JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:15 | Issue:57|Papers Count:15

Introduction: Ciprofloxacin is a synthetic antibacterial agent belonging to the family of Fluoroquinolones with a very broad spectrum against of microbial pathogens ,especially Gram-negative infectious diseases, that has been approved in more than 100 countries world-wide. Objective: The aim of this study was planed to see determine the histopathological effects of ciprofloxacin after inducement, in rat testis.Materials and Methods: The twenty male wistar rats were selected and randomly divided into two groups; control (n=10) and test (n=10). The test group was received 12.5mg/kg (PO) ciprofloxacin daily for sixty day; however the control group just received plate. In sixtieth day the testis tissue of rats in both groups were removed and prepared for electron microscopy.Results: Electron microscopic studies of testis tissue slices of test group showed many changes such as: nuclei of spermatocyt I and sertoli cells and myoid were hyperchromatined. The Mitochondria of spermatogonia and spermatocyts cells in test group were vacuolated when as compared with control group. Thickness of spermatid tail in test group was increased when as compared with control group. Conclusion: There was a marked decrease in fertility index, testicular weight in experimental group as compared with control group. Since in our study ciprofloxacin had side effects on testis tissue in rat. It was suggested that using ciprofloxacin can decreasing fertility rate in human.

Introduction: Leptospirosis is a common Zoonosis, which is more prevalent in tropical and temperate regions. Rodents, wild and domestic animals are reservoir of Leptospirosis. Usually the infected animals are carriers for the rest of their lives and the bacteri is secreted from their urine. The secreted bacteria can enter a host (animal or human) and continue the circle of disease Objective: Diagnosis of leptospirsis according to clinical symptoms is difficult due to lack of pathogenic sign(s) and the similarities of its clinical features to some common febrile diseases, so laboratory is important in diagnosis. Leptospira is fastidious and its isolation from other clinical specimens is difficult, time consuming and usually unsuccessful, so MAT is the gold standard for diagnosis and serotyping of leptospira and is usual in all reference laboratoriesMaterials and Methods: We performed this study in 1383 by taking blood sample from patients hospitalized in Emam Khomeini Hospital in Some- e-sara, Razi and 22 Aban Lahijan and had clinical symptoms and were suspected of leptospirosis. Sampling was done in spring and summer, which are prevalent seasons of leptospirosis in Gailan prorince. We stored all serums in- 200ºc until examination, and in summer of 1383 serum samples were screened by a Quantitative Elisa method to detect positive samples for doing MAT, and performed MAT to determine causative serogroups. Results: 282 serum samples were all tested by quantitative Elisa and 130 cases had IgM titer equal or greater than 1:60 which were considered for MAT test. Seventy serum samples had titer≤160 in both tests and all were positive and highest serum titer in MAT test was the determining criteria for causing diseaseConclusion: Analyzing the results of MAT was hard and complex due to alternate reactions happening between different serogroups specially in clinical samples related to acute disease. According to CDC, a serum titer of ≥ 200 and if it correlates with clinical symptoms can present probable diagnosis. In this study, considering the samples were only taken from patients with clinical symptoms and suspected of leptospirosis and then after screening by Elisa, only positive samples with IgM titer equal or greater than 1:16 were assessed by MAT; keeping in mind three criteria (Correlating clinical symptoms Elisa and MAT results) there is a high efficacy of diagnosis and determines servoirs and serogroups are prevalent in this area.  

Introduction: Weight gain during pregnancy is variable and depends on mother’s diet status before pregnancy. Based on medical resources, there is an inverse relationship between mother’s Body Mass Index (BMI) and prenatal weight gain. Objective: The aim of the study was to investigate mothers’ BMI before pregnancy and prenatal weight gain. Materials and Methods: In a cross – sectional study, we analyzed retrospectively prenatal and obstetrical reports of 480 women attended health centers of rural areas in Rasht, who delivered during year 2002. The selection of them was done by cluster and random selection in ten health centers. Maternal characteristics including age, job, education, pre pregnancy weight, height, body mass index, pregnancy weight gain, parity, and main outcome including birth weight were recorded. Student t-test, Chi-square, One-way Anova and correlation were used to analyze data. Results: On the basis of body mass index (BMI), 7.9% 0f women were thin, 45.4% of them had normal BMI and 46.7% were overweight. The mean of BMI was 26.2 ± 5.2. The mean of pregnancy weight gain was 9.2± 4.1 kg (min=0.5, max=21kg). An inverse relationship between BMI and pregnancy weight gain was showed (r=-0.26, p =0.01). Although the mean of pregnancy weight gain in thin women was higher than obese ones but, about most of them didn’t gain expected weight during pregnancy. Rate of low birth weight was about 11% Conclusion: This study shows an inverse relationship between BMI and pregnancy weight gain. Pregnancy weight gain is lower than recommendations and also rate of LBW is higher than expected in these rural regions. Use of appropriate nutritional model for pregnant women, could contribute to increased pregnancy weight gain and improved birth weight.  

Introduction: HER-2/neu is a membrane protein and it is one of the determining prognostic factors of breast cancerObjective: The aim of the study was to investigate the relationship between the expression of the HER-2 membrane protein and clinical- pathological parameters such as size: degree of the tumor differentiation, presence or absence of lymphovascular invasion and its relation with steroid hormone and P53 status in breast cancer patientsMaterials and Methods: This descriptive study was done on 465 cases of breast cancers referred to two cancer centers in Gilan from 1980-1985. Patients’ demographic data, pathological and type of clinical therapy were gathered from their medical charts. All membrane samples taken by biopsy were embedded in paraffin and stained by hematoxylin-eosin technique and were evaluation by a semi-quantitative method of immunohisto- chemistery for HER2 protein, P53 and steroidal receptor.Results: A total of 32% of breast cancer patients had positive HER2 protein. There was a positive correlation between HER2 protein and P53 protein expression (P=0.000). There was a positive relationship between presence of HER2 protein and absence of steroid receptor with high-grade tumor (grade 3)(P=0.3) and absence of HER2 and presence of steroid receptor with low-grade tumor (grade 1) (P=0.5). There was no correlation between HER2 and lymphovascular invasion and size of tumor.Conclusion: In breast cancer patients, there is a positive correlation between presence of HER2 protein and degree of tumor differentiation and it also correlates with poor prognostic factors such as hormone receptor negativity and P53 positivity.

Introduction: The value of clinical use of tumor markers for prediction of breast cancer recurrence in follow-up or level of response to treatment is still controversialObjective: In this study، the role of tumor markers in breast cancer recurrence was evaluatedMaterials and Methods: One hundred and forty-one breast cancer patients were entered into the study and followed up for 132 months (mean=34.0، SD=28.0). The mean age of the patients at time of diagnosis was 47.1 (SD=12.3) ranging from 23 to 81 years. Most patients (51%) were presented with stage II breast cancer. 81% of the patients underwent modified radical mastectomy and the remaining 19% had breast preservation surgery. The association between clinical recurrence with age، tumor size، nodal involvement، stage، type of surgery and pathology, CA15.3, CEA, P53, ER, PR, and HRE-2 status were examined by using the forward conditional logistic regression analysisResults: Recurrence occurred in 22% of patients during the follow up time. The results indicated that recurrence was significantly predicted by the status of CA15.3 (odds ratio= 6.1, 95% CI= 1.62-23.1, P= 0.007). Conclusion: The findings showed that independent of age and other known prognostic factors; CA 15.3 is an individual factor for prediction of recurrence in breast cancer patients.

Introduction: Smoking is proven to be a factor in development of osteoporosis and its related fractures and al so its role in delaying bone union in spinal fusion has been cited. In attention to popularity of smoking in patients with limb fracture in Guilan province،we studied the relation between smoking and bone healing time. Objectives: The aim was to study the effect of smoking on clinical and radiological union in closed and Type I Open fracture Materials and Methods: From 195 consecutive tibia fractures in 190 patients، 146 patients of Poorsina hospital with closed or open type I fractures have been studied in a 4 years period. 76 of them were non-smoker and 70 patients were smoker. From these patients،44 (58%) non-smokers and 59(84%) smokers were followed until complete union or up to one year. Union has been confirmed clinically and radiologically Results: Statistical differences in clinical and radiological healing rates between those who smoked and those who didn’t smoke were observed in patients receiving intramedullary fixation or external fixation. Statistical differences were not seen in the clinical and radiographic healing of tibias treated with cast immobilization Conclusion: This study revealed that smoking dramatically delay the tibia fracture union، especially when the surgical treatment has been used.

Introduction: Some of the opiate dependents use other drugs and substances that confront them with more economic social and medical problems and poor therapeutic outcome.Objective: This study was performed to identify the frequency of drugs and other substances used in opiate dependents referring to the clinic of welfare organization in Rasht. Materials and Methods: In a descriptive study, 96 patients admitted to the clinic from January 2002, in a 4 months period, were studied by clinical interview. The screening methods were not used. They were questioned about their time and type of substances (Opiate, Cannabis, Alcohol) or drugs (Codeine, Benzodiazepins, Barbiturats, Dextrometorphan,) used, withdrawal symptoms, pattern of obtaining drugs or substances and history of lapses and relapses. DSM IV criteria’s for dependency or abuse were used. Results: From 96 patients studied 93 were male and 3 female, 31/3% unemployed, 81% lived in urban area, 44% with academic education lower than elementary, and 64% married. 12.5% had at least one year abstience, 30.2% without complete detoxification, 38.5% at least one month abstience and 21.4% two times and 9.4% three times of at least one month abstience. Opium in 63.5%, Heroin in 30.2% and Codein in 3.1% of subjects were the main opiates used. The most frequency of co morbidity was seen between opiates and benzodiazepins and between opiates and Alcohol 21.8% of patients had multi substance dependency, 26% had co morbidity of opiate dependency and drug dependency, and 16.6% had co morbidity of multi substance dependency and drug dependency The most common way of obtaining drugs were by prescription and pharmacy without prescription.Conclusion: The frequency of drugs and substances use and significant co morbidity between opiate dependency and dependency to other substances or drugs despite different geographical, cultural and economic backgrounds were similar to other countries. Greater emphasis on organizing drug policy, physicians’ education and treatment of comorbide conditions and evaluation of the effects of these interventions on drugs and substance use patterns is recommended.

Introduction: Sour orange is known as an herbal plant in folk medicine. Previous studies indicate a protective relationship between the consumption of citrus fruits or juices and risk of some chronic diseases. Objective: In this study, the effect of short-term consumption of sour orange juice on blood glucose and lipid profile of diabetic patients was evaluated.Materials and Methods: In a clinical trial study (before and after), thirty-five (10 men and 25 women) dyslipidemic diabetic patients without nephropathy with mean age 53.1 + 7.7 years and serum cholesterol level greater than 220 mg/dl were selected. Each patient consumed 240 ml of sour orange juice daily for 4 weeks. The patients were asked to maintain their usual diet, physical activity and consumption of their oral hypoglycemic agent during the entire experimental period. Body weight and height were measured at baseline and after consumption of 240 ml of sour orange juice daily for four weeks and BMI was calculated Fasting blood glucose lipids and ascorbic acid level were measured at the beginning and the wnd of the study. Plasma ascorbic acid concentrations were measured by the 2,4 dinitrophenyl hydrazine method with calorimetric analysis. FBS، TG, and total cholesterol were measured by enzymatic method. A 24 hr dietary recall and food frequency questionnaire were analyzed by Nutrition III soft ware. Data were compared with paired t-test and X2-test as appropriate.Results: there were no statistical significant change in body weight, energy and macronutrient intakes before and after 4 weeks consumption of sour orange juice, but Vitamin C intake significantly (p<0.05) (24%) increased. Fasting blood sugar level significantly decreased (p<0.05) after consumption of sour orange juice (9%). Plasma ascorbic acid level were significantly increased (p<0.001) by 12.7% glycosylated hemoglobin and lipid profile، did not affected after consumption of sour orange juice.Conclusion: Short-term incorporation of sour orange juice in diabetics diet had a lowering effect on fasting blood glucose.

Introduction: Acute appendicitis is one of the most common problems requiring emergency surgery. Diagnosis is based on history, physical examination and laboratory findings. Rate of misdiagnosis of appendicitis especially in female is up to 23.2%. Some basic laboratory examinations such us white blood cell count, CRP and ESR have been suggested as aids in the diagnosis of acute appendicitis. But results are controversial Objective: This study was designed to consideration of association rate of leukocytosis, increased CRP and ESR in acute appendicitis Materials and Methods: In this prospective study, 158 patients were admitted with clinical diagnosis of acute appendicitis from September 2001 to March 2002 in Poursina hospital in Rasht. Blood samples for WBC, CPR and ESR were sent to the laboratory preoperatively. Then sensitivity, specificity, PPV and NPV of these tests were determined and analyzed.Results: There were 98 males (62%) and 60 females (38%). The mean age was 28.41 years (range 3 to 70 years). 146(92.4%) patients have histologically confirmed appendicitis and 12(7.6%) had normal appendix. Sensitivity, specificity, PPV and NPV for leukocytosis were in order: 84.2%, 33.3%, 93.9% and 14.8%; for increased CRP were in order 79.4%, 25%, 92.8% and 9.09%, and for increased ESR were: 69.2%, 8.3%, 90.2%, 22% in orderly. When all tests are used for diagnosis, these criteria were 54.8%, 66.6%, 95.2% and 10.8% respectively. In attention to sensitivity and value of positive (PPV) and increased WBC, CRP and ESR, it can be resulted that positivity of these tests in suspected appendicitis can strengthen the clinical diagnosis but lowered value of negative (NPV) tests showed that the negativity of each test or all tests together can not verify acute appendicitis.Conclusion: In presence of Leukocytosis, increased CPR&ESR probability of appendicitis was increased in clinically acute appendicitis. But normal value of WBC, CRP& ESR doesn't rule out acute appendicitis.

Introduction: For safe conduct of electro convulsive therapy (ECT) and decreasing the tissue physiological complication general anesthesia is recommended to patients. Objective: In this study we compared thiopental sodium and propofol as induction agent for ECTMaterials and Methods: Twenty-five patients each undergoing at least 2 sessions of ECT at the psychiatry department were included in the study. Each patient either received thiopental sodium or propofol for induction in a randomized manner. They are in ASA class I, II and don’t have any contraindication for ECT. Patients with cardio- vascular problem and stroke were excluded from study. Patients were anesthetized in a randomized manner wit h 2.5mg/kg thiopental and 1 mg/kg propofol in separate session. Muscle relaxant drug dose was the same for all patients. Amount of energy shock administration can lead to effective tonic-clonic seizure in-patient. Mean arterial pressure and heart rate in 1,5 and 10 minute after ECT were evaluated. Meanwhile duration of seizure and verbal eye opening, discharge from recovery room and breathing rhythm in two groups were also evaluated.Results: The mean arterial pressure in proopfol group in 1,5 and 10 minute after ECT was respectively: (88.26±13.03) mm Hg, (92.50±10.01) mm Hg, (87.56± 10.24) mm Hg. And in thiopental group in 1,5 and 10 minutes after ECT was respectively: (84.97±10.28) mm Hg, (104.13±7.85) mm Hg, (96.73±9.08) mm Hg, that was statistically significant (P< 0.00). In the assessment of mean heart rate in 1,5 and 10 minute after ECT in thiopental group was respectively:(82.2±9.07) min, (110.04±7.08) min,101.65±10.08) min. And in propofol group was respectively: (85.77±12.04) min, (98.75±11.02) min, (81.46±12.01) min which was statistically significant (P<0.05). Duration of seizure in thiopental and propofol group was respectively (31.08±4.13) min, (25.76±3.38) min. Time to verbal eye opening in thiopental  and propofol group was respectively(5.04±1.36) min, (3.28±0.89) min. Discharging from recovery in thiopental and propofol group was respectively: (13.68±1.72) min, (10.28±1.05) min Breathing rhythm time in thiopental and propofol group was respectively: (5.02±0.3)min (4.74±0.3)min which was statistically significant (P< 0.001). Conclusion: Propofol offered superior-homodynamic stability during the procedure and a quick recovery from sleep. Propofol was found to be a better induction agent for ECT as compared to thiopental sodium.

Introduction: Since electrocardiography along with the other diagnostic procedures, is applied in seeking cardiac disease, so perceiving normal and abnormal electrocardiography patterns in newborns, accelerates the diagnosis of these diseases. On the other side some ECG parameters of term and premature newborns, which changes through life span, are different from each other Objective: There was no study done in our center to compare the electrocardiogram of term and premature neonates; so we decided to compare their EKGs and its differences with other centers in the world.Materials and Methods: During 2002, from 30 term newborns (gestational age of > 38 weeks) and 30 premature (GS< 38 weeks) who were born in hospitals of Shiraz University of medical sciences and age 24-96 ours were chosen. And a complete EKG (12 leads) was conducted on lying position when newborn was calm and alert. All neonates were assessed fully for underlying diseases that could affect their EKG. All EKGS were assessed and compared as regard to heart rate, axis of heart, voltage, P wave duration and R wave in QRS complex. Comparative statistics was done using SPSS soft ware with fisher exact method.Results: QRS axis in full term neonate is shifted to the right and to the left in premature neonates (P<0.05). Duration of P and QRS waves in term is longer than those in premature babies (P<0.05). Voltage of P wave in premature neonates is higher than that in the term babies. We didn't find significant difference between R wave voltages in these two groups. Conclusion: The electrocardiogram of premature infants is different from the term ones in axis, P voltage and QRS duration. 

Introduction: Asthma is one of the most common chronic conditions in children. Objective: The present study was based on target population. After the study of prevalence, determination of asthma was matched by case- control method to identify correlates in primary school children aged 6-12 years in Shiraz (Southern Iran). Materials and Methods: This study was conducted in 2228 primary school children. The children were selected using two-stage random sampling from the four educational districts of Shiraz. A screening questionnaire was completed for each child. The consultant physician examined the children with positive result. After diagnosis of asthma, control group was selected by using matching method (age-sex-school). Conditional Logestic Regression determined the correlates of asthma. Results: The most important results were as follows: Prevalence of diagnosed asthma in primary school children estimated as %102 (boys: 1.19% – girls: 1.13%) with no significant difference. There was no significant association between asthma and birth order, social class, parent’s education, mother’s occupation and duration of breast-feeding. An increased risk of childhood asthma was associated with familiar history of allergic rhinitis (P<0.04), familial history of asthma (P< 0.01), history of allergy in children, (P<0.007) and exposure to smoking ( P<0.016). Conclusion: Our study confirmed that familial atopic diseases and exposure to smoking were significant predictors of childhood asthma in Shiraz children.  

Introduction: The majority of carious lesions are not well-defined radiolucencies. Approximately 40% demineralization is required for radiographic detection of a lesion. The actual depth of penetration of carious lesion is deeper than may be detected radio graphically. However، digital subtraction images permit to detect 1-5% decrease of mineral mass per unit volume Objective: The aim of this study was to detect central depth of dental demineralization on digital subtraction radiography Materials and Methods: This study was preformed on 15 extracted human teeth. In each tooth، one approximate enamel demineralization defect was induced using an acidified system (PH=4.8). Direct digital radiography was obtained under standardized condition over a period of 42 days. The images of the 7th, 14th, 21st, 28th, 35th  and 42nd days were subtracted from the baseline radiograph (before creation of the lesion). Because all of images showed moderate proximal demineralization on 42nd days، all teeth sectioned for histological study. Then، the mean standard deviation of the extent demineralization was obtained with the radiographic and histological measurements. The test served as the statistical sampling unit for testing difference between the measurements.Results: After 42 days, the mean ± SD of the extent of demineralization was underestimated by radiographic assessment (0.48±0.25 mm than histometric measurement 0.54±0.18 mm).However this difference wasn't significant (P=0.82) Conclusion: For monitoring the progression of carries clinically, central depth seems to be the proper parameter.

Introduction: One of the measurement indices for effectiveness and development such as in health and treatment sections is client satisfaction with governmental organizations services. In order to promote this plan, client tribute plan has been implemented.Objective: This study is done to evaluate the implementation method of client tribute plan in Rasht teaching hospitals in 2004 Materials and Methods: The research was performed in a cross-sectional descriptive method. Target population of the study consisted of Rasht six teaching hospitals. Measurement instrument used for the study was a check-list so that its validity and reliability has been approved by the quality promotion of Iranian Health and Medical Education Ministry. It was based on three methods of observation, use of documentations and registered data, and interview. In this research all activities related to 10 clients programs were studiedResults: Mean scores related to the education of staff in the study hospitals were 45.3%. They were as follows: 60% in the area of clarification and documentation of providing services for the clients, 68.3% in the area of giving information regarding the method of providing services for people 100% in the field of preparation of ethical charter of  the organization in connection with people, 93.3% concerning the prediction for appropriate space and facilities, 73.4% in the area of improvement and amendment of ways for providing services to people, 76.6% survay program from clients, 60% in the area of supervision and inspection, 53.3% concerning the appreciation and encouragement for successful managers and staff and 55% in connection with how to behave with people. The mean total scores from the "clients tribute plan" in Rasht teaching hospitals were 68.34%. Of these, Dr. Heshmat hospital had the highest score by 83.49% and Alzahra madernity hospital had the lowest score by 52.66%. Conclusion: Implementation of clients tribute plan in Rasht teaching hospital was associated with relative success. Also, we will witness the increasing success of this plan by stablishing change and development program in managerial systems as one of the important necessities as well as by changing the punishment and encouragement criteria of managers and staff from the traditional method so that the views of clients can be taken into consideration in this regard.