Journal of Guilan University of Medical Sciences
Year:2012 | Volume:21 | Issue:82|Papers Count:13

Introduction: Stroke is the most common cause of disability among neurologic disorders. Post stroke pain is a common and often neglected complication with prevalence in several studies ranging from 18.6% to 49%. Different types of pain occur following stroke that including central, nociceptive, and spastic, headache, and others. It is also important to differentiate between various causes of pain because of their different clinical pictures, risk factors and treatments.Objective: To evaluate the relative frequency of post stroke pain syndromes and respective related risk factors.Materials and Methods: In this cross –sectional descriptive study 389 consecutive patients with stroke during the last 3 months, who visited in spring 2011 at the neurology clinic of Poursina Hospital for their routine follow up, were interviewed and examined for the presence and classification of post stroke pains. Demographic data and stroke characteristics were also registered. Collected data were analyzed using SPSS 16 software version.Results: Among the 389 patients, 142 (36.5%) complained about post stroke pain. The most common types of pain were spastic pains and headaches (12.9% and 11.1%, respectively) and the most common locations of pain were upper limbs, and head (18.5% and 11.3%, respectively). Nociceptive and central pains were significantly more common in deep gray nuclei and internal capsule infarcts (P=0.002 and P=0.001, respectively) and headache was more common in brainstem infarcts (p=0.022). There were no associations between other types of pain and location of lesion.Conclusion: Post stroke pain is a common complication of stroke. As pain syndromes adversely affect the quality of life, and are potentially treatable, it is important to consider the occurrence of pain in all stroke patients in any outpatient visit. Pattern of correlated risk factors such as location of the lesion can help predict certain types of post stroke pain syndromes.

Introduction: General anesthesia and surgery cause several physiological disorders in different organs of the respective patients that may appear as several complications during recovery, which need to be identified and evaluated.Objective: Survey of the incidence of such complications at Post Anesthesia Care Unit (PACU) 1 and some of the effective risk factors in Rasht Razi Hospital.Materials and Methods: In this cross-sectional and descriptive study, 155 patients 10-75 years old, in ASA 1 and 2 classes were selected in the hospital. Cases included those who underwent general anesthesia with the same techniques for elective urology surgery and transferred to PACU, in 2010. Questionnaires consisted of two parts, part one included basic information and part two included: respiratory, cardiovascular, neural and digestive complications. Collected data were analyzed using chi-s quare, paired tests by SPSS 16 and P≤0.05 was considered significant.Results: Findings indicated that the incidence of considerable changes (increase or decrease) in BP, PR and respiration were 42%, 36% and 49%, hypoxemia (SaO2<90%) 8.4%, pain 76%, shivering 22%, postoperative restlessness 26%, and nausea and vomiting 12% cases, as observed. We found a significant correlation between age and the incidence of considerable changes of PR and postoperative shivering and also between sex and the incidence of pain, shivering, postoperative restlessness and delay in recovery. In addition, the data showed a significant relationship between duration of surgery and shivering, postoperative pain severity and delay in recovery.Conclusion: The relatively high incidence of complications in recovery indicates the importance of employing skilled personnel and also using enough monitoring equipment at PACU in order to decrease mortality and morbidity of the patients and also save on hospital charges.

Introduction: Obesity is an illness with destructive effects on health. Although psychological factors are important in the development of obesity, there is a little information about such factors because of limited data about psychological aspects of obesity in our society.Objective: To assess them in obese individuals.Materials and Methods: This research is carried out with 113 obese (94 women, 19 men) people in nutrition clinic of Rasht, northern Iran. They were selected based on Body Mass I ndex (BMI>25 kg/m2). The instrument used was Minnesota Multiphasic Personality Inventory (MMPI- 2).Results: Mean age of the samples was 31 years, and the range of BMI was 25/67 to 48/55. Data showed that scale hypochondriasis (Hs) in obese women and men, and scale psychasthenia (Pt) in men, are high. BMI was not correlated with the scales of MMPI-2.Conclusion: According to (MMPI-2) scales, the profile of obese men and women was normal. Since T scores in scales of Hs for obese women, and Hs and Pt scales in obese men were higher than 65, these cases are vulnerable for hypochondriasis and anxiety.

Introduction: Cholera is an infectious disease caused by a gram negative facultatively anaerobic bacterium called Vibrio Cholera from contaminated food or water. Cholera may be asymptomatic or indicated by mild to severe diarrhea. The main treatment of diarrhea is the replacement of water and electrolytes and if needed, antibiotic therapy. Antibiotic resistance varies in different parts of Iran. This study seeks.Objective: To determine the antibiotic resistance of V. Cholerae strains in Guilan province, summer 1390 (2011).Materials and Methods: This descriptive study was performed on Vibrio Cholera isolates from the respective patients in 1390 summer epidemic in Guilan province. All samples were inoculated to Carry-Blair medium, then to alkaline peptone water (APW). After incubation, a loopful of the culture was taken from the surface of APW on TCBS medium. After incubation the yellow colonies were cultured in KIA medium. Serologic tests were carried out by o1 polyvalent antisera, and if positive, the test was performed by Inaba and Ogawa monovalent antiserum. Disk diffusion antibiogram was done for the 7 antibiotics by Kirby Bauer method. Data were analyzed descriptively by Excel 2007 software.Results: From the 161 samples, 142 were positive for cholera of which 140 (98.5%) were related to Ogawa serotypes. Eighty samples (57%) were from the females. The mean age of the infected people was 38 yrs (range 3-84 yrs). The largest number of samples were sent from Lahijan (n=39). All the isolated samples were positive for motility, indole, citrate and oxides tests. Antibiogram study revealed 97%, 90%, 23.5%, 20%, 11% , 10% ,1.2% of the samples were resistant to Nitrofurantoin, Co-trimoxazole, Chloramphenicol, Tetracycline, Doxycycline, Erythromycin, and Ciprofloxacin, respectively.Discussion: In this study, resistance to Ciprofloxacine was 1.2% and 57% of the isolates were intermediate. It seems that resistance is low in IRAN. Regarding the high sensitivity of separated vibrio to Tetracycline and Doxycycline (76%), they may be useful in the treatment of cholera.

Introduction: Spinal Anesthesia (S.A) is currently becoming a more common and popular method for orthopedic surgeries. Unfortunately, Backache (BA) and Post Dural Puncture Headache (PDPH) are both frequent and troublesome. Several factors (including needle shape and size, frequency rates of puncture attempts, and age and gender) have been shown to affect the rates of such complications.Objective: To determine these factors and evaluate some modalities to prevent them.Materials and Methods: This is a prospective study on 200 patients- 15 to 65 years old with class type 1 and 2 A.S.A (American Society of Anesthesiology), who were candidates for orthopedic lower extremity surgeries. Anesthetic procedure was performed using a standard 24G needle L idocaine 5% plus Epinephrine. Symptom questionnaire was filled for the history of Headache and Backache and history of former S.A. postop puncture complications of 1st day, 1st week and 1st month were added to the forms. Statistical analysis was performed using SPSS version 16 and the results were considered significant at p<0.05.Results: Rates of BA and PDPH were 12.5% and 17%, respectively. Post anesthetic BA for first day, week, and month were 16%, 9%, and 3.5%, respectively and PDPH were 6.5%, 3.5% and 1% respectively with no significant differences. History of former spinal anesthesia with BA and PDPH revealed notable differences (p<0.001).Conclusion: The results of this study support the idea that history of previous spinal anesthesia could be a triggering factor for backache and headache in prior Spinal anesthetic procedures.

Introduction: Multiple Sclerosis (MS) is the leading cause of permanent disability in young adults. Iran is considered a high risk zone for MS and its incidence has risen in recent years. Fatigue is a common and disabling symptom in MS and its timely diagnosis and treatment can markedly improve the quality of life in the affected patients. There is a considerable heterogeneity in the results of most reported studies on the prevalence of fatigue in MS and its contributing factors. Most of them did not pay attention specifically to the role of clinical parameters in the prevalence and severity of fatigue.Objective: To determine the relative frequency of fatigue in MS patients and the link between fatigue and clinical statusMaterials and Methods: In this cross-sectional study, 167 patients with definite relapsing MS, according to McDonald 2005 criteria, filled the questionnaires containing items on demographic data and main clinical symptoms of MS (visual, sensory, motor, balance, and sphincteric) and Fatigue Severity Scale (FSS). Then, they were examined to determine Expanded Disability Status Scale (EDSS) score.Results: In 167 patients, 43 (25.7%) were male and 124 (74.3%) were female. Mean age, fatigue severity according to FSS and EDSS score were 32.34, 39.49, and 1.96, respectively. Relative frequency of fatigue was 60.5%. In univariate analysis, a significant correlation was found between fatigue severity and age, EDSS score, pyramidal involvement, imbalance, visual and sphincter involvement, however, in multivariate analysis a significant correlation was only found with EDSS score and age.Conclusion: Fatigue is a frequent symptom in the patients with MS. It is a heterogenous symptom with numerous etiologies; however, the clinical status of the patients can greatly help predict its occurrence. It seems that EDSS score is an efficient and sufficient clinical indicator of fatigue severity.

Introduction: Despite the many benefits of exercise behavior, lack of physical activity is a health problem in college students. A key issue in exercise behavior research is using health behavior models in order to promote and maintain exercise behavior. Previous research has shown that due to the complex and dynamic nature of exercise behavior change, it seems unlikely that a single theoretical approach can truly capture it.Objective: The effect of the integrated model of Transtheoretical model and self-determination theory on the promotion and maintenance of exercise behavior among college students.Materials and Methods: This study was a randomized controlled trial. The experimental group (66 students) received the intervention based on TTM and SDT, and control group (67 students) did not receive any intervention by the researcher. Evaluation was conducted by tools based on the constructs of TTM and SDT as well as METs, before intervention, post intervention and after 8 months.Results: There were no significant differences between the two groups before the intervention regarding the demographic variables, constructs of TTM and SDT and METs. The study findings showed significant differences in the exercise behavior stage of change and METs (P<0.001) between experimental group and control group in the post intervention and follow up evaluation. Also, significant improvement in the exercise behavior stage of change and METs in the experimental group throughout pre, post and follow up intervention was observed (P<0.001).Conclusion: Education intervention based on an integrated model of transtheoretical model and self-determination theory has effects on the promotion and maintenance of exercise behavior among college students.

Introduction: Labor augmentation with intravenous oxytocin is a common method of midwifery in dealing with delivery dystocia and considering the dangers of using high dosage or wrong prescription, the Institute for safe medication has added intravenous administration of oxytocin to the list of high alert medications and recommended creating programs to minimize fetal and maternal injury by reducing the dosage of oxytocin. One method to reduce the dosage of oxytocin is propranolol administration. It has been observed that low dosage of propranolol during the active phase of labor can increase the uterine contractions and cause delivery and reduce the cesarean section significantly without causing maternal and no neonatal complications and cesarean rate.Objective: The comparison between the effects of oxytocin with propranolol and oxytocin with Placebo on the labor augmentation.Materials and Methods: A double-blind randomized clinical trial was performed on 118 nulliparas 38-41 weeks in active phase of labor and failure to progress. Exclusion criteria: Multi-parity with History of surgery on the uterus, malpresentation (non-cephalic), cephalopelvic disproportion(CPD), Fetal distress, macrosomia, polyhydroamnius, IUGR, HTN ,Cardiac disease, lung disease, Patients with kidney or liver dysfunction, diabetes, patients prone to hypoglycemia, myasthenia Gravis and Wolf - Parkinson – White. The patients were divided randomly into two groups.The first group was given Oxytocin with propranolol and the second group oxytocin with placebo. Pregnancy outcomes including maternal complications including uterine atonic, complications during labor including hyperstimulation, fetal distress, meconium and placental abruption and neonatal complications including Apgar 1 and 5 minutes of birth, admission in NICU and birth weights in two groups were compared.Results: Duration of the active phase of labor in propranolol group 325.74±71.57 was significantly less than that in the placebo group 406.04±80.32 (p<0.001). Duration of the second stage of labor in propranolol group 23.03±8.31 was significantly less than that in the placebo group 33.83±12.33 (p<0.001). Cesarean section in propranolol group 9 (15%) was significantly less than that in the placebo group 15 (25.9%) (p<0.001). Failure to progress in propranolol group 2 (3.3%) was significantly less than that in the placebo group 5 (8.6%) (p<0.023). Conclusion: Propranolol may shorten the duration of the active phase labor and the second stage of it and reduce the dosage of oxytocin and also Cesarean section rate.

Introduction: Orthopedic tumors are most commonly seen in the young adults. Treatment delay in these important entities could have significant adverse effects on human communities.Objective: Our goal in this review is the evaluation of patients with benign and malignant orthopedic tumors to identify the main causes of delay in the presentation and treatment of such tumors.Materials and Methods: In this cross sectional study, we evaluated cases with potentially important orthopaedic tumors from December 2008 to June 2010. Treatment delay was divided into two parts; (1) patient delay, and (2) physician delay. In identifying the patient delay, the respective declaration was noted but in exploring the main causes of physician delay, the time to get complementary imaging or laboratory exams and in some cases interview with the primary physician were taken into account.Results: We studied 200 cases (108 males and 92 females) with a mean age of 27.4 years, ranged 6 to 62 years. The median patient and physician delay was 8 months (ranged 0.5 to 120) and 4 months (ranged 0.5 to 84), respectively. Total median treatment delay was 12 months. The most common cause of patient and physician delay was assuming trivial the early symptoms of tumor and not timely complementary imaging, accordingly.Conclusion: Public education about early symptoms of orthopedic tumors and promotion of general practitioners’ knowledge to follow timely and proper use of complementary imaging seem to have significant effects on reducing the treatment delay in these tumors.

Systems biology is an approach by which biological questions are addressed through integrating experiments with computational modeling and theory in a reinforcing cycle. Systems biology can be described as a discipline that seeks to quantify and annotate complexity in biological systems in order to construct models with which we can predict outcomes from inputs. Systems biomedicine is an extension of these strategies into the study of biomedical problems. In the last decade, some significant changes occurred in different biomedical areas with the introduction of systems biology. Whereas at the present systems biology aims at modeling exhaustive networks (genetic networks, signal transduction pathways and metabolic network) of interactions, systems biomedicine emphasizes the multilevel hierarchical nature (cell, tissue, organ, organism and population) of the models. Examples are given to show how the problems are tackled in systems biomedicine. Analysis with mathematical models provides insight into complex diseases such as cancer, Alzheimer’s, Aids etc. Multilayered complexity at different levels (cell, organ, organism and population) challenges mathematical solutions, and computational software tools and database provisions. It is likely that in future new mathematics and computational tools will be required to deal with these complexities.

Introduction: With the widespread use of ovulation induction regimen multiple pregnancy may occur more often and, thus, attention has been drawn to the increased possibility of multiple pregnancy with one or two normal fetuses and placenta and the other appearing as a complete or partial mole following a variety of different methods of assisted reproduction. Management of this condition is extremely challenging, especially when the pregnancy is highly desired and there is a significant risk of severe complications.Case report: A 28-yearold female, gravida1- para0 who presented with 8 years of primary infertility (as a result of ovulatory dysfunction) was referred to Alzahra Educational Center at 34 weeks of gestation with the ultrasound diagnosis of a twin pregnancy (the fetuses were female). The current pregnancy had been conceived during the 2-3 cycle of superovulation with clomiphene- HMG and IUI. She had a history of hypothyrodism for 8 years and was controlled with levothyroxin. At 34 weeks of gestation due to active uterine contractions that made further conservative management impossible, the pregnancy was terminated by cesarean section.Two female fetuses both without malformations were delivered. Following delivery of fetuses, one placenta had normal appearance and was completely removed. The second one, molar tissues containing numerous vesicles, were delivered and microscopic examination confirmed the diagnosis of hydatidiform mole and placental hemangioma.Conclusion: In pregnant women following infertility treatment, close surveillance is certainly needed to evaluate the probability of coexistence of molar pregnancy.

Introduction: Congenital unilateral absence of pectoralis muscles in combination with ipsilateral brachysyndactyly is the most acceptable definition of Poland syndrome. This very rare syndrome has been reported in association with various malignancies and deformities including cardiovascular anomalies. To our knowledge, pulmonary stenosis associated with Poland's syndrome has not been described previously in literature, and there are a few articles about atrial septal defect (ASD) in combination with this syndrome either. We present the first report of Poland syndrome associated with pulmonary valve stenosis and another case of Poland syndrome with ASD. We discuss common etiologic factors of this rare syndrome.Case history: Case one: The first patient is a 23 month old boy with Poland syndrome presentation such as absence of pectoralis major of right hemi-thorax, nipple and subcutaneous hypoplasia and ipsilateral brachysyndactyly. On physical examination, we found a systolic ejection sound in auscultation so that a complete cardiac evaluation was performed. Pulmonary stenosis with 7mm diameter was detected by Color-Doppler echocardiography.Case two: The second patient is a 5 year old girl presenting typical Poland syndrome clinical manifestation. She has congenital right pectoralis major agenesis, Right upper position of nipple and areola was compared to left hemi-thorax, and an ipsilateral hypoplastic hand with syndactyly and short fingers. The 2-dimentional echocardiogram revealed that she is suffering from an Ostium Secundum ASD.Conclusion: Although Poland syndrome is a rare congenital one, it is associated with numerous anomalies and malignancies in the reported articles. The two mentioned cases are the samples of cardiac anomalies associated with this very unique syndrome. According to critical situation of cardiovascular problems, performing a complete cardiovascular evaluation in addition to common medical-surgical treatments seems to be essential for patients with Poland syndrome.