodontically treated teeth. Material and Methods: Forty sound maxillary teeth were selected; ten of them for positive control, and on the rest, RCT and MOD cavity preparations were done with standard methods. Then, the teeth were divided to four groups: 1-Sound teeth for positive control. 2-Prepared without any restoration for negative control. 3-Prepared and restored with Vitrabond(3M, USA), Single bond(3M, USA) and Z100(3M, USA) resin composite. 4-Prepared and restored by Single bond and Z100 resin composite. Specimens were subjected to compressive load by Instron 8502 until fracture occurred. Results: Group 1 showed the highest resistance to compressive forces followed by group 4,3&2 respectively.
ANOVA, t test and Chi-square tests indicated significant difference between all the groups. Conclusion: Use of dentine bonding agents and resin composite increases resistance of endodontically treated teeth to fractures more than teeth restored with sandwich of glass ionomer cements, dentine bonding agents and resin composite.

Introduction: Cryptosporidiosis is prevalent world wide, causing a variety of problems ranging from acute, self-limiting diarrhea to fatal cases in immunocompromised persons, particulary those with acquired immunodeficiency (AIDS). Diagnosis of Cryptosporidium is made by identification of oocysts in stool specimens. The detection is most commonly made by the acid-fast staining method followed by microscopic examination which has low specificity and sensitivity. Material and Methods: In the present study, we evaluated diagnostic utility of a commercially available enzyme immunoassay (EIA), which detects Cryptosporidium-Specific antigen (CSA) in 204 unprocessed stool specimens obtained from patients less than 3 years of age. Results: When compared with the routine screening procedure applied in this field study (screening by acidfast staining and microscopy after concentration of positive results by IFA), both sensitivity and specificity were 98%. Of the 139 specimens negative by microscopy, 13 (9.3%) were positive by EIA, 11 of which were confirmed by inhibition with antibody to Cryptosporidia-specific antigen. Conclusion: The EIA is an important tool for identifying Cryptosporidium in fecal specimens in field studies since it is sensitive, specific, simple to use and unaffected by the presence of a preservative.

Introduction: Rubella infection in pregnancy results in abortion, fetal death or Congenital Rubella Syndrome. It has been since many years that the titer of rubella antibody in children and women in the reproductive age group is measured in order to have a proper vaccination program for the control of rubella and its complications. The aim was to study the immunity of women in the reproductive age group in Birjand so as to apply the obtained data for the health program. Material and methods: This research was a descriptive study done on 271 women referring to the treatment and health center for routine pre-marriage tests. The antibody titer was detected by the ELISA method using an American23 kit (Trinity Biotech). The results were statistically evaluated with SPSS program. Results: This study showed that of the 271 case, 95.2% were immune and 4.8% were sensitive to rubella. There was no significant relationship with age, living place, parent’s education, level of education and number of children in the family. Conclusion: Considering the lack of immunity against rubella in 4.8% of women at reproductive age, vaccination for girls at the age of marriage seems to be necessary.

Introduction: Use of contraceptive pills for postponement of menstruation has been a common practice for women traveling to the holy city of Mecca, although the side effects of this practice has not yet been studied. This research was carried out for determining the type and the prevalence of side effects of the contraceptive pills and for finding out the best type of regimens with least side effects in Hajj pilgrims from Kerman in 2001 Materials & Methods: In this research, 224 pilgrims were selected with similar backgrounds. A two part questionnaire was given to them during the last days of their pilgrimage. The first part was completed in the holy land of Arafat and the second part was answered two months later via telephone calls or postal service. Results: Menstruation had occurred in 2.1% of cases, 13.6% had experienced spotting, 19.5% nausea and in 11.4%, dizziness was reported. 81.1% had not experienced any side effects. 49.5% experienced normal bleeding during the first menstruation, while 66.1% had normal bleeding during the second menstruation. The rest had experienced either decreased or increased bleeding. 24.6% in the first menstruation and 20% in the second menstruation had experienced unusual pain. In 73% of the cases, the second menstruation had been normal. c2 tests showed a significant relation between the number of pills and duration of bleeding in the first menstruation (p=0.04%) and the second menstruation (p=0.03%). Conclusion: As the number and severity of side effects increase with an increase in dosage, it is recommended that lower dosages of pills should be used as far as possible. Also, since early start of pills does not decrease spotting, it is better if pills are started just a few days before the expected time of menstruation.

Introduction: The purpose of this cross sectional study was to determine the prevalence of iron deficiency anemia among high school girls in Semnan city, 2002 Materials and Methods: In this study, 402 students were selected from among 4900 students at fourteen high schools in Semnan city by simple random sampling method. Study was performed in two stages; initially, blood test for determination of hemoglobin was performed for all of the 402 students and later, after primary analysis, those students that were anemic (Hb< 12 g/dL) were selected for the second stage of study wherein their serum iron, total iron bonding capacity and ferritin levels were measured. Iron deficiency anemia was defined as serum ferritin less than 15 ng/L, and or transferin saturation percent less than 16%. Results The results showed that 38 students (9.5%) were anemic that 4.5% (18 students) had iron deficiency anemia. Also, there was no significant relationship between iron deficiency anemia and student's age, age of menarche and sports activities. Conclusion: As there was no significant relationship between iron deficiency anemia and student's age, age of menarche and sports activities, further investigations are needed for determining other etiologic factors of iron deficiency anemia among high school girls in Semnan city

Overlap syndrome is defined as presentation of a combination of two or more connective tissue diseases in one patient .Herein; we present a 34 years old lady with previous diagnosis of rheumatoid arthritis referring to us with dyspnea on exertion and some other subtle features of systemic lupus erythematous, systemic scleroderma and dermatomyositis. Her HRCT showed diffuse ground glass appearance in both lung fields, typical of alveolitis. She showed dramatic response to multiple pulse steriod therapy with resolution of her pulmonary and extra-pulmonary symptoms.