Journal of Guilan University of Medical Sciences
Year:2002 | Volume:10 | Issue:39-40|Papers Count:25

Cessation of breastfeeding, especially in the first 6 months after delivery, could have negative effects on mental and physical health of infant and mother and their mutual relationships. Despite high prevalence of puerperal psychiatric disorders, evidence of correlation between mental disorders and interruption of breastfeeding isn't existent. In this research, it has been tried to find whether there are any significant differences in general mental health, depression and anxiety mean scores among mothers who stopped breastfeeding, or used supplementary feeding with continued exclusive breastfeeding. 300 mothers who fulfilled the research requirements, were tested by General Health Questionnaire (GHQ 28), Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). Data were analyzed using One-way ANOVA, t- Test and Kruskal Wallis. Results suggested that those who stopped breastfeeding and the supplementary feeders, had higher rates in general mental health (P=0.02) and anxiety (P<0.001), but not in depression (P=0.18). A longitudinal study is suggested to study the cause and effect relationship between mental health and continuation of breast feeding.

Iodine deficiency disorders (IDD) is a worldwide health problem. Many parts of the Islamic Republic of Iran had been known as areas of endemic goiter. IDD was accepted as a priority health problem in the country, and a national IDD council was formed in 1989, under the supervision of the Ministry of Health and Medical Education. One of the main strategies of National Council for IDD control was to provide at least 150 mg of iodine per day to the entire population through making available iodized salt. This study was performed to evaluate the national LDD council program in 1996, in rural and urban areas of Gilan. 1350 schoolchildren, aged 8 to 10 year, including 50% girls and 50% boy, were selected through random sampling. Grading of Goiter was performed according to WHOs classification. Serum T3, T4 and TSH were measured by RIA and uninary iodine by digestion method. The mean of serum T4, T3 and TSH were: 10±1.7 µg/dl, 15±71 ng/dl and 2.0±1.5 µlu/ml respectively. There were no differences between males and females and schoolchildren of rural or urban areas. 0.2% had serum T4 more than 12.5 µg/dl, one person had TSH more than 5 µlu/ml. The median iodine was 23 µg/dl in entire population, 94% had urinary iodine more than 10 µg/dl. Only 3% had urinary iodine less than 5µg/dl. Total prevalence of Goiter was 72% (72% in girls and 72% in boys). Based on the available data, seven years after distribution of iodized salt and 2 years after used iodized salt with more than 50% of population, urinary iodine of school children in Gillan is inadequate range. However regarding to prevalence of Goiter in 72% of our study group, Goiter is still hyper endemic in Gillan province.

Depression is a common disorder and WHO has ranked fourth on the list of the most urgent health problems worldwide. Severity of disability resulted from depression is comparable with 8 major chronic disorders. The impact of depressive disorders on poor outcome of coronary artery disease appears equal or exceed than other well-known cardiovascular risk factors .Our purpose was to ascertain prevalence of depressive disorders in post MI patients because of the important practical implication. This study was cross-sectional and included 234 post MI patients who were admitted since 20/2/2001 to 21/5/2001 in Heshmat Hospital in Rasht. Patients were requested to fill a questionnaire, if patient's score was more than 10, types of depression were evaluated with DSM-IV clinically. With consideration of other factors such as sex, age, occupation, residence, educational and marital status،data were analysed with spss software and chi2 test. From 234 patients who filled this questionnaire, 137 (56.5%) were male and 97(41.5%) were female, 123(52.6%) had one type of depressive disorders that major depression was the most common (n=51, 21.8%), followed by, dysrhythmia, minor depression and recurrent brief depressive disorder, respectively. Also, sex, age, residence and marital status were not significantly related to depression, but there was relation between occupation and educational status with depression (p<0.05). We found that depression was common in post MI patients and require be diagnosing and managing as soon as possible.

Sciatic nerve which is responsible for innervation of major part of the lower limb, can be injured with various causes. One of the common sites of this nerve injury is gluteal region. This injury occurs following hip arthroplasty and other surgeries of the hip region, Fx - dislocation of the pelvis and femur, acute external compression of the nerve, intragluteal injections, and some other reasons. In the recent years, we have seen several cases of Sciatic nerve injury following Diclofenac intragluteal injection. In the present study, we have reviewed 11 cases clinically and electrodignostically during a 4-year period. All of them has been examined within the first month after injection, and most of them has been tested serially during 2 next years. It should be noted that all of the patients were children, old persons or young thin men. S of 11 patients (73%) had complete lesion of common peroneal nerve (foot drop), accompanied by various degrees of Tibial nerve lesion in 4 cases. 3 patients (27%) had incomplete lesion of common peroneal nerve (CPN). Tibial nerve was never involved alone. Axnoal degeneration was the path physiology of lesion. in all cases. It appears that chemical irritation (toxic neuritis) was the pathogenesis of the lesion. CPN was more involved than Tibial nerve because of its especial anatomic situation. Prognosis of complete lesion was poor and there was no functional recovery. With respect the results of this study, it is recommended to avoid Diclofenac injection in persons below 14 years old, old and thin persons.

Vocative Intestinal Polypeptide (VIP), has been found in different neurotransmitter systems and exists in various nerve tracts in the brain. Potential role of this peptide in physiological processes such as regulation of sleep and wakefulness, and biological rhythms has been confirmed in several reports. In the present research effects of intracerebroventricular (ICV) injection of a VIP antagonist, 4-CID- Phe6/leu 17, at different circadian time on rest-activity cycle of rats during free- run, has been investigated. Results of this study showed that brain clock in definite time of its endogenous rhythmic activity is sensitive to the antagonist and presents this sensitivity through phase advance following ICV injection at CT 6. While injection of same drug at other circadian time and also injection of artificial cerebrospinal fluid has no effect on this rhythm. According to our experiment and considering the results of others, the sensitivity of locomotor, rhythms to VIP ergic system is revealed. In previous studies, effect of this antagonist on sleep homeostasis has also been demonstrated. Regarding difference in type and distribution of known VIP receptors in sleep homeostasis and biological rhythm of locomotor, activity, it is clear that above mentioned synthetic antagonist has no speciftcity for known VIP receptors.

Acute myocardial infarction (AMI) is the leading cause of death in most countries. With the advent of modem coronary care units CCU during the last decades particularly since 1960, the thrombolytic therapy and interventional techniques including angioplasty; the mortality of AMI has decreased significantly. Moreover the vigilant approach towards diagnosis and control of risk factors have resulted increase in mean age of AMI cases. To evaluate the mean age of AMI occurance in recent years (1999) and to compare it with the mean age of AMI ten years ago (1989) in Dr. Heshmat cardiovascular center of Rasht, we carried out this study on 1000 cases. Mean age of AMI in 1989 at our center was 58.08 years, while in 1999 this appeared as 59.98 years. An increase of 1.9 years in mean age of AMI occurance within 10 years period was statistically significant (P<0.0005). Results of this study suggest that, during one decade mean age of AMI incidence in Rasht (north of Iran) has increased. Finally, the results are suggestive of overall positive effects of health knowledge and practice in disease control. The probable improvement in dietary regimen of patients suffering from hyperlipidemia, hypertension and diabetes mellitus may include the factors increasing the age at the time of AMI occurance.

Shivering after surgery is common and followed by many problems. Therefore prevention of shivering is important specially in elderly and Ischemic Heart Disease patients. The etiology of shivering is unknown, although is thought intraoperative hypothermia is a major causative factor. Another possible etiology is fever and chills secondary to activation of the inflammatory responses and release of Cytokinas by trauma of surgery. Dexamethasone decreases the gradient between core and skin temperature and modifies the inflammatory responses. The goal of this study was to determine the reduction of the incidence of postoperative shivering with Dexamethasone. This study was a clinical trial, randomized, double - blind and placebo -controlled that was done on 250 patients between 20-60 years old (female and male) and ASA class I and 11. Patients scheduled for elective surgery were randomly assigned to receive either Dexamethasone 0.25 mg/kg or placebo before induction of anesthesia. All of patients received standard monitoring and the same anesthetic management. In the post anesthetic care unit (P ACU) shivering and patient, temperature recorded for an hour. Compared with placebo, Dexamethasone decreased the incidence of shivering (40% vs 16.7%, P<0.001) In conclusion Dexamethasone is effective in decreasing the incidence of postoperative shivering. The effectiveness of Dexamethasone is independent of duration of surgery.

Adolescence is an important period of human's growth and development. The developmental characteristic of this period can produce many behavioral problems, such as delinquencies, drug abuse and psychiatric problems. Regarding to this fact that young population is expanding rapidly in Iran, control of these problem seems important. Thus with the aim of detecting the prevalence of psychopathology in high school students in Rasht in 2001, we have done a study. A cross-sectional study was done in 557 high school student with SC190R (Symptom check list 90 revised) questionnaire and appended's. The results were evaluated with EPI6 soft ware, that indicated prevalence of psychopathology as fallows: GSI 10.5%, paranoid-ideation 39.1%, interpersonal sensitivity 17.6% ,hostility 16.5% , depression 16.2%, anxiety 13.3%, obsessive-compulsive 11.8%, psychotism 11.6%, somatization 7.7% and phobia 3.2%. There was significant statistical difference between boys and girls paranoid ideation, interpersonal sensitivity, hostility, depression, anxiety, obsessive- compulsive (P<0.05). There was direct relation between smoking and paranoid ideation, somatization obsessive- compulsive and aggression. Also there was direct relation between age and paranoid ideation. There was direct relation between family member and aggression and phobia (p<0.05). There was no relation between subsebts of psychopathology and mothers educational level, family structure and students school average level. However, we found lower prevalence of psychopathology in our population than other published paper, much attention should be paied to mental health of adolescence.

There are some reports about hepatitis B and C Virus infection in hemophiliacs in different part of our country. We studied Guilan Province hemophiliacs to determine the frequency of hepatitis B surface antigen (HbsAg), anti hepatitis C antibody and liver function test impairments. This study was done from Feb to Apr 1999 among hemophiliacs registered in Guilan Hemophilia Society. Patients were examined for anti hepatitis C antibody (Radio immunblot assay (RIBA-II) method), hepatitis B surface antigen (Enzyme linked Immunosorbant Assay (ELIZA)) and liver function tests. 101 patients included. Mean age was 19.7 years old (Range 3-71 years old), 100 patients were male and one female. 29 patients (28.7%) had increased serum level of Alanine Aminotransfrase (ALT). 27 patient (26.7%) were HbsAg positive and 72 patient(71.3%) were Anti HCV -Ab positive. Duration of clotting factor receiving until 1376 (1996) had an association with positive Anti HCV-Ab (P=0.01) but not with positive HbsAg or increased ALT. Clotting factor activity had an association with positive Anti HCV-Ab (P<0.001) and positive HbsAg (P<0.04). Frequency of positive anti HCV-Ab in who had received leophilized Factor VIII and Cryoprecipitate Factor VIII or Factor IX and Fresh Frozen Plasma (FFP) was greater than who had received only leophilized factor VIII or FFP.(p<0.01). Frequency of HbsAg positive patients was more than what we expected. Vaccination against hepatitis B virus after diagnosis of hemophilia is advised. Although Anti HCV -Ab. frequency was similar to other studies, frequency of increased AL T was less. Because of high chronicity of hepatitis C Virus, diagnose and treat Anti HCV positive patients are suggested.

Some changes are present in ECG of about %90 of patients with subarachnoid hemorrhage (SAH) who are admitted due to cerebral aneurysm. The most common site of these lesions among the cerebral arteries is anterior cerebral arteries which supplies autonomic cardiovascular c. centers. It seems that the location of aneurysm is effective on variability of ECG manifestation and there is not refer to this important point in our refences. This prospective, cross - seetional study was done on 94 patients, presenting with SAH due to cerebal aneurysm which their angiographies detected the location of pathology during 1374-1379. ECG of these patients was taken two times, one on admission and other on discharge -after 3rd week of admission. The mean age of cases was 52.1 years old and this group was composed of 54 male and 40 females. In patients who have aneurysm based on brain angiographies, more ECG changes are present (P<0.001). The most changes of ECG were in the anterior cerebral artery aneurysms (P<0.001l). Q-TC changes observed in 46 cases in form of prolonged Q-TC interval in admission and 14 cases at the time of discharging which these differences are statistically significant (P<0.001). ST changes observed in 24 cases at first day and 2 cases at the day of discharge which are statistically significant (P<0.001). T wave changes were observed as T tall or severe inverting in st cases on admission and 11 cases on the time of discharge which are statistically significant (P<0.001). Attention to ECG of nontraumatic SAH patients could have indirect role in management of these Patients.

Preterm delivery is an important problem in gynecology and neonatology. To compare magnesium sulfat (Injection) and placebo effects in prevention of preterm delivery, in a Clinical trial, 13 women in treatment group and 19 women in control group were participated. Magnesium Sulfate (according to Protocol) and Ringer Solution or 2/3 Dextrose, 1/3 Salin Solution was given to treatment group and control group, respectively. Delayed delivery as outcome in 24 hours, 48 hours, and 7 days later was measured. Delayed delivery in 24 hours in treatment group was slightly increased, but in 48 hours and 7 days follow up it was slightly increased in control group (Statistically). There was no difference between Magnesium Sulfate and Placebo perfusion in prevention of preterm delivery. Another trial with Magnesium sulfate +Antibiotic is suggested.

OME is a Common disease in children. Over than 90% of children in preschool ages experienced this disease once at least. Despite medical therapy about 10% of the OME patients won't improved and these are the group of patients who referred to as chronic OME patients. Insertion of VT in TM is an accepted therapy for these patients and during surgery for insertion of VT, suctioning of middle ear effusion is done. This suctioning produces noise and this noise can produce SNHL. Further, during suctioning probable traumatization of external ear canal, developing hemorrhage in the canal, obscuring visual field of surgeon, and finally surgical time becoming too long are probably. This double blind clinical trial that included 50 patients with bilateral COME evaluated the effect of suctioning of middle ears effusion before VT insertion on hearing acuity of patients with COME. All selected patients had type B tympanogram and conductive hearing loss over 20db in both ears. The patient with unilateral COME and tympanogram of type C was omitted. In right ear after myringotomy and in left ear after myringotomy and suctioning of middle ears effusion VT was inserted and patients were followed up in one week, three weeks and three months after surgery and in each examination the degree of improvement of hearing was evaluated by mean of audiometery. The results of this trial analyzed by statistical chi-square and t.test. 46 suctioned ear (92.4%) and 34 unsanctioned ear (68%) developed hearing improvement at the end of the first week. Hearing improvement in the two groups at the end of third week and third month was 100%. Therefore, we concluded that the degree of hearing improvement in patients with COME doesn't correlates with middle ear effusion suctioning during surgery for inserting VT.

The aim of this study was comparing the efficacy of induction of labor using balloon Foley catheter with conventional Oxytocin infusion method in cases of unfavorable cervix. 60 pregnant women that had an indication for induction of labor with a singleton vertex fetuses, intact membranes, and bishop score lower than 4 interred in this study and allocated in one of two induction methods randomly (30 women in each group). Method of induction was insertion of Foley catheter no. 18 with a 30 ml balloon (Badex Foley Catheter) in Case group. Inductions were done by Oxytocin drip in control group. Cesarean rate, number of induction tries, Bishop Score change, dilatation of cervix, and the induction to delivery interval were assessed and compared in two groups with Chi square, Fisher exacted, T-Student, and Mann- Whitney tests. Cesarean rate were 43% and 63% in case and control groups respectively. The mean of Bishop Score change in two groups were 5±1.7 and 2.5±1.2 respectively (P<0.01). The means of induction to delivery interval were 8.6±3.3 hours and 15.8±3.2 hours respectively without statistical significant difference. The Foely catheter is a superior method for cervix ripening and labor induction of unfavorable cervixes compared with conventional Oxytocin infusion method.

Nowadays participation in sports has increased among women thus, sport injuries which makes an inevitable part of it has increased too. Determination of sports injuries incidence has a critical importance in care programs. In this study 97 cases of sports injuries occurred during the Second Islamic Countries women's sports games were evaluated. For each case referee a special form was filled out by the physician. This form included these parameters: age, field of sport, nationality, transportation to hospital, timing of the accident (training or competition, first, middle or last part of the play), anatomic location of the injury ,kind of injury, history of previous injury, involvement of another player in occurring, leaving the game, warming up and physical fitness (weekly training). Then incidence of injury was calculated in contact and non contact sports separately. Incidence of injuries per participants and incidence per hours of play were calculated. Incidence of sports injuries had a significant relationship with the kind of sport (contact or non contact), (P=0.02) Mean of age of injured cases was 20.08 yr. The highest rate of injuries was reported in Badminton, Handball and Karate, and lowest of which in Chess, Swimming and, Shooting. The highest rate of injuries occurred in the lower limb (56.7%). In 94.8% of cases, soft tissue was injured. In 47.4% of cases contusion and 14.4% wound or laceration were reported. Other kinds of injury had lower rates. 81.5% of cases had warming up equal or more than 10 minutes before playing. 8 1.1 % of cases had equal or more than 3 times hour/week training in their program. The contact sports group had significant relationship with transport to hospital (Fischer index=0.01), history of pervious injury (P=0.006), ankle vs knee (in lower limb joints) (P=0.05).leaving the game (P=0.0001), another player involved in injury (P=0.00). The most frequent sports injuries was soft tissue injuries and occurred most tTequently in the lower extremities and sports injuries occurs more frequently and more severely in contact sports than non contact sports.

Stressful life events are seen frequently, prior to suicide in persons who attempted. This study was done to survey problematic life events prior to suicide attempt in patients who had been admitted in emergency ward of Razi Hospital in Rasht 2001. To achieve this goal, 173 patients who had been admitted due to suicide attempt were interviewed by two trained male and female general practitioner .For collection of data, a questionnaire was used. Findings of investigation showed that the most common life event was family problem (76.1%). problem in interpersonal relationships (25%), especially break in love, financial problems (12.1%), death of close friends or relatives(4%), somatic illness (3.4%), academic problems (2.3%) and legal problems (1.1%) were less frequent. Significant statistical relationships were found between life evens of death of close friends or relatives (p=0.02), financial problems(p=0.04), problem in interpersonal relationships (p<0.01) with age groups and financial\ problems (p<0.001)job problems (p<0.0001), problems in interpersonal relationships(p<0.02) with sex and death of close friends or relatives with academic level and job problems(p<0.02), problem in interpersonal relationships (p<0.01),family problems (p<0.01), academic problems (p<0.03) with marital status financial problems with place of living (p<0.01). It is concluded that, problematic life events prior to suicide attempt in two sexes, age groups, different academic levels, marital status and place of living was vary and significant relationships were seen between them. More study about these relationships and their patterns for identifying of high risk groups in front of problematic life events and presenting appropriate programs for reducing suicide attempt is recommended.

The indication for venous surgery in the treatment of erectile dysfunction has been reduced as evidence of unsatisfactory long - term results have emerged. The short and long - term results of venous surgery were assessed in patients with veno - occlusive dysfunction who were selected in the basis of thorough diagnostic criteria. All of patients in this study were unresponsive to maximum recommended does of intracavemous injection therapy. All of patients provided a detailed medical and sexual history underwent a complete physical examination. Douplex Doupler US of penile arteries and cavernosometry and cavernosograpy was also performed, and serum testosterone concentration was determined. The Study group included 16 impotent men and from 27 to 48 (average, 37 years) who underwent complex penile venous surgery. Of the 16 patients, 15 (93.7%) had normal erections within one year after surgery but one patient needed to injection (20 mg papaverine) for erection. At long - term follow up, I Tom 13 to 60 months (average 60 months) spontaneous erection were demonstrated in 11 patients (68.7%). It would appear that the short and long-term complex venous surgery can result in more successful outcomes, provided that it performs in case of pure and high - degree veno - occlusive dysfunction as well as careful selection of patients.

Postoperative nausea and vomiting (PONV) is a common and unpleasant complication. Various drugs are used for prevention and treatment of PONV. Recently an antiemetic effect of Lorazepam has been reported, that it's usage as premedication can reduce PONY in children. As Benzodiazepines are safe drugs, their probable antiemetic effect may reduce the usage of other antiemetic drugs with psychologic and extrapyramidal side effects, and prevent poly pharmacy in anesthesia. This study is a clinical trial. In this randomized, placebo controlled study, the effects of Midazolam versus Diazepam or placebo on "PONV" were compared. We studied 75 patients undergoing surgical operations. They were randomly assigned in 3 groups. Patients in group 1, received 0.01 mg/kg Midazolam i.v, patients in group 2, received 0.1 mg/kg Diazepam i.v and patients in group 3, received 2ml Normal Saline i.v as premedication. The patients were observed for "PONV", 24 hours after operation. The incidence of PONY in the groups of Midazolam, Diazepam and placebo were 20%, 32%and 36% respectively. In the statistical analysis with fischer exact test no significant difference was observed between three groups (1=0.05). It was concluded that Diazepam and Midazolam neither have antiemetic effects nor different effects on "PONV".

Elderly is an experience that each person will confront with it. Loneliness phenomenon and social solitude has much share in difficult old period. The purpose of this research was to study of he situation of elderly residents in Guilan Elderly Nursing Home. It was a descriptive cross- sectional study. For purpose of this investigation 170 old men and women were selected from this nursing home .Data and information were collected with questionnaire, interview and available data from old adults records. The results of this study showed that, old men had better situation compared with old women such as: literacy and educational level, occupation and income. Also the old men were compatible with other elderly more than old women. This study showed that elderlies relation with their children, friends and family in nursing home were very limited. Recreative and amusement instruments weren't enough for old adults. The results showed that old men suffered from diseases such as: lung, digestive, skeletal, vision and hearing disorders more than the old women. Old women suffered from heart and mental disease more than the old men. 44/71% old adults were completely satisfy with live in the nursing home. This was more in women than men. Old adults said that the most important reason to live in nursing home was having no children.