Journal of Guilan University of Medical Sciences
Year:2007 | Volume:16 | Issue:61|Papers Count:19

Introduction: The cervix was colonized by potentially pathogenic microorganism that could be introduced into the uterine cavity or contaminate embryos during(Embryo Transfer). The consequences of this septic milieu on the outcome of embryo implantation is unclear. Objective: Survey the effect of microbial flora of the cervix on ICSI outcome at the time of embryo transfer in infertile women who referred to Mehr infertility institute. Materials and Methods: In this cross sectional descriptive study endo-cervical samples of 260 women were evaluated who under went intra-cytoplasmic sperm injection. After transferring the embryo were cut, about 3cm of the end of catheters and put in selective culture media. After incubating in special conditions by using current bacteriological methods; bacterias were isolated & characterized. Pregnancy rate was confirmed by measurement of β-hCG in serum after 14 days. Some confounding variables (sperm quality, age, duration and cause of infertility, embryo quality) were controlled. Data was collected, analysis was carried out with T-test, chi squares test and multiple logistic regressions by using statistical soft ware SPSS.10. (P<0.05 was considered significant). Results: The results showed that overall PR by ICSI procedure was 40% (104 out of 260 cycles).The mean age of women was 31.6±6.2 years. The most common cause of infertility was related to male factor (46.2%). The mean infertility duration was 7.7±5.5 years. The quality of the most embryos were A (85%). 246(94.6%) of groups were negative culture and the others 14(5.4%) were positive culture. The most of research unit's (94.6%) culture were negative in 4.9% of pregnant women and in 5.8 of non pregnant women, results of culture test were positive. Multiple logistic regressions showed no significant effect of female's age, duration of infertility, cause of infertility, sperm parameters(count-morphology- motility),number of oocyte, number of MII, number of cleaved, number of ET, embryo quality & microbial culture in the outcome of ICSI but there was significant relation between female age & pregnancy rate.Conclusion: This study revealed that microbial flora of the cervix didn't influence in poor ICSI-ET outcome.

Introduction: Liquid evaporation of MMA and toxic side effects including the liver complications and allergic reactions among the technicians of dental laboratories these reports emphasize to need the usage of protective methods in order to reduce the direct exposure with this material. Objective: This research was performed to determine the methanol level in dental laboratory technicians, urine who were in direct contact with the MMA compared with the control group. Materials and Methods: In this cross sectional study, urine sample were obtained from 30 dental laboratory technicians of  Rasht and Lahijan province (IRAN) before and after working with MMA and 30 normal individuals who were not direct /indirect contact with MMA (were selected) as control group. Urine methanol levels of both groups were determined by gas and paper chromatography methods. Obtained data were analyzed by Student’s t-test. Results: Mean methanol level in the individuals of experimental group (1.3 µm/Lit) was greater than the control group (0.9 µm/Lit) that revealed a significant difference (P=0/032). Mean methanol level in urine after the end of working period (1.5 µm/Lit) was significantly greater than the level of it at the starting to work by it (1.3 µm/Lit). There was no relationship between the length of working years and the level of urine methanol. Conclusion: Significant increase of mean methanol level in urine after finishing the work and the significant difference of methanol level among the dental laboratory technicians compared to the control group emphasis to usage of protective methods such as the presence of appropriate ventilation, using mask, gloves or absorbent filters of MMA dusts. These protective methods could be effective in the increase in working safety in dental technicians.

Introduction: Working length estimation is one of the important factors for biochemical preparation and obturation of root canal system. Some patients were unable to film toleration (in intra oral technique) or were Sensitive in (digital radiographic technique). Objective: The goal of this study was comparison kind of extra oral radiographic technique (that Conventional P.A Film was out of mouth) for patient who were unable in film toleration in intraoral technique with intraoral method in estimation of working length of molar teeth in endodontics. Materials and Methods: In this descriptive cross sectional study, two images with conventional P.A film were provided from 33 volunteer patients that their molars teeth followed by RCT and were in primary file step. First image was taken by intra oral method and parallel technique, (XCP) second image was taken by extra oral method. Then, length of canal was estimated, twice in 0.5 and 1 mm from the radiographic apex, randomize by an endodontist in two weeks period. Data was analyzed with SPSS statistical software and Pearson correlation   test was send to compare two variables effect on working length Estimation in molar teeth. Results: As the results, working length estimation of molar teeth in both extra and intra oral radiographic method was correlated (p<0.001, r>0.59). Also agreement percentage of working length estimation were different in both intra and extra oral radiographic method (at least 25% in palatal root from 0.5 mm to apex up to 75% distal root from 1mm to apex).Conclusion: Extra oral radiographic technique with conventional periapical film could be effective in patients who were unable to tolerate or sensitive to film.

Introduction: Ciprofloxacin is a synthetic antibacterial agent belonging to the family of fluoroquinolones that has a very broad spectrum against of microbial pathogens, especially Gram-negative infectious diseases, which  has been approved in more than 100 countries in world. Objective:  The aim of this study was planed to see apoptosis effects of ciprofloxacin after inducement, in rat testis. Materials and Methods: The twenty male wistar rat were selected and divided randomly into two groups; control (n=10) and experimental (n=10). The test group was received 12.5mg/kg (PO) ciprofloxacin daily for sixty days, in their drinking water however the control group just received its routine drinking water. On sixtieth day the testis tissue of rats in both groups were removed in 10% formalin solution and prepared for light microscopy, and the Terminal Uridine Nick End Labeling (TUNEL) technique was used to identify apoptosis. Results: Light microscopic studies showed apoptotic bodies in tissue of testis in experimental group were (15.15±10.17) and were(3±2.41) in control group, This difference in apoptotic bodies in experimental and control groups was significant (P<0.01). Conclusion: Since in our study ciprofloxacin had side effect such as increasing apoptotic body in testis cells in rat in experimental group, then it was suggested that ciprofloxacin using in human could induced many histopathogical disorders and might be decreased the fertility rat.

Introduction: Fetomaternal circulatory communication limited liberal drug administration during general anesthesia for cesarean section surgery. This might be the cause of light anesthesia in early period of cesarean section and might induced pain and hemodynamic instability. Objective: Survey the effect of low dose of ketamine on homodynamic stability of scheduled patients for elective cesarean section under general anesthesia. Materials and Methods: This randomized double blinded clinical trial was performed on two equal groups including sixty 22-38 years old healthy pregnant women who scheduled for elective cesarean section in Vali-Asr hospital during 1/1/82 till 1/1/83. Anesthesia was induced with standard dose of sodium thiopental and suxamethonium and was maintained with N2O/O2gas mixture (50/50) plus 0.5 Mac halothane in both control and ketamine groups. In ketamine group, 2 minutes before induction 0.3 mg/kg ketamine, administered intravenously. The homodynamic parameters were controlled and recorded any 3 minutes in all patients until childbirth. Results: Homodynamic parameters increased significantly after skin incision until childbirth in control group. In ketamine group there was more stable homodynamic parameters(HR 119.9±18.8 Vs 99.28±11.5, sys BP 115± 64 Vs 109.05±9.3 and p<0.05).

Introduction: Recognition of long-term immunogenicity of hepatitis B vaccine was very important. Objective: Determination of serum antibody titer following recombinant hepatitis B vaccination in 6 years old children. Materials and Methods: This descriptive research was performed on 40, six years old children who had referred to Ghods children hospital in Ghazvin in 2003. All of children were vaccinated by 3 doses Cuban recombinant hepatitis B vaccine in infancy periods. Measuring of serum antibody was performed by giving 0.5 ce of these children's serum, in Elysea method by statistical methods such T test and chi 2. Results: The results indicated that the antibody titer in five children(12.5%) was negative (<10m IU/ml) and in thirty five children(87.5%) was positive (>10mIU/ml). There were no significant statistical difference between the level of antibody titers with sex, BMI and birth weight. Conclusion: Negative antibody titer in 12.5% of research units indicated in the recombinant Hepatitis B vaccine didn't have full effect and further evaluation was recommended.

Introduction: Majority of death and disabilities in mothers was occurred during parturition. Many women were hospitalized during sixty days after delivery. Which it has significant statistical correlation with type of delivery. Objective: The aim of this research is study of the relation between type of delivery and cause of hospitalization women during post partum period in ALI-Ebne-Abi-Taleb and Ghods hospitals. Materials and Methods: This is an analytical descriptive study; data was collected from 444 files of women who had hospitalized during first 42 days after delivery in ALI-Ebne-Abi-Taleb and Ghods hospitals in Zahedan. Reasons of continues hospitalizing or rehospitalization were considered such as length of rupture of amnion sac and catheterization, in more than 7hours after normal delivery and more than 48 hours after cesarean. Of course some cases were excluded which were hospitalize for long time because of financial problems, delivery in evening or night and whom couldn’t leave hospital on time, also data from referred and released patients were included in this study. Results: The findings showed that 81.15 % of women had normal delivery and 18.85%had cesarean section. 64% of women had delivery in maternity hospital‚ 23.7% in the home 10.9% safe delivery base and 1.4% had been sent off from other cities. The most common cause of hospitalization was Preeclampsia, medical problems, infection, bleeding, and problems related to surgical wound in cesarean group, and in normal delivery were preeclampsia, bleeding, Placenta retention and infection respectively. Mortality rate was 2% in the women with normal delivery and 0.06% in C/S on discharging time. 15.5% of cesarean group and 2% of normal delivery group were transferred to I.C.U. There was a significant statistical relationship between type of delivery and duration of hospitalization (p<0.0001).Conclusion: Because of in cesarean group there was hospitalization in ICU, length of its, infection and mortality rate more than delivery group, therefore researcher advised; to encourage mothers to have normal delivery, to continue family planning programs for preventing high gravidity, to carry out pregnancy cares to early diagnosis of medical problems and referring them to practitioners, to have delivery in safe delivery base in  suburbs, and to Follow up women in the postpartum period

Introduction: Migraine is a common disease that its consequences affect individual, familial, social and economic aspects of life. Unfortunately, despite of considerable disabilities, a large number of migraine sufferers are not aware of their disorder and this leads to inappropriate care seeking and ineffective treatments. It seems that increasing people’s knowledge and awareness about this disease, Particularly teachers who are in permanent contact with a population in whom migraine most commonly begins, plays a major role in early diagnosis, appropriate management and, accordingly, the reduction of its consequences. Objective: The aim of this study was the determine teachers’ knowledge level about migraine in primary- intermediate and high schools in Rasht in 2005. Materials and Methods: This cross- sectional and descriptive study was carried out on 400 teachers who worked in state primary schools, intermediate schools and high schools in Rasht. Multistage cluster sampling was used and a questionnaire including 34 items in 2 sections, 9 demographic and 25 about knowledge was applied . Data were analyzed by using SPSS 9. Results: Level of knowledge in 172 participants (43%) was weak; it was moderate in 159 participants (39.7%); and good in 69 participants (17.3%). Less than 50% of teachers knew that migraine is common in adolescents and being of its attack occurred in these ages. Conclusion: Considering the prominence of weak level of knowledge among participants, showed that planning of educational programs about migraine for teachers is necessary. Consequently, essential steps would be taken to achieve early diagnosis and decrease consequences of migraine in adolescents.

Introduction: Botulism is a dangerous paralytic disease due to the toxin which is made by Clostridium Botulinum Bacterium. This bacterium is active in anaerobic, little salt and little sugar with low acidity condition and in a temperature higher than the temperature of refrigerator and it is reserved in home made food; also meat can be favorable reproduction condition for it. The produced toxin effected nerve system; disability by effecting on it's and at last caused respiratory disability and death. The study of the ways that this toxin can enter human food chain is really important because of high probability of death in its poisoning. Objective: This study has been done to find the main resource of Clostridium Botulinum in Guilan and purpose the ways against it. Case report: The whole number of poisoned people was 6 persons with minimum age 23 years old and maximum age 73 years old. Including 4 women and 2 men which one of them dead in the ICU of Razi hospital. The final diagnosis was through determining mount of Clostridium Botulinum toxin in food sample.Conclusion: The density of Clostridium Butilinum in the Caviar of salted carp is too high that can lead to incidence of botulism signs very quickly. Also it leads to death, in spite of accessing to medical facilities. Therefore public education about not using salted carp and training of clinical staff in order to consider Botulism poisoning is as a differential diagnosis of patients and finally careful control about preparing and keeping and distributing food, specially native food, are considered really important in preventing poisoning with this fatal toxin.

Introduction: Job satisfaction is an Individual attitude towards a job and Indicates how much there are compatibility and coordination between the individual expectations with the rewards which job or the organization offered to him. Job satisfaction means that a person to achieve his / her intended demands and values. Objective: This research was done to determine the rate of job satisfaction among the heads, managers and supervisors in different units of governmental hospitals in Guilan province in 2005. Materials and Methods: The present research is a cross – sectional and descriptive – analytical study. Target population for this research, are 90 people of heads, managers and supervisors in different units of 19 governmental hospitals affiliated to the Guilan University of Medical Sciences (GUMS).They were heads of hospitals, hospital managers, hospital matrons, and heads of financial affairs, heads of administrative affairs, laboratory heads, drugstore heads, and heads of radiology departments. Data collection instrument was a questionnaire containing 46 questions in two parts consisting of demographic characteristics of the managers and their satisfaction rate from their job. Data collection was carried out during a month. Results: results from this research indicated that (10.11 %) of the heads, managers, and supervisors of the study hospitals were very satisfied from all their job aspects, (58.43 %) of them satisfied, (4.22%) of them indifferent, (14.7%) unsatisfied and (6.67%) very unsatisfied. Satisfaction rates in terms of welfare, education, structure, management and physical conditions of the work environment were as follow, respectively: (48.11%), (79.99%), (66.64%), (77.2%) and (70.77%). Conclusion: There was a significant relation between the job satisfaction rate and demographic characteristics such as age, education level, service years, and sex, as well as, between the job satisfaction and physical conditions of work environment. By considering physical conditions hospitals, providing managers with welfare facilities and material and spiritual rewards, changing the old and traditional ways and by applying new approaches for managing the hospitals and by using the graduates of management disciplines (courses) in the field of health and treatment for managing the hospitals, we can witness the increase of job satisfaction.

Introduction: The province of Guilan is one of the regions with endemic Goiter in Iran. Following initiation of the program of control of iodine deficiency in 1989, production, distribution and consumption of Iodized salt were begun. Objective: This survey was conducted in the frame work of national monitoring survey in 2001 to find the prevalence of Goiter and urinary Iodine level in order to evaluate the Iodine status of school aged children in Guilan. Materials and Methods: 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Guilan, and the grade of Goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Results: Total Goiter rate was 11.3%, 8.7% in girls and 13.6% in boys. Median urinary Iodine was 17 µg/dl. Urinary iodine was above 10 µg/dl in 87.5% and less than 5 µg/dl in 4.1%; no one had urinary iodine below 2 µg/dl.Conclusion: It is concluded that the rate of Goiter in Guilan has decreased significantly since 1996 and urinary Iodine levels in schoolchildren are indicative of adequate Iodine intake; Guilan province therefore can be considered a “Iodine deficiency free” zone.

Introduction: Patellofemoral pain syndrome is a common disease in sportsmen- militaries and people. One of the most important pathologic conditions involving athletic population and common people is patellofemoral pain syndrome. One of the most important reasons of this condition is foot pronation. One of the effective treatment approach for individual with patellofemoral pain syndrome who exhibited sign of excessive foot pronation is the use of foot orthoses. Objective: This study has done to determine the effects of functional foot orthoses on quality of life of people individual with patellofemoral pain syndrome who demonstrates excessive foot pronation. Materials and Methods: Data from 18 patients with patellofemoral pain syndrome were collected which had excessived foot pronation, pain function in daily living, function in sport and recreation and quality of life. The Womac was administered subjects at the time preintervention during 2 and 6 weeks following foot orthotics intervention. Data was evaluated by variance analysies test. Results: It showed statically significant improvements in the stiffness, pain, function in daily living , function in sport and recreation and kned related quality of life 2 and 6 weeks following the foot orthotic intervention(P<0.05).Conclusion: Functional foot orthoses may improve patellofemoral pain syndrome symptoms for patients who also exhibited sign of excessive foot pronation.

Introduction: Growth disorder is a complex and multi-factorial problem which needs a precise assessment. In Thalassemia major there is much more growth disorder due to chronic anemia, Iron overload, endocrine dysfunctions and etc which can be prevented by accurate and regular treatment. Objective: In this study we wanted to evaluate height and weight disorders in order to guess clinical feature and condition of treatment in Thalassemia major patients. Materials and Methods: we measured height and weight of thalassemia major patients (height and weight<5% were considered as a disorder) and some factors such as age, the age of first treatment, the number of visits (for transfusion therapy) and the number of transfused blood units in per year by interview, examination and survey of their files. Results: Among 392 patients, 42.3% of them had height under 5% and 37% had weight under 5%. Totally, 190 patients (48.5%) had growth disorder (height, weight or both). Sex had no significant relation with growth disorder. Most of disorders occurred in second decade of life. According to the logistic regression analysis, age, the age of first treatment had positive relations and the number of visits in per year had a negative relation with growth disorder.Conclusion: Comparing these results with developed countries showed that we are in a backward state and our patients need more precise treatment.

Introduction: Postpurtum period begins after delivery, this period takes 6 weeks existing deciduas of uterus caused red vaginal discharge. Acording to present resorces if this discharg continued over 2 weeks it would be patologic. Different studies have shown different duration in Postpourtun hemorrage. Objective: The main aim of this research was to determine a lochia pattern and some factors which influence its period length, and to find, the relation between variables such as the number of pregnancies, the birth weight and frequency of breast feeding with the lochia time length. Materials and Methods: In this descriptive – analytic research, 200 cases of nuliparous and multiparous with ntural labor, selected randomly. For collecting data were used an information form and standard jackebson form for determination of the lochia time length. The data were analyzed by using regression and survival Koplen – Mair analysis. Results: It showed the number of pregnancies had a significant relation with the lochia duration (P<0.01). More number pregnancies, caused less lochia duration. Also; more birth weight, caused more lochia duration (p<0.01) and the frequency of lactation, caused less lochia duration (P<0.01). Conclusion: Increased lochia duration was not unusual and lactation reduced strongly lochia duration.

Introduction: orbit is an osseous pyramit that contains soft tissues including the eye. its contents may only protrude from anterior aspect, so measurement of protrusion is important for diagnosis of related diseases. Normal level of protrusion is different in different populations and is important to differentiate fromabnormal levels. Objective: To determine the normal exophthalmometry range and inercanthal distance in healthy adult population in Kashan city. Materials and Methods: This was a prospective descriptive study which was performed in spring months of 1374 In Gholabchi clinic on normal families of patients who came for any disease to that clinic. All persons with a history of orbital trauma or fracture and myopia of more than 5 diopter or strabismus or any vascular or inflammatory orbital disease or skull deformity and all persons with endocrine abnormalities and pregnant women were excluded from the study. Results: From 1002 candidates for examination 926 persons fulfilled criterias and included in the study. Medium exophthalmous in males was 17.1mm and in females 16.4mm. Upper limit of exophthalmous in males was 21mm and in females was 20mm. mean exophthalmometry in the left eye was 16.76mm and in the right eye was 16.68mm. There was not any statistically significant relationship between exophthalmometry and height and weight of cases. Conclusion: normal range of exophthalmometry in one of the urban population in Iran is different with what was reported previously in world. Exophthalmous more than normal range must be evaluated clinically and if needed paraclinically.

Introduction: Fulminant hepatitis is a massive necrosis of liver that occurs in 1-2% of symptomatic acute hepatitis. Its most common etiology is co- infection of HBV & HDV and less commonly seen after HCV infection. In pregnancy, HEV can lead to Fulminant hepatitis in up to 20% of cases and it is also described following medications, metabolic diseases like Wilson, and Post liver transplantation. One of its rare etiologies is Hepatitis A (0.14% in U.S.A) because this infection is a common benign and self limited viral disease in ages under 20. Although, if the patient suffers from underlying disease such as G6PD deficiency (that is common among Mediteranian region and has a complex duration), HAV infection can be complicated and tends to Fulminant hepatitis.Case report: In this case report, one 6 years old male child with Fulminant hepatitis has introduced who had a positive serology for HAV and at the same time a G6PD deficiency as the predisposing factor. This report suggested to search for underlying diseases (like G6PD deficiency) in all patients who have an unusual form of Hepatitis A.