JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:12 | Issue:48|Papers Count:14

Introduction: In spite of various methods available for treatment of Alopecia Areata, treatment of diffuse Alopecia Areata is still a difficult problem. Although systemic corticosteroids are frequently effective but long term consumption of oral steroids is not recommended because of complications.Objective: To determine response to treatment and relapse in patients with diffuse Alopecia Areata. Materials and methods: In this interventive and quazi- experimental we studied 26 patients with Alopecia Areata (first attack or relapse in the current year). Intravenous Methylprednisolone, 500mg, was prescribed for 3 successive days and the patients were examined in the months of 1,3, 6 and 12. Photographs of scalp were taken at each visit.Results: Results were registered in the forms prepared for each patient and analyzed statistically (Fisher test). Of a total of 17 patients with multifocal Alopecia Areata, 53%, 76.5%, 76.5% and 64.6% showed response to treatment at 1,3,6 and 12 months respectively. Relapse occurred 17.5%, 23.5% and 35% in the months 3,6,12 respectively. From the 7 patients with Alopecia Universalis, only one patient showed response. In two patients with Ophiasis (one case) and Totalis (one case), no response to treatment was seen. Conclusion: All responses to treatment were obtained in the patients with diffuse muttifocal Alopecia Areata. There was no statistically significant difference between response to treatment and relapse in patients with first attack and repeated attacks.

Introduction: Considering the high prevalence of Tricomonas vaginalis (TV) in women and the known side effects of Metronidazol, the focus has been concentrated on herbal therapy in order to reduce drug side- effects in the recent decades. Objective: To determine of M.communis effect on Trichmonas Vaginalis infection.Materials and Methods: This study has been carried out as double blind in test and control groups. Methanolic extraction was performed by percolation and essential oil prepared by hydrodistillation. The parasite was isolated from vagina and determined directly. Samples were collected from vaginal discharges. Identification were done through direct smear preparation. Parasite was added to the 5 test tubes containing Drosse medium, metronidazole, Dimethyl sulfoxaide (DMSO) myrtus extraction with concentration of (0.1, 0.01 ml and essential oil with concentrations of (0.1, 0.01, 0.001, 0.004, 0.0002 and 0.0001) in order to determine the effect of these concentrations within 72 hours.Results: Findings suggested that Trichomonas could be alive in Drosse medium for 72 hours, in presence of Metronidazole for one hour and in Drosse medium for 6 hours. Also, the results revealed that methanolic extract at concentrations of 0.1 and 0,01 and essential oil at concentrations of 0.1, 0.01, 0.001 and 0.0004 were effective at the beginning of the inoculation and at concentrations of 0.0002 and 0.0001 after 2 and 9 hours respectively.Conclusion: Considering the significant effect of essential oil and methanolic extract of M.communis on Trichomonas in-vitro condition, it is recommended that the therapeutic effects of the substance from this plant be studied in- vitro condition and if having positive effect, to be used as a drug.

Introduction: Convulsive disorders are among chronic diseases, which usually need a long-term drug therapy. Unfortunately, most of the drugs used clinically to treat these disorders exert many side effects. Therefore, search for finding new drugs is being carried out in many laboratories. Objective: The object of this research was to compare the anticonvulsive effect of the aqueous extract of the plant Melissa officinal is with Phenobarbital in Pentylenetetrazol (P)-induced seizures on mice.Materials and Methods: After acclimatization, animals were randomly divided in different groups. Control group received normal saline (6ml/kg), standard groups received (10, 20, 30 and 40 mg/kg) Phenobarbital and the test groups received aqueous plant extract (3, 6, 9 and 12 ml/kg). All injections were carried out as i.p. All animals were firstly exposed to P (80mg/kg, i.p). The onset of seizures, behavioral changes, duration of the seizures and number of deaths were recorded in all groups during the first 24 hours.Results: All doses of the plant extracts delay the onset of seizures but the most effective dose was 12ml/kg, which was comparable to phenobarbital (30mg/kg). All amounts of the extract, except 3ml/kg, significantly reduced the duration of seizures compared to the control group. Number of deaths was 45 and 10 percent in control, standard and test groups, respectively.Conclusion: Findings showed that 12ml/kg of the aqueous plant extract is able to reduce the onset of seizures, duration of seizures and number of deaths after 24 hours in Pentylenetetrazol-induced seizures.

Introduction: The most common disease of the facial nerve is Bells palsy. The recent finding of viral genome surrounding the seventh nerve suggests that antiviral agents may be useful in the management of Bells palsy. The use of Acyclovir and Corticosteroid in combination was under study for treatment of this disease. Objective: The present study aim was to compare Prednisolon and Acyclovir regimen with Prednisolone alone in treatment of Bells palsy.Materials and Methods: Our study was double blind, and for comparison outcomes between two groups, we used the t-test, Fishers exact test and Chi2 analysis. We compared the final outcome of 65 patients with Bells palsy, in Rasht, treated with either acyclovir-prednisolone (33 patients) or prednisolone alone (32 patients). For patients receiving Acyclovir, the dosage was 2000mg (400 mg 5 times daily) for five days. The dosage of Prednisolone in both groups of patients was 60 mg daily for the first week and then tapered. The time of complete improvement in all patients was recorded.Results: Final Complete improvement did not differ between two groups, but in Acyclovir- Prednisolone group, improvement was earlier (mean duration of improvement in Acyclovir- Prednisolone group was 23.7 9.8 days but in Prednisolone group was 36.9 days, P=0.0001).Conclusion: We conclude that adding Acyclovir to Corticosteroids can reduce the time of improvement but does not alter final recovery.

Introduction: Bacterial vaginitis is one of the most common infectious disorders affecting women. Several types of antibiotics have been used to treat this condition. Although Metronidazole was found to be the most effective, none was completely successful in either cure or prevention. Objective: The purpose of this study was to compare the efficacy and safety of oral Clindamycin and oral Metronidazole in the treatment of bacterial vaginitis.Materials and methods: In this study, 60 women with age range of 16 years or older in whom bacterial vaginitis was diagnosed by standard criteria such as Amsels and Grams stain criteria were enrolled in a randomized, double - blind study to receive either oral Clindamycin 300 mg twice a day for 7 days or 500 mg of oral Metronidazole twice a day for 7 days. Women with coexisting vulvovaginal candidiasis or vaginal trichomoniasis were excluded. Test of cure was repeated 7 to 14 days following treatment. Vaginal symptoms, complications, side effects and general complaints in patients were noted. Results: There were no statistically significant differences in cure rates for oral Clindamycin (93.3%) and oral Metronidazole (86.6%). Adverse reactions were mild in both groups. Four patients who had received Clindamycin developed non - bloody diarrhea and 4 patients who had received Metronidazole developed symptomatic candida vaginitis. Conclusion: We conclude that Clindamycin may be a safe and effective alternative to Metronidazole for treatment of bacterial vaginosis in women.

Introduction: Different studies show that educational programs about BSE increase knowledge, competency and BSE rate. Students prefer computerized assisted instruction (ASI) to traditional methods. CAI is an important instrument in education of BSE. Objective: In this study, researchers try to determine the effect of education by using compact disc (CD) and booklet on learning outcomes (knowledge, Health Belief and BSE). Materials and Methods: This study has a Quasi- Experimental design; the sample consisted of 20 midwifery students and 30 nursing students in Nursing and Midwifery faculty in Rasht. CD was given to nursing students and booklet for midwifery students. Their knowledge, health belief and BSE times were compared in 2 groups. Data were gathered through filling questionnaire, subjects answered a three part questionnaire which covered: Socio- demographic data, knowledge (10 statements) and health belief (based on Champion health belief models). Computer experts provided CD based on education items by using macromedia flash (version 5) and windows. Results: Result showed that 73.9% of the nursing students and 80% midwifery students were in 18-19 year age group. The knowledge, Health belief and BSE between two groups were compared by student. Results showed that there was no significant difference in two groups (by using paired T test) (P<0.000). After education, knowledge level in two groups was significant (P<0.01) but health beliefs and BSE times by using T student and Krasskul wallis were not significant.Conclusion: Research findings indicated that education in both methods increased the knowledge but it had no effect on health and the times of breast self-examination. Further more, it revealed that belief and times of self- examination stemmed from the internal feelings.

Introduction: Headache incidence after spinal anesthesia is a complication of this kind of anesthesia. There are differences in incidence of headache at different functional conditions.Objective: This study was carried out to examine headaches after spinal anesthesia for cesarean section in Alzahra hospital, Rasht. Materials and Methods: In this cross sectional study, out of 331 patients undergoing spinal anesthesia after 24 hours, they were asked questions about headache after postural puncture. If headaches were present in frontal or occipital areas that increased with sitting or situational movement, they were considered as Post Spinal Puncture Headache.Results: We observed post spinal puncture headaches (PSPH) in about 51 patients (15.4%). The incidence rates of headache by using needles with number 22,23,24 and 25 were 63/8%, 11/2%, 4/5% and 0% respectively. The incidence rates of headache when injection operators were first degree resident, 2nd degree residents and anesthesiologist were 23/2%, 14/9% and 8/1% respectively (P=0/04).Conclusion: The incidence of PSPH in this hospital was high and with decreasing needle diameters and increasing operators experience, incidence of headache will decrease.

Introduction: Reexpansion Pulmonary Edema (RPE) is a complication of the treatment of lung collapse secondary to Pneumothorax, Pleural Effusion, Chylothorax or Atelectasis and can be potentially deathful. Recent studies about its pathogenesis are based on altering pulmonary vascular permeability secondary to hypoxic injury during collapse of the lung. Shift from cellular metabolism to anaerobic metabolism releases the mediators which cause alveolar epithelial and endothelial damages. Objective: This study was carried out to examine incidence rate of a Reexpansion Pulmonary Edema (RPE) and its approaching.Materials and Methods: In our study, we selected all inpatients with Pneumothorax (200 cases), Pleural Effusion (100 cases), Chylothorax (9 cases) and Atelectasis (80 cases) in Razi Hospital of Rasht (surgery department) from January, 1994 till March, 1999. Chest tube was placed in patients with Pneumothorax, Pleural Effusion and Chylothorax and in patients with Atelectasis, management for elimination of intrabronchial obstruction was done.Results: We found 20 cases of RPE (%5.1) in a total of 389 patients. In these 20 cases, 16 cases (%80) were symptomatic within first hour and 4 cases (%20) were symptomatic within 24 hours of reexpansion. Severe tachypnea was seen in 15 cases (%75) and mild tachypnea in 5 cases (%25).Frothy or blood- tinged sputum was observed in 15 cases (%75). Wet rales and anxiety in all of the patients were evident. There was Freely perspiring in 14 cases (%70). One of the patients with pneumothorax died.Treatments in these 20 cases were as follows: oxygen in all of the patients (%100), steroids in 14 cases (%70), suppository of Indomethacin in 11 cases (%55), disconnection of the chest tube in 9 cases (%45), Digoxin in 7 cases (%35), lasix in 6 cases (%30), bronchodilator in one case (%5) and ventilator support in 5 cases (%25). Conclusion: Incidence of RPE is considerable, so its recognition very importance. Clinical manifestations are always those that we expect in pulmonary edema. Although mortality in our study was %5 but the reported figure in previous studies was as high as %20 after reexpansion that is a cosiderable percentage.

Introduction: Contraception is a major component of preventive health care for women. Several methods are used for family planning but tubal ligation (TL) is different from other contraceptives because often it isn't reversible. Recently, due to decrease in acceptability of TL in women, there are questions on safety of this method. Objective: The purpose of this stuy was to investigate attitudes and knowledge about tubal ligation and possibility of Post Tubal Ligation Syndrome in women residing in Rasht.Materials and Methods: In this study, 403 women were collected with stratified randomized sampling. The data collection instrument consisted of a three-part questionnaire which included:(1) the demographics (2) knowledge level and (3) questions concerning the attitude. We applied the SPSS.9 statistical analysis software and Chi-square tests, pearsonian coefficient. P<0.05 was determined as statistical significance.Results: The research showed that 45/9% of women have poor knowledge and 21% have negative attitudes about tubectomy. There were significant correlations between the number of children, education level, and information source with level of knowledge (P<0.05). Also, there were significant correlations between variations like education level, information source and contraception methods with level of attitude (P<0.05). Our results showed that 82/1%,41/5% and 21/8% of women believed that Pelvic and Lumbar pain, Menstrual disorders and Ovarian cyst might occur after tubal ligation respectively.Conclusion: Our research showed that many of women due to fear of tubal ligation complications (Post Tubal Ligation Syndrome) had a negative attitude. It seems that increasing the knowledge of women and more comprehensive studies are necessary for Post- Tubal Ligation syndrome about which there is no consensus yet.

Introduction: Unwanted pregnancy is a worldwide problem that affects women, their families and society, and the essential aim of family planning is to prevent women from unwanted pregnancies.Objective: This cross-sectional study was performed for determining prevalence rate of unwanted pregnancy and some correlative factors in urban areas of Guilan. Materials and Methods: 500 pregnant women in urban Health Centers for prenatal care were selected by cluster sampling. Data were collected with questionnaire consisting of 29 closed questions. Results: Analysis of the information showed that 27.4% of pregnancies were unwanted. There was a significant relation between unwanted pregnancy and the variants: age of mother (p<0.002), number of children (p<0.0001), and mothers educational level (p<0.014). Tendency to abortion among pregnant women with unwanted pregnancy was 58.8%.17% of mothers with previous pregnancy had unwanted pregnancy and 41% of them had abortion. There was a significant relation between going to Health Center during pregnancy (regular or irregular) and unwanted pregnancy (P<0.015). In this study, 70.8% of unwanted pregnancies were as a result of contraceptive failures and 29.9% of them were due to non-use of contraceptives.Conclusion: The results of this study emphasize the necessity for more care on quality aspects of family planning services and specific attention on counseling.

Introduction: One of the most important causes of mortality in parturients is early postpartum severe hemorrhage that accounts for 28% of maternal death.Objective: The aim of this study was to determine prevalence of postpartum hemorrhage in cesarean section and requirement of blood transfusion during 24 hours after operation. Materials and Methods: This was a cross sectional study that performed among patients who underwent cesarean section at Alzahra Hospital in Rasht in 2000. Selection of 1600 records out of 3200 records by systematic Randomization was the base of this study. Of these, 100 records were omitted because of poor information and the rest (1500 records) were considered with these variables: blood transfusion requirements, kind of anesthesia, amnionitis, kind of uterine incision and labor abnormalities. Test of chi-square has been used for making a comparison between two groups, namely those requiring blood transfusion and those who didn't need it.Results: Our study showed that incidence of early postpartum hemorrhage in cesarean deliveries was 2.26 percent and it was similar to other studies and the risk factors associated with early postpartum hemorrhage were pre - eclampsia, labor abnormalities and general anesthesia.Conclusion: Considering the results obtained, women with preeclampsia or labor abnormalities or receiving general anesthesia, were at higher risk of early severe hemorrhage after cesarean section. Thus, the hospital should be well- equipped in dealing with such high- risk patients.

Here we represent a report of 31 patients treated for increasing the distance between two points on skin surface by using two triangular and one square flaps. Theoretically, best skin lengthening is made by using one triangular with right - angled position. Squared - flap procedure as compared with other procedures for increasing the distance between two points of skin surface including Z - plasty and all its other modified procedures and also in comparison with Limberg procedure is more effective.We performed square - flap procedures for 31 patients with post- burned contractive scars and clefts in ear lobules and nasal alar rim in Poorsina Teaching Hospital (Guilan - 1989) with excellent results. And we found that square flap procedure is an effective procedure and has many practical applications.