Journal of Guilan University of Medical Sciences
Year:2008 | Volume:16 | Issue:64|Papers Count:18

Introduction: Benign Prostatic Hyperplasia is a pathologic process and main reason for lower urinary tract symptoms in old men. Its most common sign is nocturia. BPH treatment has relative response to al-blockers and 5- a reductase Inhibitors (25-39%). Celecoxib is used as a cyclooxygenase II allocated inhibitor, low price, available drug and could be effective in decreasing the incidence of Nocturia.Objective: Survey efficacy of Celecoxib on nocturia in patients with Benign Prostatic Hyperplasia.Materials and Methods: In this clinical trial study, among patients with LUTS suggestive of BPH, 40 men those had IPSS score³8 and prostate volume³20cm2 were, enrolled. These patients had nocturia³2 despite previous standard medical treatment. Patients underwent primary urotlowmetry and received 100mg celecoxib at 9pm every night along with previous treatment for I month. Reevaluation of disease with second urotlowmetry and determining incidence of nocturia after treatment was performed. Statistical analysis was done by chi-square test, simple Hest, and pair t-test and krusskal-wallis test.Results: Forty patients with mean age of 64.3±7.7 years were studies, mean prostate size of them was 41.8±13.2 cm2, initial mean IPSS score was 18.2±3.4 and initial mean Qmax was 12.5±2.5ml/s. 95% of patients complained nocturia twice at night. After receiving 100 mgcelecoxib during I month, Range of received answers were appraised. The effects after treatment were assessed: excellent reaction (nocturia disappeared or decreased by 2 or more voids/night), improved reaction (nocturia decreased by 1 void/night) and unchanged reaction, obtained in 70%, 12.5% and 17.5% in patients, respectively. Mean frequency of nocturia decreased from 5.17±2.1before treatment to 2.5±1.9 after it (P<0.0001), Mean IPSS score and Mean Qmax of patients after treatment were 15.5±4.2 (P<0.0001) and 12.9±2.7ml/s (P=0.05) respectively.Conclusions: Improved or disappeared nocturia is 82.5% in patients. The results of our study advise to use celecoxib in combination with standard medical therapy for BPH as a useful alternative treatment.

Introduction: Several methods have been developed to estimate the functional or biological age of the ovary. Survey Follicle Stimulating Hormone (FSH) is used as a means of predicting value to fertility treatments success in most of fertility clinics across the world.Objective: Predicting value of FSH, Luteinizing Hormone (LH), and Estradiol (E2) levels in third day of menstrual cycle and the day of HCG injection in follow of Intra Cytoplasmic Sperm Injection (ICSI) outcome.Materials and Methods: In this cross-sectional study we evaluated all infertile couples who referred to Mehr infertility institute between Sep. 2004 and Dec. 2006 for ICSI, with male factor, tubal factor, ovulatory factor and unexplained infertility prospectively. Long protocol Controlled Ovarian Hyperstimulation (COH) was performed for all patients.Evaluated variable consisted of female and male age, duration and cause of infertility, LH and FSH levels, estradiol (E2) levels in the third day and day of HCG administration and embryo quality. Logistic regression was performed to determined associated factors with success of ICS. An alpha error of <0.05 was considered significant for all calculations.Results: 500 patients were evaluated during study. Rate of pregnancy was 162 (36.2%). The mean age of patients showed a significant influence on ICSI in pregnant women (30.9±5.4) in comparison with non pregnant (32.4±6.4).The mean duration of infertility and cause of it didn't show any significant difference in pregnant and non pregnant (P>0.05).The mean of estradiol levels in 3rd day of period and HCG injection's day and LH level weren't statistically significant between pregnant and non pregnant (P>0.05). Relations between pregnancy rate (PR) and FSH level were statistically significant (6.4±7.4 in pregnant versus non pregnant 9.2±15.4 pg/ml) (P<0.05). Multiple logistic regressions showed no significant effect of male age, duration of infertility, cause of infertility, embryo quality also esteradiol and LH levels in the outcome of IVF/ICSI (P>0.05), but there was significant relation between female age and FSH level in ICSI success (P<0.05).Conclusion: Age of female and mean of FSH level has predictive role on success of lCSI treatment.

Introduction: Thalassemia is the most common monogenic disorder in the world and cardiac complications are the most common causes of mortality of Beta Thalassemia Major Patients.Objective: Survey of relative frequency of cardiac complications including Diastolic, Systolic Dysfunctions, Arrhythmia and Pericardial Effusion in Beta Thalassemia Major Patients (10-20 years old).Material and Methods: In these descriptive study 58 beta thalassemia major patients, 10-20 years old, 32males, 26 females who had referred to Heart Clinic were studied by history, electrocardiogram and echocardiography. Holter monitoring was recommended if there were history of palpitation, abnormal electrocardiogram or antiarrhythmic therapy.Results: There were cardiac complications in 19 patients (32.8%), 15 patients were above 15 years old and 4 patients were 15 years old and less than. Cardiac patients were including 13 males (40.6%) and 6 females (23.1%). There was arrythmia in 4 patients (6.8%) including one Mobits II, one PSVT, one ventricular tachycardia and one PVC. Diastolic dysfunction was in 8 patients (13.8%). Systolic dysfunction was in 6 patients (10.3%).There wasn't pericardial effusion. One patient was died due to heart failure. In cardiac patients ferritin average was 3247.32±1359.07 ng/ml. There was correlation between serum ferritinr level with cardiac complications and age but there was not correlation with sex or arrhythmia.Conclusion: Increase of feritin level and age is effective in heart faliture in Beta thalassemia major patients.

Introduction: Salivary immunoglobulin A (IgA) has known as a biomarker of stress. Recent studies has shown chronic stress could weakened immune system. Nursing is a stressful occupation due to decrease quality of care and impairment of nurse's health.Objective: This study was performed to assess stress levels among nurses and official personnel and its relationship with IgA.Materials and Methods: 90 nurses and official personnels of various units of Aligoudarz Hospital enrolled this study. Stress level of them was measured by questionnaire and their saliva was collected and 19A level of it was measured by ELISA.Results: 71 of patients were female and 19 of them were male. Mean age and working years were 33.04 and 9.4 receptively. 52 patients were married. The highest score of stress belongs to nurses of Urgency, Male surgical and manager ward. The lowest score belongs to internal ward nurses.The lowest Value of saliva IgA was seen in Urgency ward nurses (12 mg/-) and the highest value of it was seen in pediatric ward nurses. There was inverse correlation between saliva IgA and stress. Significant relationship was seen between stress and years of working, place of work, kind of ward, age, nurses and personnels.Conclusion: In attention to nurses worked in various units under different condition and level of stress, measurement of saliva biomarkers such as IgA by several methods can perform in any place or ward in order to cure stress.

Introduction: A change in natural and shining properties of Enamel is called as developmental defect of Enamel. Enamel defects caused a negative change in aesthetics of teeth and increased the susceptibility of caries; therefore, some opaque spaekles will appear on the teeth which destroy tooth aesthetics. Causes of enamel defects are divided into two major groups such as local and systemic.Objective: The objective of this study consist of: Developmental defects of enamel (DDE) incidence in permanent dentition of children between 11 to 13 years old in Rasht (2002-2003).Materials and Methods: In this cross-Sectional descriptive study, 578 students (286 boys and 292 girls) based on multistage cluster sampling and DDE index were studied, the researcher employed DMFT index to study condition of caries in the given subjects and X2 test was used.Results: Results indicate that1- There is a 59.8% developmental defect of enamel incidence among children between 11 to 13 years old in Rasht and most of incidence occurs in Labial tooth surface.2- The mean of DMFT is 2.01 in an SD of 2.05 (2.01±2.05)3- According to X2 test, there isn't any significant difference of enamel defects among ages and sexes.Conclusion: result s of this research showed that half of this student had developmental defect of enamel and anterior teeth had more defects that is relate" to longer developmental time.

Introduction: Hepatitis B is a most common infectious disease with noteworthy mortality and morbidity. Dentists and assistants are among the people who are expected to receive this infection from oral fluid or occupational injury, therefore viral hepatitis is one of dentists' occupational hazards.Objective: Survey of dentist's and their staffs' vaccination in Guilan in year 2004-2005.Materials and Methods: In this cross sectional study questionnaires were sent to all dental offices in 2004 and 2005. Those questionnaires consisted of age, sex and previous works and previous vaccination. 319 dentist, include 241 (75.4%) specialized and general dentists (26 and 215 respectively) and 258 assistants in offices in Rasht and 18 other cities in Guilan province replied to the questioners. The data were analyzed by SPSS V 10 software and statistical test of X2.Results: Of 499 that were studied, 359 (71.9%) had full doses of vaccination and 140 (28.1%) received no kind of vaccination. 26 specialized dentists (100%) and 240 general dentists (94.9%) (CI 98%: 92-97.8%) had full coverage of vaccination and 11 (5.1%) received no kind of hepatitis vaccination. But only 50% of the staffs had significant vaccination (CI 95%: 43.9-56.1 %) and this showed a meaningful difference between dental staffs and dentists (P<0.001).And there is also a meaningful difference between assistants previous works and their vaccination coverage (P<0.001).Vaccination in assistants with lesser than one year in comparison with the groups that had more than one year experience, who had not received vaccination, had a significant different (P<0.001). But there isn't any difference between previous works of dentists with their vaccination coverage. Sex had no role among dentists with their vaccination coverage but it was totally effective in dental staffs (P<0.001).Conclusion: Determining antibody titer against HBV in all dentists has been recommended in order to make sure the total effect of the vaccination. All of the assistants should have a health card that has shown receiving HBV vaccination in their first entrance in the clinics.

Introduction: According to increasing use of modern technology in some industries and equipment by men protect of EMF is very important as a new problem.Objectives: Survey of effects of electromagnetic fields on prostate in rat.Materials and Methods: In this study 50 male and 50 female 15 rats (15 weeks age) were selected as parents’ rats. Reproductive system were exposed 50 Hz EMF (non-ionizing radiation). Among born rats, 30 rats were selected as control and case groups randomly. In case group, Rats were exposed under EMF during 5 weeks. At the end of this time, biopsy of prostate was performed of 50 rats of both groups.Results: Prostate is an important gland of male genital organs. It is made up 30-50 small glands. In this study we found that secretary epithelial cells were inactive and cubical generally. Their nucleuses were dense. Corpus Amylase was more than normal. Smooth muscle cells spread out in different directions with heterochromatic nucleus.Conclusion: Based on this study it is suggested that human's staying under EMF exposure not safe for spermatogenesis process and prostate gland's normal activities. So it can increase the risk of sterility in men.

Introduction: Indirect immunofluorescent antibody (IFA) test is one of the most common serologi61 tests for toxoplasmosis. Some of Toxoplasma seroepidemiological studies used this test in Iran. Review the studies which were performed by this test in different areas of the country with different climates, shows according to main way of transmission of Toxoplasma gondii in Iran, performing the test needed consideration. It seems that these probable contradictions are due to mistakes of the test procedure in some of the laboratories.Objective: This study was performed to determine the agreement rate of IFA toxoplasmosis test among 4 laboratory centers.Materials and Methods: The study is a multicenter evaluation. With the consideratiorof et hical values, serums were prepared from 100 subjects' who had referred for pre-marriage examinations to Qazvin medical community center in the year 2006. Each serum divided to four parts and in each laboratory was examined for specific IgG anti-Toxoplasma antibodies with the IFA test. The tests in each center were performed according to common protocol of that center. The sera in all laboratories were examined at 1:20, 1:100, 1:200 and above. The titration ³1:20 was considered as positive. The kappa coefficient between each 2 centers was calculated.Results: The seropositivity rates of IgG-IFA Toxoplasma test in the 4 centers were 72%, 44%, 34% and 23%. The kappa coefficient in comparing with 2 centers, for upper limit was 0.36 and for the lower limit was 0.16.Conclusion: In the present study, the agreement rates among the four centers were very lower than our expect it seems that, performing this test in some of laboratories in country accompanied with some defects that should be corrected. Therefore, we recommend to survey separately.

Introduction: Leishmania is a kind of infection which arises of a mono cell. This disease prevalenced in topical countries of world. In despite of several studies which are done in overall the world, researchers didn't find an effective vaccination for it and common treatments didn't effective completely. Infect to leishmania create permanent immunity. Thus vaccination is the only cost-effective means to control leishmania.Objective: Assaying the obtained immunogenicity by vaccination of C57BL/6 mice with transgenic leishmania major.Materials and Methods: In present study transgenic strain of L. major which express two suicide genes; thymidine kinase gene of Herpes Simplex Virus type 1 (HSV-tk) and cytosine deaminase gene of Saccharomyces cervisiea (Se-cd) in its genome have been used for vaccination of mice. C57BL/6 mice were infected by transgenic L. major and treated with gancic10vir and 5-fluorocytosine together.Result: The ELISA cytokine assay in this group showed high increase of IFN-g and low IL-4, next challenge in vaccination was blocked disease progression, which was due to high level of immunity.Conclusion: The inducible expression of suicide gene and drug can used as valuable method to find the safe and effective vaccine against Leishmaniasis.

Introduction: Non-fermentative Gram negative bacilli including some bactries are widely distributed in our environment. Despite of their low pathogen city potential, they are often the causative agents of infections in susceptible and immunocompromised patients.Objective: The study goals included: 1) determine of the prevalence of non-fermentative Gram negative bacilli among the total clinical specimens, 2) determine of the Genus and species of the bacterial isolation, and 3) determine of the relationship between different species isolation rate with the specific clinical specimen.Materials and Methods: During 11 months, clinical specimens were obtained from hospitalized patients in different hospitals in Tehran. Non-fermentative Gram negative bacilli were cultured from the specimens and their genus species identity were determined microbiologically. The differentiation tests which have been used included: growth on Mac Conkey, TSI growth characteristics, oxidative fermentation of glucose and lactose, oxidize and moti1itytests, DNase, Nitrate reduction, Bile-esculin, and Indole reactions.Results: of 6952 clinical specimens that were studied, 100 (1.4%) were isolated of non-fermentative Gram negative bacilli. Fifty two of them were Pseudomonas aeroginosa, and the rest were members of other species; 19 Alca1igenes faecalis (39.5%), 16 Acinetobacter baumannii (35.4%), 10 Acinetobacter lwoffi (20.8%), 2 Stenotrophomonas maltophilia (4.1%), 1 Flavobacterium meningosepticum (2%).Conclusion: Comparing the result of this study with similar investigations which were performed in other parts of the world, showed that: despite of the most encountered non-fermentative Gram negative bacteria isolates include, in order of prevalence, Pseudomonas aeroginosa, Alcaligenes faecalis and Acinetobacter baumannii respectively, but the rate of their prevalence are strikingly different in different hospitals and in different areas. Due to the widespread existence of antibiotic resistance in these bacteria; their isolation, exact identification, and antibiotic susceptibility patterns are of paramount importance.

Introduction: When an accident occurs in out of reach places, supporting the injured persons in early moments has a high importance. Because hypovolemic shock as a result of haemorrhage is one of the most causes of mortality in casualties, proposing appropriate instructions to reduce this problem is important; especially in underdeveloped provinces of country that access to medical services and transferring of the injured person is difficult and takes a long time.Objective: Study the effects of trauma life support course in improving physiologic situations of injured persons in the Mehran area, Ilam province from 1380-84.Materials and Methods: In this four years study, at first Trauma life support course was done in Mehran and five rural areas around it. Then 471 casualties because of car accidents, land-mine accidents and bullet strike were analysed. To determine physiologic situation of the victims, were determined by PSS (physiologic severity score).Required data was collected by via a check list that was designed for this study.Results: Of 641 cases, 471 were eligible for final analysis. The supported (first) group consisting 226 cases and not supported (second) group consisted of 245. The most prevalent cause of trauma in both groups was car accidents (%61.5). Stopping bleeding was the most frequent measure used for %50 of casualties. The mean PSS for the first group and second group were 7/505 and 6.799, respectively at the time of their transfer to surgical hospital in Ilam. There was a statistically significant difference between two groups (%95 CI for difference: 0.3 to 0.912).Conclusion: This study revealed that the traumatic patients which were supported in the first minutes by the help providers that were educated in this research, has better general condition at the time of admission in the central hospital. Because of high prevalence of injuries in Iran and poor medical services in transferring injured patients to higher referral centers, especially in areas with lower socioeconomic situations, such education classes can reduce injury-related morbidity and mortality and could lead to better management old treatment of these casualties, and it is suggested that health-care systems considered as one of their major priorities.

Introduction: Hypokalemic periodic paralysis has familial and secondary types. In familial type, the genetic abnom1aJityof calcium channels, produced. These kinds of paralysis are benign and with increasing of age reduced frequency and severity of attacks.In secondary forms, underlying diseases such as hyperthyroidism, primary hyperaldosternism produced the paralysis attacks; usually the time of this attack in longer than first kind and patients may also complain of weakens between attacks.Case Report: The patient was 38 years old man who admitted for low back pain, numbness of lateral and posterior aspects of thighs, and urinary retention. In his history cramp of muscles of lower limbs, hypokalemic periodic paralysis (with normal condition between attacks), and hypertension was noted.Evaluation of patient showed metastatic lesion of lumbar spine with adrenal adenocarcinoma origin.Conclusion: In patients with hypokalemic periodic paralysis that more of them referred in teenagre and young duratings, probable underlying diseases such as primary hyperaldosteronism and hyperthyroidism should be conansidered, especially in absence of fmilial history. With early diagnosis and treatment of underlying conditions, we can control the paralytic attacks and prevent from the consequences of these diseases.

Introduction: Nosocomial infection is a major concern in the recent century and as post surgery infection is being concidered as important complication of surgery. Undoubtedly prevention best method in the infection control and surgery staffs may have an important role in this measure by fidelity to sterile principles during hand scrub, to wear gown and gloves, during and after surgery.Objective: To determine the rate of accomplish essential priniciples to infection control by operation room's staff in the Rasht hospitals in the 2006.Materials and Methods: This study is a cross- sectional undertaken on operation room's staff in the Rasht hospitals. Data collection instrument was a three part questionnaire including demogrophic characteristics and infection control data and operation room check list. Sampling procedure was cencus and was determine accomplish essential principles to infection control by 150 persons in Poorsina-Razi-Heshmat- Amir-Al Momenin-Alzahra Hospitals operation rooms were working in the morning and afternoon and night shifts.Results: Almost all (97.9%) staff who were participated in this study had good practice in accomplishment of infection control priciples. Surgeones had more favorite practice in this domain 100%, however most of anesthesians (61.8%) had good practice. Most of operating rooms (83.3%) who were observed in this study had suitable physical environment and equipment regarding infection prevention.Conclusion: The accomplishment of infection control priciples, including hand washing, dressing, groming and other aspects of control were good in this study.

Introduction: Working in some kinds of jobs which include unsuitable body postures, repetitive motions and exposure to different risk factors of musculoskeletal system, can lead, to more musculoskeletal diseases and disorders such as household assembly manufacturing is one of them in comparison with other jobs.Objective: Evaluating the existing risk factors on job sites and also to assess the state of musculoskeletal disorders among workers of a large household good assembling factory.Materials and Methods: The QEC checklist was used to evaluate work risk factors and Nordic questionnaire was used to determine incidence of musculoskeletal disorders. Then the results were analyzed by SPSS soft ware.Results: The study showed that 85.3% of the persons who involved in this study had some kind's musculoskeletal disorders. Extracting results from QEC checklist showed that nearly 82% of the assessed persons were exposed to sever ergonomic conditions especially in and low back.Conclusion: In spite of youth of the population and significant relationship between work experience and musculoskeletal disorders the incidence of disorder is high. Also, influenced risk factors on the body, mostly in the regions of low back and neck, so the situation must be immediately improved.

Introduction: Neonatal hyperbilirubinemia is a very common problem in neonates that can lead to kernicterus and auditory disturbance. Neonatal icter is a common cause of neuro-sensory hearing loss and an important factor for children deafness.Objective Survey the relationship of neonatal icter on brain stem and auditory state of neonates that were admitted in hospitals of Rasht.Materials and Methods: In this cross sectional, research we evaluated 63 neonates with increase of indirect hyperbilirubinemia that were admitted in the hospitals of Rasht for assessment of auditory state by A.B.R (Auditory Brain Response). The evaluated variation of A.B.R consisted of: Lack of wave, latency and inter-peak time of wave. The neonates with direct hyperbilirubinemia, preterm with LBW, asphyxia and hypcrosmolarity were excluded of this study.Results: The neonates have been divided into two groups based on the level of bilirubin (12-20 mg/dl & >20 mg/dl). From 63 patients the bilirubin level of 45 (%71.4) neonates was 12-20 mg/dl and 18 (%28.5) neonates were more than 20 mg/dl.In the first group (bilirubin 12-20 mg/dl) A.B.R changes were not seen and the auditory state of these neonates was normal, however in the second group (bilirubin >20 mg/dl) inter-peak latency I - V was elevated in 8 (%44.4) neonates.Conclusion: Increase the level of indirect bilirubin (>20 mg/dl) caused disorder on the auditory neonatal state, of that should be prevented by exchange transfusion. So we recommend A.B.R for screening and early detection of bilirubin ototoxicity and necessary audiologic intervention in all cases of severe neonatal hyperbiJirubinemia.

Introduction: Head injury has been recognized as a major public health problem and is a frequent cause of death and disability in young people and makes considerable demands on health services.Objective: Study some demographic characteristics and causes of head injury.Materials and Methods: This descriptive study was, conducted by Guilan Trauma Research Center on head trauma patients who were admitted in Poursina hospital since September 2004 to September 2005. A Questionnaire including Age, Sex, Time and place of injury, cause of injury, associated injuries, GCS, Brain CT scan finding for every head trauma patient; was completed by a general practitioner under supervision of a Neurosurgeon. Data were analyzed by SPSS10.Results: About 64% of all trauma patients had head injury. Mean age was 31.35±18.16 and the ratio of male to female was 3 to 1. Most of them were 25-44 years old. Traffic accidents were the major cause of injury (77%) and 48% of them were motorcyclist. Most of the injuries occurred in 5 PM. 38.75% of injuries occurred in summer. About 12% of patients had severe head injury and intracranial hemorrhage formed 12.24% intracranial traumatic brain lesion. Finally 13% of them died and 55% of them occurred due to motorcyclist accident.Conclusion: Traffic accidents are the major reason for head injuries. Pay attention to prevention of this accident can perform important role in decreasing of head injuries.

The hypoglossal nerve according to its embryological origin, function and nerve fibers is completly different from vagus nerve. Except their relationship at the base of the skull where the hypoglossal nerve receives some fibers from the inferior vagal ganglion, along the rest of their way to carotid triangle they are separated from each other and in surgical approach to pharyngeal wall or carotid sheath each of them are clearly distinguishable. The inferior vagal ganglion the hypoglossal nerve entered the carotid sheath and descended as a common trunk with vagus nerve down to the angle of mandible where it left the trunk as a major branch to tongue. This rare case has been reported due to its great surgical importance at the side of neck and carotid sheath.