Journal of Guilan University of Medical Sciences
Year:2002 | Volume:11 | Issue:41|Papers Count:14

In this study, the frequency of delirium syndrome was surveyed in 245 patients who admitted in CCU of Dr. Heshmat hospital in Rasht. For this reason trained nurses visited all patients in every morning and evening and one psychiatrist visited them on every evening, from the first day of admission till the end of their staying in CCU.Data were obtained by structured Nursing report and clinical examination. The diagnosis was based on DSM IV criteria for delirium due to general medical condition. According to nursing reports, 33 patients (13.4%) suffered from delirium and 22 patients (67%) belonged to the above 65 years age group. There was a significant relationship between age and the occurrence of delirium with sex (p=0.0001) but not with history of admission in any CCU ward. This study confirms that delirium with a significant frequency was seen in CCU, and elders appear to be more prone to this syndrome.

The production, distribution, and consumption of iodized salt have increased in recent years. Also, a mild increase in the incidence of hyperthyroidism has been described previously and following implementation of iodinated salt programs, reinforced by other reports. Therefore, this study was carried out to assess iodine status in men and women aged more than 40 years in Tehran in 1996.In a cross sectional study in Tehran, 741 women and 514 men over 40 years of age were selected randomly. Thyroid size was examined by palpation and graded according to the WHO classification. Urinary Iodine was measured by digestion method. Serum T4, T3, and TSH (IRMA) concentration were also assayed by kits.In 211 men and 367 women aged 40-50 years old, percentage of grades 1 and 2 goiter were 53% and 22% in men and 53% and 35% in women, respectively. In 303 men and 374 women over 50 years old, percentage of grades 1 and 2 goiter were 50% and 14% in men and 51% and 23% in women respectively.The mean urinary iodine was 17±5.4 µg/dl. In 87% of the subjects, urinary iodine was more than 10 µg/dl.Mean serum T4, T3 and TSH were 8.4±1.3 µg/dl, 168±35ng/dl, and 1.4±0.7 µu/ml, respectively. Combination of high T4, T3 and suppressed TSH were observed in 2 subjects.This study points to the adequacy of iodine intake. The prevalence of hyperthyroidism has not been increased.

The goal of infertile male management is to improve the quality of semen sufficiently to allow the couple to conceive with the least invasive and the most economical method. Varicocele is the most common treatable cause of male factor infertility and its deleterious effects such as oligoasthenospermia, are likely multifactorial. Thus, with presence of varicocele in male partner of an infertile couple, surgical repair as the current standard of care is offered. It is hoped that varicocelectomy will allow the infertile patient with a clinical varicocele not only to improve the likelihood of pregnancy through natural conception, but also increase the chance of conception with a less invasive and less costly technique.However, it has been suggested that the serious oligoasthenospermic patient may not benefit from varicocelectomy substantially. In this study, from 330 patients with varicocele associated male factor infertility who underwent varicocelectomy during 92 months, 252 patients were included because their postoperative and preoperative seminal parameters were available.Preoperatively, the patients were divided into three groups, based on their preoperative total Motile Count (TM). Patient with TM >20 million (mild oligoasthenospermia) was defined as Group A, with TM, between 5 million and 20 million (moderate oligoasthenospermia) as group B, and TM<5 million (severe oligoasthenospermia) as group C. Postoperative dividing of patients was done based on postoperative TM.Retrospective data analysis has been suggested that men with mild to moderate oligoasthenospermia (TM>5 million) had significantly better seminal improvement following varicocelectomy. While preoperative dividing showed no difference in pregnancy rates. Men who achieved a postoperative TM>20 million were more likely to achieve conception by less invasive techniques.Varicocelectomy may be the most cost-effective initial intervention in infertile males with varicocele with preparative TM>5 million. Patients with preoperative TM<5 million and concomitant female factor infertility may be better initial candidates for IVF/ICSI.

Pediculosis capitis is a major health problem in the world. As W.H.O statistics, Iran is one of the most infected countries. Applied surgery in Guilan showed high incidence of pediculosis capitis in children. The aim of this study was to report the situation of infestation among 3-7 year old child. In this prospective and Cencus study we examined all 3-7 years old children in 29 kindergartens in Rasht, with a careful inspection by light microscope after seeing pedicular eggs.Live eggs infested a total of 5.1 percent. The rate of infestation was higher in girls (59%) The most incidences were in 6 years olds and the last in 3 years olds. This study showed a high incidence among 3-7 years old age group that it was more in governmental kindergartens.

Drug interactions happen when two or more drugs are administered at the same time. It is known by changing therapeutic effect of drug or drug poisoning. In this research drug interactions of anti-depressant drugs in Anzali in 2000 were evaluated.This descriptive study was conducted on 13692 regular, randomly sampled insured prescriptions. Drug interactions were studied based on the ratings of Drug Interaction Facts book.21.9% of prescriptions had at least one anti-depressant drug (61.2% in women and 38.8% in men). Drug interaction was observed in 22.4% of prescriptions and type of interaction from first degree to fifth was 14.86, 33.95, 13.49, 17.98 and 19.72 percent respectively. Psychologists and neurologists (42.1%), other specialists (21.9%) and general physicians (36%) prescribed these prescriptions. The most drug interaction was observed in other specialists prescriptions. The mean number of drugs were 3.48 1.13 in prescriptions. Excessive prevalence of anti-depressants and drug interactions in these prescriptions emphasize the correct teaching of practical pharmacology.

The Syndrome of Transient Neurologic Symptoms (TNS) after spinal Lidocaine injection has been presumed to be a manifestation of local anesthetic neurotoxicity.The purpose of this study was determining the effect of lower doses of intrathecal Lidocaine compared with conventional dose of Lidocaine on the incidence of TNS.110 patients in ASA class's I-II presenting for cesarean section were randomly assigned to receive spinal anesthesia with either hyperbaric Lidocaine 50 mg-25 g Fentanyl or hyperbaric Lidocaine 75 mg. Patients were evaluated for hemodynamic status, peak block level and regression, and Transient Neurologic Symptoms.Both groups had a median peak block level of T4.The control group had a greater need for Ephedrine (P<0.05). Ketamin requirement was similar in both groups (P>0.05).Block regression was faster in case group (P<0.05). TNS incidence was 29.1% in control group and 5.4% in case group (P<0.05). PDH incidence was similar in both groups (P>0.05).Spinal anesthesia with 50mg Lidocaine and 25 g Fentanyl provides adequate anesthesia with more hemodynamic stability, faster recovery and lesser incidence of TNS syndrome than spinal anesthesia with 75 mg Lidocaine.

Histological confirmation of respected specimens of vas deferenses after vasectomy is important, particularly from medicolegal aspects in cases of procedure failure. Non-availability of pathologists in small towns imposes difficulties for surgeons performing vasectomy. Availability of cytologists is more likely, and they can examine the smear of vasal lumen easily for this purpose.We carried out this study in 1998 in Guilan Family Planning Research Center, whether pathological reports of vas deferenses could be were substituted with vas smear.After obtaining 300 smears, all specimens were also sent for pathological examination.The specificity of vas lumen smear in recognizing "vas deferenses" was 100% and the sensitivity was 99.32%.It is recommended that in case of shortage of pathological facilities, cytologic report can be so helpful to confirm the vas deferense.

One of the anesthetic techniques with a lot of clinical benefits is spinal block that is produced by injection of local anesthetic solution into the subarachnoid space. This procedure caused 15-18% reduction in peripheral vascular resistance.Decreased blood pressure as a complication of spinal block may be seen in one third of cases. Intravenous fluids before induction are recommended for prevention of this event. There are contradictory studies in this Issue. Propose of this study was determination the effects of Crystalloid administration as a prehydration before operation on decrease of blood pressure.In this randomized clinical trial, double- blind study we selected 112 patients 60-90 years old who did not have any history of hypertension and CHF and antihypertensive medication and were candidate for elective lower abdomen operation.After taking informed consent, patients divided into 2 groups randomly. 500cc Ringer was infused 20 minutes before spinal anesthesia for the first group, second group received no intervention. Blood pressure after 5th, 10th, 15th, 20th minutes was reported. Blood pressure lower than 90-mmhg or more than %30 lower than baseline considered as decreased blood pressure and treated with 5mg Ephedrine.Data was analyzed with SPSS/9 software. We used Chi square and student T-Test, P<0.05 was considered meaningful.There was no significant difference between sex, age, weight and height with level of anesthesia in patients.The rate of decreased blood pressure in 5th minute in first group was 34 (60.7%) and in second group was 27 (48.2%) which was no significant difference. Ephedrine administration was 34mg in first and 27mg in second group. In both groups 5 persons (8.9%) had nausea and vomiting after spinal anesthesia. In this study Crystalloid administration as prehydration did not reduce occurrence of hypotention. This procedure is not useful for aging people and more studies for prevention of this complication is recommend.

The gallbladder stone is a common disease; its best management is cholecystectomy with surgical operation. Since 1882 cholecystectomy is a conventional procedure, but Laparascopic cholecystectomy procedure initially begins in France (1978) and quickly spreads in USA, European countries, and other counties around the world. Its popularity was because reducing postoperative pain, abdomen aesthetics, patients quick return to normal daily activity, shortening hospitalization and reducing costly hospital expenses. In some private hospital in Iran since nearly 10 years ago laparascopic procedures - mainly cholecystectomy- usually are done, although it was not initially welcomed. It gradually spreads on nearly all training hospitals.Since 1373 (1994) in Razi hospital 380 laparascopic procedures including 90 Cholecystectomies and others was diagnostic or cancer stagings. There were four general surgeons in Razi hospital, all in some way engaged in different Laparascopic procedures.For first 15 Laparascopic cholecystectomy operations we faced with many problems; all due our limited experiences; since then we had more experiences, and our next patients were as follow: Acute cholecystitis (12) chronic cholecystitis (shrinked gallbladders (four patients) and gallbladder empyems (two patients)).Mean of hospitalization was two days.In one case patient did not believe his/her management and repeatedly returned complaining of limited incision.In eight cases we forced to perform Conversion procedures; due to visceral perforations (three cases), hemorrhagia (one case), sever adhesions, and bad anatomical positions (four cases). It is noteworthy that four complications were in first 15 patients, and three in men.As described above we suggest Laparascopic cholecystectomy with an experienced team is a preferential procedure; limited incision and quickly return to normal daily activity are its advantages.

Ophtalmia Neonatorum means bacterial conjunctivitis in first months of life. Considering the fact that it is the commonest infectious diseases in first months of life, this study was performed in Sh. Beheshty hospital born-neonates, in order to determine the frequency of various pathogenic bacterial agents and their sensitivity patterns to common antibiotics. This study was carried out on 230 term neonates (38-40 wks of gestational age), between 0-25 days of age with conjunctivitis, who were born in Sh. Beheshty hospital and visited by pediatricians. Following examinations of patients, clinical diagnosis of conjunctivitis and recording the data, samples for microbial cultures, smearing and staining were taken. Then antibiotics sensitivity patterns with nine available antibiotics for each organism were investigated.Coagulase-positive staphylococci were found to be the commonest causative organism (30%) and Chlamydia was the least common (2.2%). Nisseria gonorrhea (Gonococcus) was not found in the spectrum of the various isolated bacteria. The most sensitive antibiotics were Ceftrioxane and Chloramphenicol, whereas the most resistant were Tetracyclin and Ampicillin. Also the most sensitive antibiotics for Coagulase-positive and negative Staphylococci, Haemophilus Influenza was Chloramphenicol, for Streptococci and Kelebsiella was Ceftrioxane, for E.coli was Amikacin and for Pseudomonas was Amikacin and Ceftrioxane. It was also revealed that all causative organisms could cause the disease in the first day of life.Unlike the results of the studies carried out in other countries, this one showed that Ophtalmia Neonatorum is infrequently associated with sexually transmitted diseases (Chlamydia and Gonococcus). Since the Gonococcus was not found among various causative organisms, revising the primary ophthalmic prophylaxis seems necessary. Moreover, since it was revealed that all organisms can cause conjunctivitis in the first day of life ,there needs to be a prophylactic agent immediately after birth which can reduce the colony count of the bacteria in conjunctivitis

Today, there are more than 60,000 scientific journals publishing over the world. More than two- third of these journals are published in the field of different medical sciences. Among biomedical publications, epidemiological papers have a big proportion. This group of papers is not only submitted by epidemiologists but also by other medical researchers. This article attempts to present some simple guidelines for evaluating and appraising of such epidemiological papers. The methodological aspects of causation are addressed. The main errors, biases and cofounders are introduced, and the circumstances of critical appraisal are discussed. The main objective of this article is to present the major points of manuscript writing up and reviewing of such papers to those who are more involved in this job.

Multiple sclerosis is a chronic disease from which mostly the young adults may suffer. Pathologically, it might be distinguished by the inflammation, demyelination and sclerosis in several regions of white matter in central nervous system. In present report, I have introduced a patient who suffered from a period of Acute Mania with Psychosis after a experience of psychological stress .In the diagnostic examinations, it was known that she suffered from Multiple Sclerosis. Although a very small part of hospital admission is related to this disease, and the occurrence of Acute Mania Syndrome with Psychosis as the initial presentation of disease might be a rare phenomenon , the higher prevalence of bipolar disorder in this disease increases the probability of the fact that such few patients might also have been seen with the bipolar syndrome presentation in the psychiatric hospitals and notices the necessity of recognition and attention to this disease in the differential diagnosis ,especially when there are inexplicable neurological signs.