Journal of Guilan University of Medical Sciences
Year:2009 | Volume:17 | Issue:68|Papers Count:15

Introduction: Considering the surface water resource as one of the main potable water supplies and the application of chlorine as one of the main disinfectant drinking water has increased the rate of Disinfection By-Products (DBPs) formation. One of the main group of DBPs are THMs compounds that the studies showed they  have the potential of increasing the rate of kidney, liver adverse effects and are carcinogen compounds.Objective: Survey the THMs concentration in lahijan drinking water and relation between THMs formation with temperature, pH, free residual chlorine and Total Organic Carbon (TOC).Materials and Methods: In this study, five locations in four steps were selected for sampling; two points in sangar water treatment plant (SWTP) include: raw water and treated water and three points in lahijan distribution system include: before and after of chlorination unit and in termination of distributed water, where samples collected in winter (9 samples) and summer (7 sample) and then analyzed by the GC set with EC detector.Results: This study show that the THMs concentration in raw water and treated water in SWTP was normal and THMs concentration in treated water was less than raw water that showed effective efficiency of treatment plant units. THMs concentration in before of chlorination unit was normal and in after of this unit and termination of distributed water was more than US.EPA standard. This study showed a positive relation between THMs formation with temperature, pH, free residual chlorine and TOC. Minimum and maximum concentration of THMs compound was seen in treated water of SWTP and in termination of lahijan distributed water, respectively, that show the relation between exposure time and DBPs formation.Conclusion: Regarding to high statistic of digestive cancers in Guilan, epidemiological studies showed effective agents about this cancers including: genetic agents and usage of salty foods. But, high concentration of THMs in total samples in lahijan distributed water could be an effective agent in increase of statistic digestive cancers in lahijan.

Introduction: Ghrelin is a 28-amino Aside peptide that predominantly produced by the stomach, which is the major source of systemic ghrelin. The anorexigenic and orexigenic hormones leptin and Ghrelin acted in opposite of each other. There are limited studies related to levels of leptin in hematopoiesis, and there is no literature pertaining to the effects of ghrelin on hematopoiesis. Objective: Determination the effect of Ghrelin on Hematopoietic Wistar Rats. Materials and Methods: 30 male wistar rats were allocated for this study and were randomly divided into control and experimental groups. To monitor the effects of Ghrelin on blood parameters including hematocrit, albumin, total protein and white blood cells differential count, a general protocol of SC injection of Ghrelin (1 nmol/100ml N/saline) or 100 ml vehicle (physiological saline) to the control group was applied once a day for 10 consecutive days. The animals were killed by decapitation on days 5 and 15 after the last injection and above mentioned parameters were measured after their blood collection. Results: Hematocrit percentage and RBC count significantly increased on day 5 and MCV decreased on this day (p< 0.05). However there was no significant difference in other parameters. Conclusion: It seems that Ghrelin acts directly via bone marrow or indirectly increases ACTH or growth hormone secretion and therefore modulates hematopoiesis.

Introduction: Although cancers occur rarely in children, they considered as the second cause of death in children under 14 years old.Cancers in children differ markedly from those in adults according their nature, distribution, and prognosis. Acute Lymphoblastic leukemia and lymphoma account about 40%, central nervous system tumors consist of 30% and embryonal malignancies and sarcoma account for about another 10% of all pediatric cancers.Objective: Epidemiologic evaluation of pediatric causes of cancer who referred to 17 Sharivar hospital in Rasht during 2001-2007.Materials and Methods:  This descriptive cross- sectional study was carried out in 17 Sharivar hospital in Rasht from 2001-2007. All cases of pediatric cancers were included in this study. All information about the age, sex, type of cancers and residence of patients were collected from their medical records; 152 forms were completed and the data were analyzed by SPSS.Results: Among 152 patients with different types of malignancy there were 89 male (58.6%) and 63 female (41.4%). Ratio of male to female was 1.36 in acute lymphoblastic leukemia, 0.71 in AML, 4 in non-hokin ulmphoma (NHL) , 0.33 in sarcoma. 1.6 in Wilms Tumor, 2 in Hodgkin disease, 5 in neuroblastoma 0.25 in soft tissue sarcoma and 0.5 in medulloblastoma.  The peak incidence of cancer was in the ages between 3 to 4 years. (11.2%) and lowest was in the ages of 14 to 15 years. (0.7%). ALL was the most common cancer 47.6%  and Langerhanse histiocytosis was the least common  one (0.7%). The prevalence of other malignancies  were NHL 9.9%, Wilms Tumor 8.6%, AML 7.9% CNS Tumors5.9%. HD 5.9%. The majority of patients were inhabitance of Rasht (47.4%). Hashtpar 7.2%, Rudsar 5.9% Langrood 5.3% and Fouman 4.6% consisted the next four cities with high rates of pediatric cancers. Amlash and Siahkal had the lowest prevalence of patients (0.7%).Conclusion: In this study pediatric malignancies were more prevalent in males and the other epidemiological characteristics were quite different from the other studies, It need further evaluation.

Introduction: Inability to establish a success vascular access or associated complications are major causes of morbidity and mortality in ESRD patients.Objective: Relative Frequency of Success and Complications of Vascular Access in End Stage Renal Disease (ESRD) in Razi Hospital (2007).Materials and Methods: This descriptive-cross sectional study was performed on ESRD patients in Razi Hospital. The data were collected based on interview and physical examination. Because of the probability of failure in access of any patient and need to another access establishment, the access numbers was more than the patients number.Results: Among total of 151 patients 59.6% of patients was man and 40.4% was woman. The mean age of patients was 54.22±14.39 years. Success rate of dialysis was 86.1%. 82.9% of vascular access was used less than 2 months of creation (mean=31-60 days). 32 cases of complications (15.6%) were recorded which included: 9 cases of false aneurysm, 9 cases of venous hypertension, 5 cases of infection, 4 cases of steal syndrome, 3 cases of true aneurysm and 2 cases of thrombosis. The most number of complications were happened in antecobital AVF.Conclusion: Success rate of dialysis in this study is like that other studies.  Because of patients don't refer in proper time; use of vascular access was performed in less than 2 months of creation. It can increase complications and decrease patency rate of vascular access. On the other hand, to decrease the cost, usage of graft is less than native AVF, it could be reason of increased presence of complications in native AVF.

Introduction: The biophysical profile is one of the best methods of assessment of fetal well-being and prediction of adverse prenatal outcomes. Non stress test is a part of biophysical profile which had a high rate of false positive and decreased the score of biophysical profile that resulted to increase cesarean rate due to early intervention for termination of pregnancy.Objective: Prenatal outcomes in high risk pregnancies with abnormal biophysical profile score without Non-stress test.Materials and Methods: This cross-sectional descriptive study was performed on 1000 women with high risk pregnancy who was admitted in Alzahra hospital for delivery.Information about variables were found according the contents of their files such as maternal age, gestational age, parity, cesarean rate, 1 and 5 minutes Apgar score <7, fetal heart abnormalities rate, meconium passage, low birth weight, fetal and neonatal death, and preterm labour. The score of biophysical profile 6-8 was considered normal and score <6 were considered abnormal.Data were analyzed by SPSS 11.5 and chi-square and Fisher Exact Test.  P<0.05 was considered significant. Results: 1000 pregnant women with high risk pregnancy were evaluated in this study. 24.9% of them had biophysical profile score less than 6 which had considered abnormal.The comparison of the two groups showed that the rate of cesarean section, 1 and 5 min Apgar score <7, fetal heart abnormalities rate, preterm delivery, and neonatal mortality rate were higher than in abnormal group (P<0.001), But there weren't statistical significant differences between low birth weight, meconium passage, and fetal death in two groups.Conclusion: The biophysical profile without non stress test can be predicted poor prenatal outcomes in high risk pregnancies.

Introduction: Oldness is an inevitable phase in the end of every human’s life, so knowing the process of oldness and special problems of it and designing curative and supportive services for it is a necessity for medical principles of the every society. Objective:  Determine satisfaction of services which are given to elderly in Rasht disabled and elderly residential in 2008.Materials and Methods: This is a descriptive census study. Date was collected from questionnaire and interview of 100 person population of RDER who had more than 55 years old and hadn’t dementia or psychological and mental disorders according to their medical files. The study was a survey (without sampling) and the data collection was done by a researcher- made questionnaire. The disabilities were measured by LTC disability categories and answers which are given in interviews. Questionnaire had two parts: The first part collected demographic data, the second part related to physical mental social and physical Environment. Following likert, every question had five answers as satisfied: completely (4), satisfied (3), unsatisfied (2), unsatisfied completely (1) and no opinion (0). Satisfaction level was classified as weak (0-33), moderate (34-66) and high (67-100). Data analysis was done by Man Whitney, croscal wallis and spearman and tocki indices and one way variance analysis using SPSS 14.Results: Level of satisfaction from physical cares was 58%, from psychological cares was 66.29%, from social cares was 59.39% and from physical environment was 71.1%. There was a statistically significant relation between satisfaction from physical services with the marital status, Income average level and inabilities in ADLs; Relation between mental satisfaction and previous residential place, relation between social satisfaction from physical environment and gender were significant.Conclusions: The overall level of satisfaction from services which are given in RDER was in middle range (62.07%). Therefore manageria and exe cutive officials of RDER Should modify their plan of care giving for preparation of more equipment and educated care givers (Especially psychologists), special services for religious and spiritual rituals, sports and enterdainment. This modification should cover abilities and desires of olds and make opportunity for visiting friends and family beside routine programs.

Introduction: Beta-thalassemia major caused abnormalities of the eyes because of skeleton deformities, especially in the skull and long-term desferrioxamine (DFD) treatment. Objective: Assessing the refractive errors in Beta-thalassemia major patients.Materials and Methods: A total of 71 thalassemia patients who referred to Qoads hospital of Qazvin, were included in this study. Thirty-seven patients (52%) were female and thirty-four patients (48%) were male seventy one persons who were referred to same Hospital for opthal examinations were randomly selected as control group. All the patients (sample and control) after filling the questionnaires underwent an ophthalmologic and optometric examination by the same optometrist. Ultimately, the data were analyzed by using Spss. Result: The mean age of patients was 16±50, 37 patients were females and 34 patients were male. Among 71 patients 142 eyes 48 cases, 96 eyes (68%) were hyperopia and 18 cases (25%) were myopia. Whereas, from 142 aged-match control group, 64 persons (90%) were myopia and 4 persons (5/6%) were hyperopias. The mean of Right and Left Axial length in thalassemia patients showed 22.52±0.34 and 22.57±0.38 and for control group showed 23.12±0.7 and 23.13±0.64. There was significant difference between two groups (p<0.05).Conclusion: The occurrence of refractive error (hyperopia) in thalassemia major patients is affected by either orbital deformity or toxicity of desferrioxamine treatment and should be taken into consideration. This study showed involvement of the Beta-thalassemia major in visual system especially in hyperopia.

Introduction: Cyclic mastalgia is a common cause of anxiety among women that leads to a health care centers. Because of some characters, it is important to advice correct cure.Objective: Evaluation of correlation between BMI and cyclic mastalgia in 20 years old to premenopausal women.Materials and Methods: This was a case- control study that has been done on 102 women in Navab clinic of Qazvin. They were divided into two groups of 51 members: case group with cyclic mastalgia and control group with normal women. Duration and intensity of pain was evaluated by visual analog scale (VAS) and breast pain chart. BMI (Body Mass Index) was determined in two groups and then they were compared. Data was analyzed by T test and chi square. Results: Mean age of two groups were 31/2 and 31/5, that there was no statistically significant difference. Range of BMI in case group was 21-36 and in control group was 20-30 .Mean of BMI in case group was 28.81 +3.22 and in control group was 25.14+ 2.19. That showed significant statistically difference, (p= 0.000).Conclusion: This study showed that BMI of control group without mastalgia was in normal range. BMI of case group with mastalgia was in abnormal range and significantly was higher than control group.

Introduction: Acute Urinary Retention (AUR) related to benign prostatic hyperplasia (BPH) is an increasingly prevalent condition in men, and the presenting feature in about 25% of men undergoing prostatectomy. Objective: Eevaluate the efficacy of sildenafil for treating patients with AUR due to BPH.Materials and Methods: This is a clinical trial, randomized, double blind study. Eighty patients with AUR related to BPH randomly assigned to receive either 0.4mg tamsulosine hydrochloride and 25mg sildenafil citrate or 0.4mg tamsulosine hydrochloride and placebo. After 48hours, the catheter was removed and ability to void in each group was assessed. Data were analyzed by SPSS 10 and K 2 , T test, P<0.05 was considered significant.Results: Differences in age, prostate size and residue was not significant between two groups (p=0.791, p=0.587, p=0.364 respectively). After catheter removal 22 patients (55%) in placebo group and 32 patients (80%) in sildenafil group voided successfully (p=0.017). After 1week 19 men (47.5%) taking placebo and 28men (70%) taking sildenafil could void yet (p=0.041).The difference between two groups was statiscaly significant (p=0.041).Conclusion: Addition of sildenafil citrate to alpha-blockers is effective in successful voiding after catheter removal for AUR related to BPH. Sildenafil may be recommended for reducing the re-catheterization rate.

Introduction: Open surgery is the gold standard of treating the saghorn calculus which all other forms of treatment are compared with it. New endourological techniques leads to treating staghorn calculus with more effective and less invasive methods. Objective: Compare the complication of PNL (percutaneous nephrolithotomy) versus open surgery in staghorn stones.Materials and Methods: In this study 120 patients with staghorn stones who admitted in Razi hospital during September 2005 to September 2007 were considered. The requested information was extracted such as age, sex, treatment method, intraoperative and postoperative complications (including Obstructive uropathy, Massive hematuria, and Wound infection) and hospital stay. The results and complications were compared in patients who underwent PCNL with open surgery and were compared and data were analyzed by T-test and chi- square. Results: We studied 72 patients (60%) underwent PNL and 48 patients (40%) underwent open surgery. We recorded intraoperative complication in 18.8% and 13.9% in PNL and open surgery respectively. The most common intraoperative complication was bleeding requiring blood transfusion. We recorded postoperative complication in 12.5% and 4.2%of patients in PNL and open surgery repectively. Mean hospital stay was 3.93±1.76 and 5.08±2.42 day in PNL and open surgery respectively. Stone free rate was 81.9% and 91.6% of patients who underwent PNL of patients and open surgery respectively.Conclusion: PNL is a valuable treatment option for staghorn stones with complication and stone free rate approaching that of open surgery. Moreover, it has advantages such as shorter hospital stay that because it is the first stage in treatment of most patients with staghorn stones.

Introduction: Covernous Hemangioma is the most common vascular orbital tumor which appears gradually progressive with axial proptosis without any pain and inflammation.This tumor sometimes appears bilateral but very seldom multilobes in one orbit or in the bone.Case History: In this report we in traduced a 37 years old woman who has complained from progressive axial proptosis in her left eye for 2 years.In the MRI examination 3 separated lobes with hyper dense was observed intraconal area which three lobes of tumor were extracted by surgery through lateral orbitotomy. In the pathologic report of tumor cavernous hemangioma was confirmed. Conclusion: Orbital cavernous hemangioma sometimes appears bilaterally and very seldom multilobes in one orbit, which the last case was very rare. Thus it’s recommended to pay complete attention during operation in order to remove the tumor entirely to prevent its recurrence.

Introduction: Schwannoma is a nerve sheath tumor originates from Schwann cells, with slow growth and usually benign. Spinal schwannomas almost arises from dorsal (sensory) root. C1 ventral root schwannomas which limited to the anterior part of medullospinal junction is extremely rare. These tumors may extend to foramen magnum and manifest as foramen magnum syndrome.Case History: This report is presented a 60-years old female with cervical and occipital pain, spastic quadriparesis and dissociative sensory loss. Cervical MRI demonstrated an extramedullary intradural tumor in anterior part of foramen magnum.C1-2 Posterior midline suboccipital laminectomy with spinal cord decompression was performed. After surgery, her symptoms improved. Histopathological evaluation revealed schwannoma.Symptoms of foramen magnum syndrome are various. Conclusion: Nonspecific, so diagnosis requires a high suspicious in early stages, when tumor resection may lead to significant improvement of the patients.