JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:13 | Issue:49|Papers Count:17

Introduction: The endotracheal route for drug delivery is a valuable alternative in emergency conditions in which intravenous access is difficult or impossible. Lidocaine is an antiarrhythmic agent with tracheal absorbency, commonly used in cardiac emergencies. Objective: The purpose of this study was to investigate Lidocaine pharmacokinetic behavior following endotracheal administration in critically ill patients. Materials and Methods: 14 mechanically ventilated critically ill patients received 2mg/kg lidocaine 2% (diluted as necessary with 0.9% Saline up to total volume of 5-10 ml) via an endotracheal tube. Five positive pressure breaths were provided immediately after instillation of the drug into the airway and then patients connected to the ventilator again. Venous blood samples were drawn for 4 hours after lidocaine administration and plasma concentrations determined by HPLC method.Results: After 5 min, average lidocaine concentrations reached the therapeutic range (1.5-5 µg/ml) and remained in this range for 30 minutes. Volume of distribution (Vd) was found to be 0.7±0.3 L/Kg, and clearance (Cl) 4.29±1.4 ml/min/kg. These values are lower than those described previously for healthy volunteers (P<0.001), but similar to those described in ICU patients (P>0.05).Half life was 113.1±34.1 min and was not different from parameters published previously for healthy and ICU patients (P > 0.05).Conclusion: In conclusion, endotracheal administration of Lidocaine can provide therapeutic levels in critically ill patients. It is not definitely clear that the technique of endotracheal drug administration or the unstable physiologic condition of the patients alters the pharmacokinetics of lidocaine.

Introduction: Gastric cancer is the most common cancer in Guilan province. Objective: This study was performed to evaluate the relation between gastric cancer and lifestyle habits.Materials and Methods: This is a hospital-based case-control study of matched pairs. Study subjects included 144 cases and 398 controls (from ophthalmology ward). All subjects were interviewed using a structured questionnaire. An average of approximately two controls were matched to each case based on age (±3 years). Sex and time of hospitalization (2WK). Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were used to evaluate results, and a multivariate analysis of the data was performed by using a logistic regression model.Results: A significantly elevated risk of contracting gastric cancer was observed in cigarette smokers (OR: 2.8. CI: L.2-S.S). Furthermore, a statistically significant positive dose-response trend in gastric cancer was demonstrated based on age at which smoking was initiated, the duration of the habit, and the number of cigarettes smoked per day. We did not find any significant association between other factors (dietary habits and socioeconomic factors) and gastric Cancer.Conclusion: Cigarette smoking is an important risk factor for gastric cancer in this region.

Introduction: Adolescents are the fastest growing risk group for the development of AIDS worldwide. Preventive education is the only tool available for reducing the risk of HIV infection among the youth.Objective: For assessment of knowledge and attitude of university students, this cross- sectional study was designed. Materials and Methods: The study population consisted of 850 non-medical students of Guilan University that were selected by random sampling. For this survey a questionnaire consisting of demographic data, knowledge and attitude questions was designed. Knowledge was ranked into good, intermediate and weak levels and 5 score Likert scale was used for attitude assessment. The data were collected by self-administered questionnaires, 744 of them were completed and analysed by Mantel - Haenzel x2 statistical method. Results: This study showed 11.7% of the students had good, 7.6% intermediate and 10.7% weak knowledge. Knowledge of Engineering Faculty students was higher than others (P<0.05). Also, the younger students who were married had better knowledge than the older ones who were singles (P<0.05). Most of the students (70.2%) were informed of HIV/AIDS by media.Conclusion: The results underline the importance of providing information with higher quantity and quality by media and also health subjects in the educational courses of the non- medical students.

Introduction: There are many methods for treatment of patients with unexplained infertility. The easiest method is induction of ovulation and the most commonly used drug for induction of ovulation is Clomiphen Citrate. Objective: This study was carried out to compare the efficacy of different methods of Clomiphen Citrate administration for induction of ovulation. Materials and Methods: This is a randomized clinical trial performed on 60 cases with unexplained infertility in Mirzakoochakkhan Hospital of Tehran from September 23, 2001 to March 20, 2003.Patients were divided into three groups with 20 cases in each group. All three groups were treated with Clomiphen Citrate 100 mg/d. In group A, 100 mg of Clomiphen Citrate was given for the first 5 days of the cycle and in group B on days 3-7 and in group C on days 5-9.Results: The results showed no significant differences in age, parity, duration of infertility, weight or endometrial pattern in the three groups.The mean follicles number in group A was 2±0.85, in group B 2.25±0.9 and in group C 1.1±0.8. There was significant difference between three groups. We observed 2 pregnancy cases in group A, 4 pregnancies in group B and 1 pregnancy in group C. No differences in the mean serum progesterone levels in mid - luteal phase were detected between the three groups.Conclusion: Considering the results obtained, it appears that administration of Clomiphen Citrate on days 3-7 exert the best impact on the follicle number and pregnancy rate.

Introduction: Today, population is the greatest problem in developing countries and family planning is accepted as a strategy against it by all countries and correct education of family planning and improvement of awareness level has a significant role in control of population in this field.Objective: Present study was carried out to examine knowledge, attitude and performance of teachers in Rasht- City concerning Family Planning and Contraceptive Methods in 2001-2002. Materials and Methods: This study was performed in all teachers with different degrees. Sample size was 544 individuals and data were collected with questionnaires. In general, 503 questionnaires were analyzed by SPSS software.Results: Age range of individuals studied was 25-55 years with mean age 38.4 years. Mean age of marriage was 24.1 with ±3.7 standard deviation and mean number of children 1.94 with ±0.9 year standard deviation. 57.5 percent of contributors have license degrees.44.1 percent of subjects regarded physicians and health care workers as the most important reference for achieving information. Mean score of awareness was 4.21 from a total score of 10 and 62.8 percent of them in terms of awareness were in intermediate degree. There was a reliable relationship between age and awareness (P Value 0.000).Mean score of attitude was 3.73 in range of (-12, 12) and 83.3 percent of persons were located in positive attitude group. It was found that there was reliable relationship between children number and attitude. (P.value:0. 005)Most common method for contraception was coitus interruptus (19.7 percent). 42.7 percent of parents indicated that they had an unexpected childbirth.Conclusion: What was presented in this research revealed positive attitude among persons. In other words, there were strong motivations in the subjects concerning the necessity for family planning and prevention of unwanted pregnancies. However, due to low knowledge level about contraceptives, there was a high rate of unwanted pregnancies that suggest the poor performance of the investigates.

Introduction: Meningiomas are usually slow growing and benign neoplasms that arise from the intracranial and spinal meninges and their dural extensions. They constitue about 20% of all central nervous system neoplasms. Objective: The objective of this study was to gain more insight into some of important characteristics of meningioma in neurological department of the hospital.Materials and Methods: We reviewed retrospectively a series of 62 patients operated on for an intracranial meningioma over a period of 6 years (1994-1999).Setting of study was Rasht Poorsina Hospital and medical records were used. Demographic characteristics, age, gender, clinical, pathological, radiological and other important data were investigated and analyzed.Results: Meningioma represent 19.1% [CI95%: 14.8%-23.3%] of intracranial tumors. Mean age was 49.1 11.7 years. Female/ male ratio was nearly 1.6:1. History of head trauma was seen in 5 (8.1%). Contraceptive pills were used in 23.7% of women. The most common presenting symptom was headache.The majority of tumors originated in convexity of brain. Peritumoral edema was observed in 37 (59.7%) of cases. Fibroblastic tumors were the most common reported pathology. In our series, we did not observed malignant meningioma and/or multiple meningioma.Conclusion: Findings of this study were consistent with other demographic and clinical studies.

Introduction: Placenta is essential for normal fetal development. Failure of the placenta can result in many fetal conditions. Placental development and function can be assessed by a number of methods, including measurement of placental weight. Objective: The aim of this study was to evaluate survey of placental weight and associated factors. Materials and Methods: In this study pregnant, women with singleton pregnancy and gestational age between 37-42 weeks delivered following complicated or no complicated pregnancies were included in a cross-sectional study. Also the patients were categorized into high placental weight (>750 gr), normal placental weight (330-750gr) and low placental weight (<330 gr). The placental weight, birth weight, maternal age, gestational age, parity, preeclampsia, history of maternal diabetes, route of delivery, infants gender and Apgar score were recorded and analyzed with chi2 test.Results: 1088 patients were included in this study. The mean maternal age was 25.35±5.6 and gestational age at delivery was 274.51±9.56 days. The mean weight of birth and placental weight were 3214.28±529, 529.72±113 respectively. The prevalence rates of low and high placental weight were 2% and 2.8% respectively. There were statistically significant relationships between placental weight and birth weight, fetal distress, Apgar score, maternal diabetes, preeclampsia and kind of delivery. (P<0/05) Conclusion: In this study, it was seen that placental weight can be related to some important variables that influence some maternal and neonatal outcomes. Therefore, attention to placenta and its growth during pregnancy, for example by sonography can guide us in providing neonatal health and even can be the base of preventive medicine. It appears that placental weight lower than 330gr can be a warning.

Introduction: Fasting in word means refuse to eat or drink, and not to do or say anything unreligious. Fasting affects spiritual and emotional aspects of human and stress is also an emotional variable.Although it is believed that a little stress is necessary for daily living but excess stress has serious side effects on body, mind and social relationships. In last years, there has been an increasing emphasis on decreasing stress by means of non - invasive and non - medical methods that are justified in a particular culture.The researchers were interested to assess the effects of fasting in Ramadan on students level of stress through an applied research. Objective: The main goal of study was to determine the relationship between fasting and students stress level during and after Ramadan. The assumption of the study was that fasting affects students stress level.Materials and Methods: This study was cross - sectional and the sample consisted of 110 male students living in dormitories who were randomly chosen. The data collection instrument was a two-part questionnaire. The first part covered demographic data and the second part consisted of Hamiltons Stress Checklist. At first, students stress level was measured at fourth week of Ramadan and then after a month, it was remeasured.Results: The results indicated that the students stress level was medium and showed a significant correlation between stress during and after Ramadan (P< %01). Stress decrease was not related to age, level of education or tea consumption assumption. Smokers had higher level of stress in Ramadan (P< %05).Conclusion: The research results showed that the study assumption was accepted and fasting in Ramadan influences students stress level.

Introduction: Anxiety is a kind of agitation and concern stemming from the feeling of threat or hazard in human soul. It can reduce or increase understanding ability of individuals. Most of clinical patients have anxiety in confronting with a new and unknown enviroument of hospital. A non-pharmacological method such as pleasant sound of Holy Quran recitation can be used as a useful and effective procedure to decrease the anxiety. Objective: The aim of this research was to study the recitation effects of Holy Quran on anxiety of patients before undergoing coronary artery angiography .Materials and Methods: In this clinical trial, study sample consisted of 108 patients waiting for coronary artery angiography. 54 patients were chosen randomly in control group and 54 patients in experimental group. Data collection instrument was a three part questionnaire including demographic characteristics, Spilburges state -trait Anxiety Inventory and check list of vital signs record. The degree of state and trait anxiety and vital signs for the control and experimental groups was evaluated one day before angiography, and 1.5 hours before angiography, the Holy Quran recitation was played for experimental group for 20 minutes. Results: The results showed that the degree of state and trait anxiety in experimental group significantly decreased with control group (p<0/0001). Also the degree of vital signs in experimental group decreased significantly compared to control group (p<0/0001). Conclusion: Since Holy Quran recitation reduces degree of anxiety and vital signs, it can be used as a non-pharmacological, safe and cheap procedure for reducing anxiety before surgery and invasive diagnostic procedure.

Introduction: Dysmenorrhea is a common gynecologic disorder that at least half of women experience it in their reproductive period. The most important cause of primary dysmenorrhea is the enhancement of prostaglandins production and their role in appearance of the pain. Objective: The purpose of this study was to compare the effect of Mefenamic Acid and fish oil with Mefenamic Acid alone in reduction of the severity of pain in primary dysmenorrhea. Materials and Methods: This study was designed as a double blind crossover trial. 60 women with primary dysmenenorrhea presenting to Zahedan Ghods hospital clinic were selected as presenting sample and divided into two groups 1 and 2 alternately. First group used Mefenamic Acid and Fish oil for 2 first months, then they didn't take any treatment for 2 months and then used Mefenamic Acid with the previous dose and similar placebo for 2 months. Second group used this therapeutic regime reversely. Visual analogue scale (VAS) was used to assess the response to treatment. Results: The results indicated that the efficacy of prescription of Mefenamic Acid and Fish oil in reduction of the severity of the pain is significantly more than Mefenamic Acid and placebo. Conclusion: So, it is recommended to use Mefenamic Acid and fish oil instead of increasing dosage of NSAIDS.

Introduction: Chronic otitis media with effusion (COME) is one of the most common diseases in otolaryngology. The most important complication of COME is development delay of cognitive and linguistic skills due to hearing loss. Treatment of COME is both surgical and medical. Because of the high cost of operation and its complications, many studies have been done to replace it with medical therapy. Oral steroids are one of the most important drugs which are studied for treatment of COME.Objectives: Purpose of present study was to examine the effect of adding oral steroids to antibiotics in treatment of otitis media with effusion. Materials and Methods: The study was carried out as double- blind controlled clinical trials and eighty cases of 4 - 10 years old patients who had type B tympanometry in both ears were divided into two equal groups. Forty patients received only Amoxicillin (Group 1) and the remaining received Amoxicillin with prednisolone. (Group2) Tympanometry was repeated after two weeks. Type A tympanometry in both ears was supposed as improvement and the other form indicated no improvement.Results: In Group (1) only 2 out of 40 patients (%5) and in Group (2) 11 out of 40 patients (27/5%) were improved. There was a statistically difference in improvement between the two groups,(P=0/013) which was greater in group 2.Conclusion: The results of this study confirmed previous studies and showed that the combination of steroids with Antibiotics has a greater efficacy than antibiotics alone. At the same time, because of steroids potential adverse effects, their routine use is not advocated until greater studies will carried out.

Introduction: Spinal canal and spinal cord injuries are one of the most common causes of death and disabilities in trauma victims. Since treatment and long term care for these patients causes a major economic burden on the society and there isn't adequate data in this regard in our country. Objective: This study was carried out in Naghavi University Hospital, Kashan, from December 1995 to December 1999 to determine the incidence of these injuries.Materials and Methods: This descriptive study included all admitted trauma victims. Age, sex, cause of trauma, site of fracture, kind of fracture, and neurological status of the patients were recorded. All of patients were studied by x- ray and CT scan. Findings were statistically analyzed.Results: During the study period, 225 cases were included. Age of the patients was 39±18 and the age range was from 6 to 82. 177 (78.5%) were males and 48 (21.5%) females (male to female ratio was 3.7 to 1). The most common age range in terms of injuries was in age group of 20-50 (60.4%). Burst fracture was the most common type of injury and was seen in 102 cases (43%). The most common cause of injury was falling down which was seen in 128 cases (56.9%) In 39 cases (17.3%), spinal cord injury was seen.Conclusion: Incidences of spinal fractures and spinal cord injury are similar to those reported in the literature, but the mechanism of trauma and kind of fracture, falling down and burst fracture respectively, are different from most of references and this needs further etiologic study.

Introduction: Effective research management at the universities requires managerial skills. Objective: This study was conducted to assess the managerial skills of the research managers at the Universities of Medical Sciences in Iran in 2003. Materials and Methods: Self-administered questionnaire containing 21 items was designed to assess the technical skills (methodological, technological, budgeting), conceptual skills and the human skills of the managers. The rating scale of 5 degrees was used. The consuming time on each skill and the managers motivation for work were also asked. Results: Of the total number of 78 managers, 50 answered. About 60% of them have assessed their skills at high degree and 40% moderate or weak. Their assessment revealed that they are weaker in technical skills such as quantitative approach, data analysis, and resource identification, budgeting and financial skills. Concerning conceptual skills, they needed to be trained in systems approach, designing, situation analysis and prediction.The most of the managers time was spent on methodological skills (35.7%) and the other skills took the following ranks respectively: conceptual skills (22.4%), budgeting and financial skills (15.4%), human skills (14.5%), technological skills (11.8%). A personal incentive had more effects on their function (39.7%), and the organizational task was the second effective factor. Conclusion: It is concluded that managerial skills of the research managers should be empowered within the framework of in-service programs basing on the educational goal proposed in the paper.