Journal of Shahid Sadoughi University of Medical Sciences
Year:2002 | Volume:10 | Issue:3 SUPPLEMENT|Papers Count:20

Viral Hepatitis is still a major hygienic problem in both developing and developed countries . The Hepatitis B vaccine is important for fighting against the hepatitis B virus and preventing its chronicity.The purpose of this study was to inspect the effectivity of immunity of hepatitis B  vaccine seven years after the Iranian Public Vaccination Program. The search was a descriptional and a cross sectional one . The surveyed society included Yazd primary school 8 year old students who had been vaccinated 2 or 3 times according to the public vaccination program. 200 samples with an equal number of boys & girls were included in the study. 69% of the society was positive 7 years after injection ( HbsAb>10mIu/ml). Seventy one percent boys and 67% girls were positive HbsAb . The children with high BMI had low positive HbsAb. The was no clear difference between the group with birth weight<2500 gr and the group with birth weight > 2500 gr regarding positive HbsAb. Considering the results of the above study, with reference to the immunity permanence 7 years after vaccination (69%), which confirms with similar researches of other countries, a booster dose is not recommended.

In rheumatoid arthritis , Osteoporosis initially occurs in bones around joints (juxta - articular) and later progrsses to become diffuse leading to pathologic fractures which are the most important complications of Rheumatoid Arthritis. Taking into consideration the high prevalence rate of Rheumatoid Arthritis in Khoozestan , this study was carried out to determine the rate of osteoporosis in Rheumatoid Arthritis patients of this province. In this study which extended over one year , 183 female patients with Mean age of 45.3 years were studied and an equal number  women with a mean age of 48 years were included as the control group. The density of the bone of the spinal column (L2-L4) and the femoral neck were measured using dual X - Ray absorptionetry at the Apadana hospital of Ahwaz. The study revealed that 40.4% of the patients suffered from osteoporosis of which 15.3 % had only femoral neck involvement , 5.4% had only lumbar spine involement , while in 19.6% both the regions were invobved .The Study demonstrated a significant statistical difference between the BMD of the lumbar sacral bones of the two groups (P<0.05) but this difference was not significant for the femoral head ( P> 0.05).

Stress has been the focus of attention as a predisposing factor of addiction in many studies. Actually, it is the concept of specific stress for the person and the coping mechanisms used by him, which determines the effect of stress on his behavior, not the type of stress itself. The present study was done to show the differences using stress coping mechanisms, between opioid addicts and non-addicts, in order to be able to declare another perspective for preventive and therapeutic interventions in opioid addiction. The study was done in the addicts rehabilitation center of Iranshahr(Iran). It was a descriptive (cross-sectional) study, which was performed on two groups, 35 addicts , resident in the center, and 35 matched non-addict people fromIranshahr. They comleted the Carver coping mechanisms questionnaire and their score in each mechanism were compared statistically with each other by t-test. Our analysis showed that the two groups had no difference in using problem solving focused coping, but their difference in using emotional focused and non-effective coping mechanisms was statistically meaningful.  Discussion: These findings, if replicated can help us in establishing educational programs in the field of coping skills for prevention of addiction, especially in high risk groups; and also planning more effective strategies in therapeutic programs for opioid addiction. The questionnaire can also be used for determining the risk of addictive behavior in young people.

In industrial countries events due to accident with vehicle is known fourth cause of mortality in all ages. Head trauma is most cause of deaths with motor vehicles. Head injury in age below 45 years has reported in the most common cause of mortality in U.S.A as well. With world of turbulent and high speed of vehicles increasing trauma and statistics of increasing day to day of accident, most common mechanism of trauma is by car accident. Which has close relative with culture safety of roads, city streets, automobible speed and possibility of community. The aim of study is evaluation demografic of etiology and complication injuries by car accident in the Yazd city. This study is type of descreptive cross – sectional in second six months of 1378 and first six months of 1379. Casualties evaluated by random in one month of each season. Results show most of casualties are male (81.9%) and female (18.1%). They were less than one year age and up to 84 years. From point of education was not meaningful relation with knowledge of people. Only 45% of them were with high qualification. Damage to body organs include head and neck 42.5% lower limb 21.8% upper limb 5.4% and 5.4% had trauma to the chest and abdomen. Most accidents happened in summer and most common kind of vehicles was motor cycle. Average time of casualties to arrive in emergency department was 60 minutes and average day stay in hospital 2.5 days and 12 days has rested at home. Most of the patients were in the way of home and work. With hospital,s cost, disability and occupied hospital beds is cost efective to community. Otherwise young people specially men which are the active member of community are exposed to damage. So for perevention of loss of life and property suggest to teach the rule of driving and safety manner traffic department.

Group B streptococcus (GBS) is a major cause of neonatal meningitis and septiscemia. Infection is transmitted from infected pregnant mothers to infants during delivery. This study was carried out in order to identify the rate of vaginal GBS carriers among pregnant women and also some of the factors effecting vaginal colonization of the bacteria.  Vaginal cultures were done on 624 women on arrival for term delivery, preterm labour or premature rupture of membrane (PROM) , in Shahrekord Hajar hospital and were screened for GBS. In addition, a Specical form consisting of age, type of delivery, parity, intrapartum complications and use of oral contraceptive pills (OCPs) or IUDs was completed for each person. Infants born from infected mothers were monitored for the infection three months after delivery. One- hundred ten of 624 pregnant women (18%) were vaginal carriers of GBS. OCPs and IUDs have been used by 23% and 15% of them respectively. Fifty eight percent of the deliveries were  by cessarian section. There was no significant difference between the rate of preterm labour and the type of delivery in GBS- positive and GBS- negative cases. But the rates of IUDs usage and PROM were significantly different. Since the rate of maternal vaginal carriage is high, it is recommended that, a vaginal culture for all of  pregnant women in the terminal stapes of pregnancy be performed and a prophylactic choice therapy in culture positive mothers with PROM and high risk labours to be performed.

Nitrous oxide is one of the most common inhalational anesthetics in current anesthesiological practice. This gas has many side effects. Hypoxia, particularly "diffusion hypoxia" and diffusion into air-containing cavities within the body are the side effects of N2o that cause significant morbidity and even death in the patients. N2o also inactivates synthesis of methionine. The hematological, neurological, immunological  and reproductive systems are affected by this unique property of N2o. Many anesthesiologists believe that the potential dangers of N2o are so great that it should no longer be used for routine clinical anesthesia. Because of the analgesic effect of fentanyl, a short acting synthetic opioid; it may be used instead of N2O . Our study was a clinical trial study and included 120 patients in two groups. In both the groups, induction of anesthesia was the same with thiopental sodium + fentanyl + pavlon and the trachea was intubated. Maintenance of anesthesia in group " N2o " was with oxygen + Halothane + N2o and in group “fentanyl” with oxygen + Halothane + fentanyl (o.5 mg/kg 1.2hr) .Blood pressure and pulse rate of patients were measured and recorded before, during, and after the anesthesia. The results were analyzed with K square, Z and t.tests. Blood pressure and pulse rate before, during and after anesthesia were the same in the two groups. These Hemodynamic measurements in the recovery room were not significantly different in the two groups. According to our finding it was concluded that: It is possible to use fentanyl [0.5 mcg/kg/1.2 hr], instead of N2o for the maintenance of anesthesia. With this dose, the hemodynamic conditions of the patients are stable during general anesthesia and recovery. More researches are needed to study the  efectivity of dosages lower than 0.5 mcg/kg/30 min.

Herpes Viruses genome contains a linear DNA and is a good model for eukaryotic DNA replication system. The restriction map of different HSV–1 strains has been identified in the developed countries .In our country; Iran, the HSV–1 viruses isolated have been detected and isolated from patients using immunological techniques, but molecular genetic aspects need to be studied more in the future. In this study viruses were amplified using Vero cells. It was demonstrated that this isolate was HSV–1. This verification was done using southern blotting in which the probe was prepared from UL29 gene cloned in PNN-1 plasmid. In addition, it was shown that HSV–1 isolated from the Iranian patient was identical with HSV–1 KOS strain . The amplification of UL29 gene via PCR-RFLP was performed with 5 restriction enzymes. In summary, this study proved that other isolates can also be used in molecular epidemiological studies of different Iranian populations.

Manganese is an essential trace element. This element is an important part of some metallo enzymes. There is little evidence for deficiency of manganese in humans , where as it’s toxicity has been reported in several cases. There are a number of stages by which iron metabolism is achieved. The first stage is the uptake of iron from the lumen by intestinal mucosal cells. In mucosal cells, the exact mechanism by which iron transportation occurs is still a matter of speculation. It has been reported previously that manganese may interfere with iron metabolism  either through intestinal absorption and / or via blood transportation sites which might be due to chemical similarities between these two metals. In this project , the inter relationship between iron (Fe) and manganese (Mn) absorptions in rat everted gut sac (EGS) has been investigated. Incubation of freshly prepared EGS in Krebbs ringer phosphate (KRP) Medium pH=7.4 containing either Fe(II) or Fe (III) showed that iron absorption completed within 60 min of incubation time , whereas maximum manganese absorption occurred after 30 min. The absorption of metal Irons is a dose dependent process and maximum absorption occurs in the presence of 1.78 or 1.85 mM of iron and / or manganese respectively. Addition of iron to reaction mixture reduced manganese absorption significantly by 40% , while identical levels of manganese decreased iron absorption by approximately 15 precent. From the results of this study, it is concluded that both iron and manganese probably follow a sinilaw route of intestinal absorption such that iron has more priority than manganese.

Post operative pain can be a major source of fear and anxiety in hospitalized patients leading to so many complications including pulmonary , cardiovascular gastro – intestinal , urinary dysfunction , impairment of muscle metabolism and function , neuroendocrine , metabolic changes and many other complications. Therefore control of post operative pain, especially in children is very important. Caudal bupivacain analgesia is a very effective method for controlling post operative pain, but premedication with oral clonidine may improve the quality and duration of bupivacain caudal analgesia. In this study, effect of oral clonidine on the duration of caudal bupivacaine analgesia was studied in 60 children in the age group 3-8 years. All of them were subjected to ortheopedic, urologic and surgical procedures of the lower extremities. All patients received caudal bupivacaine anesthesia (0.25%) after the induction of anesthesia at the dose of 2mg/kg.Anesthesia was induced with halothane, N20 and O2 and maintained throughout the procedure. 30 patients received 5 µy/kg oral clonidine and 30 patients received placebo 1.5 hour before caudal anesthesia . Patients were assessed for duration of analgesia and the time and dosage of receiving the first analgesic drug postoperatively. Blood pressure and HR of patients were recorded at equal intervals from the time of receiving clonidine . In addition to age, sex and weight of patients were recorded to study presence of any relationship between them and duration of analgesia.The following results were recorded: Both groups were almost similar in regard to sex ,age and weight. There was no effect of age, sex and weight on the duration of caudal bupivacaine analgesia. Patients of clonidine group were remarkably more hypotensive as compared to the placebo group but the occurence of bradycardia was the same in both groups.The duration of pain relief was 1.9 times more in clonidine group as compared to placebo group (The average time of receiving the first dose of analgesia post operatively in placebo group and clonidine group was 293 ± 30 and 433 ± 155 minutes respectively. Therefore, it is recommended that oral clonidine (5 mg/kg) should be adminstered 1 1/2 hours before caudal bupivacaine analgesia for induction of a good quality and long duration analgesia in children post operatively.

Post operative shivering is one of the  serious and important complications that may cause many problems including increase of  myocardial oxygen requirement, production of co2 and increase of minute ventilation leading to respiratory fatigue , increase in IOP and pain because of wound stretching. Clonidine is a α2 receptor agonist that is used as a premedicant to relieve mild pain and anxiety , prevention of salivation , nausea , vomiting, induction of hemodynamic stability and reduction of anesthetic requirement. There are some reports of anti shivering property of clonidine in recent studies.This study is a prospective double blind clinical trial to study the efficacy of clonidine on prevention of post-op shivering after general anesthesia. 100 patients condidated for elective surgery were divided in two equal study and control groups. Study group received oral clonidine, 0.2mg in 100ml of water, 2hr befor surgery and control group received 100ml of water as placebo. Shivering was marked as involuntary muscular activity and treated appropriately if necessary . 2 patients from study group (4%) and 11 patients from control group (22%) had shivering at the end of surgery (P=0.007). Comparison of shivering prevalence in the two groups reveals that oral clonidine as a premedicant decreases or prevents shivering after general anesthesia with no significant side effects in the mentioned dose.

Considering the report on the difference in results of the Wright test with the antigens of Pasteur Institute and Razi Institute in order to diagnose Brucellosis, it was decided to compare these two antigens in this study . The serum of 50 patients from 345 patients who had a positive Wrights with one or both of these Antigens were included in this study . It was a descriptive cross-sectional study . The procedure included an interview and a questionnaire with details of demographic characteristics such as age,sex, job,any background of Malta fever and consumption of nonpasteurized dairy products. 5cc of blood was taken from each subject and after screening the serum , Wright serologic tests were carried out with the antigens of Pasteur and Razi Institutes. Of the 50 subjects under study, 27 (54%) were male and 23 (46%) were female. The age range of the subjects was from 8 to 60 years. The results of rapid Wright using the antigens of Pasteur and Razi Institutes showed a significant difference (PV=0.001). Similarly, the results of the tube Wright test with the antigens of Pasteur and Razi Institutes were significantly different. In conclusion, with rapid procedure , zone phenomenon is observed with the antigens of the Pasteur Institute while no such phenomenon is observed with antigens of the Razi Institute. Also , the tube procedure with the antigens of Pasteur Institute indicates a high titer antibody as compared to the antigens of Razi institute .

Tarsal tunnel syndrome (TTS) is a defined as entrapment of the tibial nerve and its plantar divisions under neath the flexor retinaculum as the nerve curves behind the medial malleolus. The purpose of this study was to compare the involved nerves with intact nerves in TTS. This technique allows the subject to serve as his or her own control for early diagnosis. The subjects included 50 healthy adults(25 male,25 female) with an age range of 19 to 54 years and average age of 36 years. Each of these volunteers had no symptoms or signs of neuropathy . To determine compound muscle action potential (CMAP) , the nerves were stimulated proximal and distal to the tarsal tunnel .The upper limit of normal for proximal latency, distal latency and across tunnel latency was 8.5 ms, 6 ms and 3.5ms respectively (mean ± 2SD). To determine compound nerve action potential ( CNAP) , plantar nerve was stimulated at the sole of the foot. Recording point was located behind the medial malleolus. The upper limit of normal for plantar CNAP latency was 3.7 ms(mean ± 2SD) .The upper limit of normal for side to side diffrence was 1ms for across tunnel CMAP latency ,0.8 ms for medial plantar CNAP latency and 0.9ms for lateral plantar CNAP latency (mean ± 2SD) . This value for ipsilateral plantar CNAP to sural sensory nerve action potential was 0.8ms (mean ± 2SD). This study offers a new technique in diagnosis of TTS.

It is well known that medicinal herbs play an important role in medicine today. The plants from the cabbage family have been used for treating various diseases in Iranian traditional medicine since ages. Though the cabbage has been introduced as an abortive agent and for expulsion of dead fetuses in Iranian traditional medicine , no confirmatory study has been carried out in modern times . The aim of this study was to evaluate the effects of aqueous and hydro- alcoholic extracts of cabbage leaves on the contractibility of isolated uterine horns of a rabbit invitro. For this purpose , the above mentioned extracts were applied to organ baths in varying strengths and the resulting tonicity was measured using an isometric transducer . The results showed that these extracts cause significant contraction of the uterus in a dose dependent manner .As a significant reduction of these effects is seen in the presence of 0.2ng/ml fentolamine , it is estimated that the cabbage extracts have an effect on the alfa  receptors .

A 28 year old male presented with hypertension since one year. Physical examination was unremarkable, lab tests revealed elevated VMA and Metanephrine levels in 24hr urine sample and CT scan revealed normal adrenal glands, but a large (10 cm) tumor was seeen in the pelvic area below the aortic biforcation anterior to the sacrum. The patient was scheduled for surgery with a diagnosis of pheochromocytoma. Preoperative preparation was started one week before surgery with phenoxybenzamine. After removal of the tumor the patient developed sudden severe hypotension which was refractory to intravenous fluids, blood and vasopressors, He responded only to noradrenaline. The drug was continued for 24 hrs. Postoperative VMA and metanephrine levels normalized and remained normal during the three months after surgery. There were no instances of hypertension throughout this period.

Surgery is the most effective method of treatment in esophageal carcinoma. Due to the wide spread invasion of carcinoma in sub mucosal lymphatic channels, total esophagectomy is mandatory. Open surgery in esophageal carcinoma is with extensive dissection and big incisions in the abdomen and thorax. An excellent alternative for esophageal release in esophageal carcinoma is thoracoscopy. A 54 years old lady complained of dysphagia from 2 months ago and hoarseness since 4 months . She had 5 kg weight loss during this time. Barium swallow showed a filling defect in the middle third of the esophagus which was confirmed by endoscopy. Due to paralysis of the vocal cord, thoracoscopy was planned to rule out any invasion of cancer to the recurrent nerve. Laparoscopic esophageal release was performed successfully. In this patient using thoracoscopy, all of the pleural space was explored effectively. No invasion of tumor to the recurrent nerve or trachea was seen. Esophageal release was performed and 2 small lymph nodes were excised. Thoracoscopic esophageal release is an effective method in esophageal carcinoma wherein thoracic incision is omitted & post operative complications including morbidity are minimal. One-lung anesthesia is mandatory for obtaining a good view.  

Subcutaneous tuberculous abscess in the chest wall is an unusual presentation of extra-pulmonary tuberculosis and usually results from underlying bone disease with costal, lymphnodal or pleural origin without concomittant pulmonary involvement and rarely have cases without evident bone disease been described. We report two patients with subcutaneous tuberculous abscess in the chest wall who were admitted due to chest wall masses. After paraclinical studies including Radiography, Isotope scanning, Pathological and Microbiological investigations; the diagnosis of subcutaneous tuberculous abscess originating from the sternum was established. Both patients were cured completely after appropriate treatment for tuberculosis.