JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:15 | Issue:59|Papers Count:22

Introduction: Now days it is proven that maternal hyperglycemia increases production of free radicals and decreases antioxidants in the embryonic cells and through this it injures the embryos of diabetic mothers. Therefore it seems that use of antioxidants can decrease deleterious effects of hyperglycemia on embryos.Objective: This study aims to investigate the effect of vitamin E in control of embryonic developmental disorders in diabetic rats.Materials and Methods: In this experimental study, diabetes was induced by intraperitoneal injection of 65-mg/kg streptozotocin in Wister female rats with 250-300g weights and was placed with healthy male rats in the same cage for mating. Then they were divided into two groups. One group received 150mg/kg Vitamin E per day from the first day of pregnancy. Animals were killed on day 13 of gestation and embryos were collected and examined for number, size and incidence of malformations in cerebral hemispheres, cranial and caudal neuropors, upper and lower limb buds, otic and lens placodes using a stereomicroscope. Then, One Way ANOVA compared the means of length, number of reabsorbed and achieved embryos in three groups. The incidences of malformations in the groups were compared by Chi-Square test.Results: Findings show a significant difference between control group and experimental diabetic group when achieved and reabsorbed embryos counted. Frequencies of malformed embryos (at least one diagnosed malformation) in control group were 1% and in diabetic and treated diabetic groups were 46.3% and 11.6% respectively. Result showed that the incidence of embryonic malformation significantly decreased in diabetic rates, that received vitamin E and there was a significant difference in diabetes and treated diabetic groups (P<0.001).Conclusion: ‏The results shows that Vitamin E supplementation in early stages of pregnancy in diabetic mothers can prevent deleterious effects of diabetes.

Introduction: Bladder Cancer is one of the most common urologic malignancies. The risk of recurrence in the same place or a new growth elsewhere in the urothelium, with the same stage or higher, is always with the bladder cancer patient. Therefore, a close follow-up and surveillance is of fundamental importance. Cystoscopy is limited in its ability to discover early urothelial changes. Urine cytology does not have enough sensitivity.Objective: The aim of our study is to compare the sensitivity and specificity of urinary tumor marker Urinary Bladder Cancer- Linked Immunosorbent Assay (UBC-ELISA) with urine cytology in the diagnosis of transitional cell cancer of the bladder.Materials and Methods: Voided urine samples were collected from 73 patients with active or history of bladder cancer, prior to cystoscopy at Urmia and Tehran universities urology sections, from March 2004 until March 2005. Ninety-eight volunteers were sampled as controls. Fresh samples were processed and frozen. UBC-ELISA and urine cytology were done during next 3 months period.Results: UBC and cytology sensitivity and specificity were 70%, 97% and 30%, 98% respectively. Positive and negative predictive values were 93%, 86% and 87%, 74% respectively. Accuracy of UBC was 87% as compared with urine cytology, which was 75%. There was no statistically significant relationship between UBC and grade or stage of the tumors (p= 0.11/ p= 0.28). A statistically significant relationship was demonstrated between urine cytology and grade or stage of the tumors (p= 0.01/ p= 0.001). Both tests had a statistically significant relationship to the size of the tumor if the cut-off was at 3 centimeters (p= 0.003/p= 0.006).Conclusion: Our study shows that the UBC test is much more sensitive than urinary cytology, but the specificity is not very different. Since UBC is less expensive and is an objective test, it can be used instead of urine cytology in the diagnosis and follow-up of transitional cell cancers of the bladder.

Introduction: Nerve conduction studies and needle electromyography (EMG) play a central role in the evaluation of patients with neuromuscular disorders. The tibia nerve H-reflex is one of the most common parameters in clinical electro diagnosis, especially in the diagnosis of SI radiculopathy. H- reflex is important because involvement of SI root most common in disc hernia causes rapid changes.Objective: The purpose of this study was to determine the mean values of tibia H-reflex in healthy individuals aged 20 years and older.Materials and Methods: In this cross-sectional study 110 asymptomatic volunteers were controlled. All of them were placed in prone position with flexed knee by 20 degree tibia H-reflex latency was recorded by Medelec machine from midcalf on each side. Stimuli were applied at the midpopliteal crease. Data were analyzed by EpiInfo software and by using ANOVA tests to compare means of different groups. The results were reported as mean (CI 95% of mean).Results: 55.5% were male and 44.5% were female. Mean age of subjects was 41.6 years and mean height was 165.26 cm. The mean H-reflex latency for 220-tibia nerve (110 of right & 110 of left) was 26.46 m/sec (Cl 95%=26.62-26.28 m/sec).The maximum mean H-reflex latency was 28.23 m/sec in over 60 years old age group and the least mean H-reflex latency was 25.93 m/sec in 40-60 years old age group (P<0.0001). Mean of H-reflex latency were 25.92 m/sec in less than 150 cm height group and was 29.78 m/sec in more than 180 cm height group (P<0.0001). Conclusion: Since from references, age and height have major effect on normal value of H-reflex latency and this is also evident in this study, and on the side, there is a significant difference in H-reflex values measured in different studies; so we recommend the use of normal values according to standardized measurement in each region or clinic.

Introduction: Ischemic stroke has a high prevalence and is accompanied with high mortality, severe complication and high expenditure and cost. Increase awareness of risk factors can improve the prevention of stroke. Although several studies have proposed hyper homocysteinemia as a risk factor for ischemic strike but some investigations have not confirmed this association.Objective: The aim of this study is to determine Homocysteine serum level in ischemic infarct patients in Poorsina Hospital, Rasht, from 2005 to 2006.Materials and Methods: In this descriptive study on hospitalized ischemic stroke patients according to clinical findings, imaging and R/O of exclusion criteria; 200 patients were selected and their plasma homocysteine level measured at the base of paraclinical findings. History and manner of smoking have been considered. Smoking defined as ≥ 8 pack per year.Results: From total patients, 24.5% serum homosysteine level was normal (<10µ mol/lit), 34% mild elevation (10 – 14/99 µ mol/lit), 36.5% moderate elevation (15 – 29.99 µ mol/lit), and 5% had intermediate elevation (30-100 µ mol/lit) and none of them was severe (> 100 µ mol/lit). 8.5% of patients were smokers. No significant statistical relationship was found between smoking & homocysteine level. (p=0.053).Conclusion: Hyperhomocysteinemia is a risk factor for ischemic stroke and its effect is independent from smoking. Thus prescription of vitamin B groups and folat that decrease serum Hcy level may play a roll in decreasing of this risk factor.

Introduction: Leptospirosis is most widespread Zoonosis in the world, especially in Tropical and temperate regions with moist climate. Diagnosis of Leptospirosis according to clinical symptoms is difficult and uncertain due to lack of specific sign (s). Leptospira is a fastidious bacterium. Isolation of these bacteria by culture is difficult, time consuming and hence doses not contribute to an early diagnosis. Specific antibodies against Leptospira appear from 6th day of disease onset. The Microscopic Agglutination Test (MAT) is most reliable assay but generally requires paired sera for detection of seroconversion and is considered too complex for routine use.Objective: We performed this study to final a simple and reliable method for diagnosis of acute human leptospirosis. ELISA is another common method for diagnosis of Leptospirosis.Materials and Methods: In summer of 2004, we examined 282single sera of patients who were suspected of Leptospirosis by a commercial none quantities and an in-house semi quantative ELISA assays and compared their results with MAT.Results: Mean time of first taking blood samples were 6:36 after onset of symptoms. All specimens with titers ≥640 against a pathogenic serovar in MAT were regarded as confirmed leptospirosis(104 from 282). All specimens which were positive in any IgM-ELISA assays were compared with the results of MAT. In our study, sensitivity, specify, positive and negative predictive values of in house ELISA were 89.4%, 87%, 80.2% and 93.4% consequently but were 87.5%, 41.5%, 44.6% and 85% for comerical IgM-ELISA assay consequently.Conclusion: The results of our study show that IgM- ELISA assay is a reliable and sensitive method for diagnosis of acute leptospirosis and also show that in house semi quantative IgM ELISA was more specific and commercial qualitative IgM- ELISA was more sensitive.

Introduction: In studies or lifestyle of patients with (Chronic Obstructive Pulmonary Disease COPD), physical and, social activities, nutrition and smoking are the behavioral patterns, which aggravate this disorder and cause a dysfunctional circle, which prevents healing.Objectives: This study aimed to compare the lifestyle of patients with COPD and control group and then the two groups according to severity and length of disease.Materials and Methods: This descriptive-analytical study was done on 70 patients with COPD as the case group, which was selected, based on American Thoracic Society and also on 70 healthy persons as the control group. Patients with any psychiatric or chronic disorder or those who didn’t cooperate were excluded from this study. The questionnaire included demographic information such as age, sex, education level, duration of affliction to this disease and FEV1 and Miller-Smith lifestyle questionnaire were filled for all patients. All data were statistically analyzed by t-student and ANOVA tests.Results: The mean age of case and control groups were 66.3±9.2 and 64.2±11.6 respectively. Thirty-six persons (51%) in case group and 35 persons (50%) in control group were male. The means of education level in case and control groups were 8.3±4.1 and 9.2±3.4 respectively.The mean score of lifestyle in case group was 66.64±18.6 and in control group was 32.01±6.49, which was statistically significant (P<0.013). The mean score of Miller-Smith questionnaire was significantly increased as the severity of the disease (based on FEV1) and the duration of the disease increased (P<0.003).Conclusion: Lifestyle is an important factor in patients with COPD. Suitable management and effective pulmonary rehabilitation can be effective in the treatment of patients with COPD. So it is necessary to consider lifestyle change as a part of patients’ treatment.

Introduction: Rheumatic fever and rheumatic heart diseases are among the chronic diseases. Rheumatic fever is the most common heart disease in children and young adults especially in the developing countries.Objective: The purpose of this study was to investigate the educational needs of mothers referring to the Health and Treatment Centers of Lahijan- City for prevention of rheumatic fever and its complications and to prepare an educational pamphlet on the basis of research findings.Materials and Methods: This research is a descriptive study performed in 2001.Required data were gathered by a questionnaire. Research population was mothers presenting to the Health and Treatment Centers of Lahijan-City who were selected by a convenient randomized sampling. Thus, all of the mothers who had the determined criteria for the samples (such as true mother of child, married and having at least 1 child between 5-15 years of age, having minimum literacy for reading and writing, lack of history of rheumatic fever or rheumatic heart disease and absence of formal education regarding the subject under study) were given a code. Then, from these given codes, drawing was performed and from each health and treatment center, 56 mothers were selected in a convenient random sampling .On the whole, 280 mothers were studied from 5 health centers.Results: The majority of mothers needed high education regarding all research objectives (cause and predisposing factors, symptoms and signs, complications of rheumatic fever and its prevention) 56.0%, 51.8%, 53.2%, and 43.9% respectively.Conclusion: Research results indicated a low level of knowledge (high educational need) of mothers concerning the disease of rheumatic fever and complications.

Introduction: Information system and its main effect in empowering the management decision-making results in highest quality of a system Therefore if information is given to managers rapidly and correctly it helps them in correct and useful decision-making. Not receiving the information can create problems especially in Health and treatment centers.Objective: The goal of using Geographic Information system (GIS) in Health management is to help in prevention of incidence and prevalence of different diseases via their analysis with attention to geographic situation and environmental conditions. In such a way useful approaches for proper management for control of health and treatment problems can be achieved.Materials and Methods: After necessary assessment and meetings, three cities (Farsan from Chahar mahal Bakhtiary, Dashti from Boshehr and Bam from Kerman) which have different race and related environ mental diseases, were chosen for this study. This study was done under agreement with private sector and with the cooperation of Health centers of above-mentioned cities.Results: In intervention of this project based on the descriptive information of Health and treatment centers and need assessment, the data model was designed and provided in a geographic information bank (place).Conclusion: Finally system was able to answer many information needs of health system and the possibility of development was provided.

Introduction: Following the teeth loss, the changes in the shape and angulations of alveolar ridge happens Tomographic images can be helpful for providing the sufficient details about vertical and horizontal dimension of alveolar bone, situation of vital and anatomic structures, and deduction of surgical injuries.Objective: Considering the importance of spiral tomography in determination of mandibular canal and vertical height of alveolar ridge, we decided to use this advanced method in evaluation of the alveolar bone height from crest to mandibular canal.Materials and Methods: Three dry human mandibles were selected in this analytical study for comparison of tomography and real measurements. Cross-sectional tomographic slices with 2 mm thickness ware taken at three or four different locations distal to the mental foramen by means of Cronex Tome unit (Sordex, Helsinki Finland) in each side. These sites marked by gutta-percha filled pits. On tomographic image, a line was drawn from crest to the inferior border of mandible (MC) and the distance from crest to mandibular canal was measured on MC line. Meanwhile the distance from the crest to mandibular canal was measured. Subsequently, vertical sections were provided at the sites marked by gutta- percha, perpendicular to the lower border of the mandible by special disk .The real anatomical bone height, after estimation of magnification factor 1.5 were compared. SPSS software (version No 11.5) and sign test analysis were used in order to evaluate the statistical details.Results: In measurement of the distance between crest to mandibular canal, showed no significant difference between tomographic measurements and real dimensions. Measuring height in tomography indicated an underestimation ranging 3.7 to 0.07.Conclusion: This point that there is an underestimation in measurement of height justifies  the safety of spiral tomography in estimation of distance from crest to mandibular canal. Which itself prevents serious injuries to neurovascular bundle.

Introduction: Maintaining an adequate coronal access seal is an integral part of multiple-visit endodontic therapy or after root canal treatment until crown reconstruction. This is provided by filling the access cavity with temporary restorative materials. The thickness of the temporary restorative materials is one of the important factors in preventing of coronal microleakage. Objective: This research was conducted to determine the effect of the thickness of three temporary restorative materials of Cavizol, Cavtemp and Coltosol on coronal micro leakage of extracted human teeth.Materials and Methods: In this Invitro study, 100 multi rooted posterior human teeth, were randomly divided into nine experimental groups (n=10) and two negative and positive control group (n=5). According to manufacture’s instruction, the access cavities in experimental groups were filled with three temporary materials, Cavizol, Cavtemp, Coltozol in 2, 3, 4 mm thickness each. Linear dye penetration and clearing technique were used to evaluate coronal leakage of temporary filling materials. Data was analyzed with one way ANOVA test.Results: Comparison of experimental groups in different thicknesses (2, 3, 4 mm) showed no statistical difference (p<0.05) of coronal leakage between different groups as regard as to level.Conclusion: There was no preference between the materials were put for preventing coronal micro leakage. There was no limitation for their essential thickness in access cavity. So they may be suited for clinical situations in access cavities which have the depth of 2mm or more.

Introduction: Beta-thalassemia patients require regular iron chelation therapy based on the severity of disease, treatment and its complications. Then these patients should receive regular medical care. The relation between dental caries and some diseases are identified. But unfortunately dental and oral problems in these patients received less attention and present information is little. Researchers also stated different opinions. The prevalence and severity of dental caries have been documented to be associated with a number of diseases. Little data are available on the association of dental caries with beta- thalassemia major. While some studies reported increase dental caries in these patients, other studies showed no differences between thalassemia patients and healthy controls.Objective: This study aimed to examine the levels of dental caries in beta-thalassemia patients and to compare it with matched nonthalassemic healthy controls.Materials and Methods: This study is cross sectional with control group. 60 thalassemia patients in health center of Iran Institute thalasemia and 60 healthy controls (referrals to college and patients healthy accompany) were assessed by DMF Index. The two groups were matched in age sex, socio-economic condition, oral hygiene, eating carious material and its frequency.Results: Mean DMF were 7.3 (SD=3.80) and 7.26 (SD=3.73) in patients and healthy controls respectively. There was no significant difference between patients & healthy controls in DMF index. Mean D and F were 5.55 and 1.33 in patients and controls respectively. There were significant differences between two groups in D and F indexes. There was not significant difference between DMF index in males and females in both groups.Conclusion: There was no significant difference in the two groups regarding DMF and it seems that there is no relation between Beta – thalasemia major and dental caries. As advanced treatment has greatly increased the probability for a thalassemic child to reach adult age, regular dental visits are recommended. Since decay was seen in patients more than controls, it's necessary to examine and fill them.

Introduction: Cesarean Section (CS) is more dangerous than normal delivery for mothers and neonates. Rate of Cesarean in our country (total 35%) especially in Guilan province (57.6%in urban areas) is very high. A major reason for this high rate is maternal request.Objective: This survey is done to detect the relationship between knowledge and attitude has pregnant women requesting Cesarean Section and their choice reasons.Materials and Methods: This is a descriptive- analytic study. A total of 210 pregnant women in Rasht who were at 36-40 weeks of pregnancy and had chosen CS as their delivery method without previous history of CS or any medical indications. Cluster sampling was performed at health- treatment centers of Rasht. Data were collected by interview and a questionnaire that was completed by investigators in 2003-2004. Statistical analyze was performed by descriptive and analytic methods (Chi-square and Fisher exact test.Results: The majority of participants (68.6%) had moderate knowledge about benefits and harms of CS and most received their information from their relatives and friends. The majority of women (71.4%) had abstained attitude to CS. More than (50%)of the mothers had chosen CS for following reasons in decreasing order of frequency: child's health, fear of pain, stress and anxiety, prevention of genital tears, fear of vaginal exams, prevention of deformity and relaxation of genital system and shortening of labor duration. There was a significant relation between knowledge level and following reasons: fear of pain, psychotic stress and anxiety, shortening of labor duration.Conclusion: Findings of this study gives attention to the need for instruction deployment by midwives and other health staff. High rates of negative and abstain attitude (84.2%) in spite of choosing it shows that pregnant mothers demand cesarean subsequent to flighting of classic painful vaginal delivery. Thus we can utilize new obstetric and complementary methods, counsel with target mothers and support them by giving information, emotionally and socially in order to decrease cesarean section.

Introduction: In Attention to the importance of caring for patients referring to treatment centers specially ICU, the care prided should be in concordance with the severity of disease so that it give satisfactory result and patients with more sever disease receive intensive care. It is necessary to use standard scoring of APACHE II to determine the severity of disease and compare it with other standard treatment centers.Objective:  This survey is carried out to determine relationship between APACHEII scoring system and mortality rate of patient in ICU.Materials and Methods: This descriptive and retrospective study was performed in one-year period from mid Agust 2004 to 2005 in ICU ward of Poorsina Hospital. Overall admitted patients were 600 and data were collected from 200 patients and recorded in special data sheet of APACHEII Scoring system. In APACH II system there are two criteria that together make the acute physiology and two other criteria including chronic disease and age were included and the maximum score was 710.   Data sheet were prepared for all patient and at the end of sheet, total scoring was recorded. This scoring system had relationship with mortality. In the scoring: 0-12, 16-19, 20-30 and >30, probability of mortality were: % 10, %15, %35 and> %75 respectively.Results: In the assessment of 200 patients, men group were 66.5% (133) and women group 33.5% (67). Mortality and viability in these two group was 22% (44) and 78% (156); respectively. All of 117 (%58.5) patients with scoring below 15 were alive and scoring above 30 died. (2.5%). In 50(%25) patients with scoring between 20-30, 37(%84.59) died and 13 patients were lived. In the patients with scoring number between 16-19, mortality rate was % 4.54(2) and viability was 16.6% (26). In comparison with standard scoring system, mortality rate in scores below 19 in Poorsina center was lower than standard, but with scores above 20, mortality rate was greater than standard system. So scoring between 20-30, mortality rate was %39 and with scoring above 30 , mortality rate was % 25 greater than standard system.Conclusion: With increasing the scoring number, mortality was increased. In greater scoring numbers, severe intensive care must be considered for ICU patient.

Introduction: Group B streptococci (GBS) have a tendency to colonize female genital tract and is a causing factor of premature delivery. In addition, they can also induce serious life – threatening infections such as meningitis and septecemia in the newborn. GBS infection are generally higher in pre-mature infants in relation to fullterm born neorates.Objective: The purpose of this research was to determine the prevalence of Group B streptococci in genital tract 28-37 weeks of pregnant women.Materials and Methods: In this study specimens were obtained from 100 pregnant women (28 – 37 pregnancy weeks) who had not taken any antibiotics within one-month period prior to sample collection and referred to prenatal ward and special clinic of Alzahra Hospital during summer 2005 in Rasht Three vaginal swabs were taken from each woman. The first swab was used for direct lamb from vaginal secretions.The second swab was inoculated in 3ml of Todd– Hewitt broth (without antibiotic) and the third swab was inoculated into 3ml of selective Todd– Hewitt broth, supplemented gentamicin and Nalidixic acid. After 24h of in­cubation at 37oC in 5% CO2 results of cultures were compared. For identification of isolated strains, the following tests were done, Hemolytic reaction, susceptibility to bacitracin, optochin and SXT discs, CAMP test, bile esculin, Hydrolysis of hippurate.Results: Based on various biochemical and microbiological tests, 15 GBS strains were isolated from the vaginal secretions of 100 pregnant women (28 – 37 pregnancy weeks). Fifteen strains of Streptococcus Viridans, One case of  group A streptococcus Pnenmonea, 5 isolated belonging to the group C, G, F Streptococci, and 30 group D streptococci strains were isolated. Beside streptococci, other microorganisms were also isolated based on Gram staining and growth characteristics on blood agar , and eosin methylene blue agar plates. One hundred Gram positive bacilli, 45 Gram negative bacilli, 60 staphylococci spp, and 40 yeast isolates were also detected.Conclusion: In attention to %15 of 28-37 weeks pregnancy women who were carriers, it is possible that it can cause premature delivery and also infections neonates.

Introduction: Postpartum depression is a prevalent disorder that has undesirable effects on mother and child’s health. Its prevalence is reported different in various studies.Objective: The aim of this study was to determine the prevalence of postpartum depression in mothers who delivered at Alzahra hospital in Rasht in 2004.Materials and Methods: In this cross sectional study 335 women who delivered at Alzahra hospital after signing informed consent were assessed with a demographic questionnaire including variables (age, live child number, home living, delivery type, wanted or unwanted pregnancy, history of abortion or dead child, delivery number, educational level, employment status after delivery). Samples were screened with Beck depression inventory (a standard self questionnaire and independent of any cultural bias) 2-3 weeks after delivery.  For mothers who scored 16 or higher, a structural clinical interview for major depressive disease was done. The interview results were evaluated according to DSMIV-TR criteria and the results were analyzed and statistically significant difference was determined (α=0/05).Results: According to the screening examination, 61 patients had mild depression (scoring 16-230) and 6 patients suffered moderate depression (scoring 31-46). From 59 patients who referred for clinical interview, 48 had essential depression disorder based on DSMIV-TR and 43 had mild depression. There was a significant relationship between mothers’ occupation and depression (P=0.02) and between history of still birth and infant death in past with depression (P=0.02).Conclusion: The prevalence of mild depression in our study was notable. In addition to the limitations of this study, more studies with more specific screening assessment and more subjects are recommended.

Introduction: The prevalence of autoimmune thyroid disease (AITD) had been shown to be markedly increased Diabetes Mellitus Type I (DM1). Some report have indicated that AITD is ten times more commonl in DM1 than in the general population, as might be expected due to the autoimmune nature of the two diseases. However it is difficult to find report regarding the incidence of AITD in type2 DM2, although this condition accounts for the majority of the population with hyperglycemia.Objective: This study aimed to determine the prevalence of AITD in diabetic patients.Materials and Methods: This cross sectional study was on 62 performed patients with DM2, and 601 DM2, for a total of 633. The subjects were selected randomly from diabetic out patients of an endocrine clinic. There were 467 women and 196 men with both types of diabetes with an age range of 8-84 years. One screening basis all patients had thyroid function testing (at least a sensitive TSH).Results: Overall 39 patients (5.8%) had AITD (Graves disease and Hashimototos thyroiditis). The incidence of AlTD was 8% and 5.6% in DM) and DM2 respectively. However the prevalence of AITD in DM1 was more striking. Because these patients were younger, and at age when generally AITD is more unusual, the incidence of AlTD in DM2 was surprisingly high, but may be accounted for by the older ages of these patients.Conclusion: There is definitely an increased prevalence of AITD in patients with DM2 as well as DM1. While in contrast with latter this may not represent a true disease association, the merit of screening for thyroid function in type 2 diabetes is questionable.