Journal of Mazandaran University of Medical Sciences
Year:2010 | Volume:20 | Issue:79|Papers Count:12

Background and purpose: Stomach cancer is the 2nd cause of mortality in the world and one of the most important causes of mortality in Mazandaran Province. Therefore, this study was designed to explain geographical and demographic patterns of mortality caused by stomach cancer in Mazandaran province and to identify the high-risk areas.Materials and methods: A descriptive study was conducted between the years 2001 and 2005.Through this study, 1663 deaths from stomach cancer were registered in Mazandaran Health Centers.Demographic and geographical data including age, gender and residential location of the Patients’ were collected and analyzed using descriptive methods and Poisson regression, using WIN BUGS statistical package.Results: Of the 1663 registered deaths, 1210 cases (72.8%) were males and 453 (27.8%) were females.Descriptive statistics demonstrated that the mean age for males was 66 years and for females was 69.9 years. Univariate analysis indicated that the incidence of stomach cancer is higher in rural areas compared with urban areas (P<0.05).Conclusion: The results demonstrated that the mortality rate due to stomach cancer is higher in individuals with more that 50 years of age. It can also be said that the mortality rate in males is twice as much as in females and more common in rural areas compared with urban areas.

Background and purpose: Based on the high prevalence of diabetes mellitus and hypothyroidism and different disorders from their coincidence, the present study was designed to determine the correlation between type 2 diabetes mellitus and hypothyroidism.Materials and methods: In this case-control study, 103 type 2 diabetic patients were compared with 103 healthy subjects. Age, gender and family history of thyroid disease were matched between the two groups. For all patients, anti-thyroid peroxidase antibody (Anti-TPO), FBS, Triglyceride, Cholesterol, HDL and LDL were measured. Descriptive analysis, T-test and X2 were used for data analysis.Results: In each group, 14 (%13.59) cases were men and 89 (%86.4) cases were women.The prevalence of hypothyroidism in the case group and the control group were %17.5 and %26.2, respectively, which was not statistically significant (P>0.05). Twenty eight percent of hypothyroid patients in diabetic group and 55% in the control group had autoimmune hypothyroidism (P<0.05).Conclusion: The results of this study showed that the prevalence of hypothyroidism in type 2 diabetic patients is as high as normal population. Because of the interaction between diabetic mellitus and hypothyroidism, screening of hypothyroidism and suitable treatment in diabetic patients is recommended.

Background and purpose: Diabetes mellitus is associated with coronary artery disease, and diabetic patients are frequently referred for Coronary Artery Bypass Grafting (CABG). Plasma Haemoglobin A1c (HbA1c) shows mean blood glucose over a 3 months period. This study aimed to determine whether elevated plasma HbA1c levels were associated with increased postoperative morbidity and mortality in patients undergoing CABG.Materials and methods: Plasma HbA1c was measured prospectively in 135 consecutive patients undergoing emergency and elective CABG in the two cardiac surgery departments of Mazandaran Heart Center and Shafa Hospital in Sari, Iran from 11 April 2009 to 11 September 2009. All patients were under observation for 6 months after operation to assess the postoperative morbidity and mortality.Results: Of 135 studied patients (81 males and 56 females) who were admitted for emergency and elective CABG, 88 subjects (65.1%) were non-diabetic and 47 (34.9%) were diabetic patients. The mean age was 52 years ranged from 33 to 78 years. Suboptimal HbA1c levels were found in 48 (54.5%) patients without diabetes and in 24 (51%) patients with diabetes. Wound infection, low cardiac output state, need for Intra Aortic Balloon Pump, long hospital stay, and Cerebrovascular Accident were more common after CABG in non-diagnosed (suboptimal HbA1c) patients. No significant difference was found in terms of length of hospital stay between the two groups.Conclusion: It seems that the complications of CABG surgery is significantly higher in patients with high level of plasma HbA1c level and those patients whose blood sugar was controlled inappropriately.

Background and purpose: Preterm birth accounts for 10 percent of total deliveries and is the most important cause of neonatal mortality. Levels of salivary estriol is, among others, an important indicator for early detection of preterm labor. This study carried out to determine the relationship between preterm delivery and estriol level in saliva.Materials and methods: This nested case-control study was conducted on 466 pregnant women referred to health centers in Sari from 2008 to 2010. Saliva was obtained and frozen from pregnant women during 25 to 34 weeks of gestation. After sampling and follow up of women until childbirth, women with preterm delivery (58 cases) considered as case group. Among the rest of the subjects, 58 women were matched for mean age, educational level and body mass index (BMI) considered as control group. The saliva samples were melted and estriol level was measured.Results: There was no significant difference between the two groups regarding age, parity, educational level and BMI. However there were significant differences between the two groups for gestational age at the time of sampling (P<0.05), the time interval between taking saliva samples and delivery (P<0.05), weight gain during pregnancy (P<0.05), birth weight, (P<0.05) and employment (P<0.05).Odds Ratio showed a relationship between salivary estriol levels and preterm delivery [OR=5.91, CI 95% (2.51-13.9)].Conclusion: Considering the high negative predictive value, it can be concluded that salivary estriol level has the potential to be used to identify women who are not at risk of preterm delivery, and unnecessary interventions can be avoided. Further researches are necessary for determining the role of estriol in prediction of preterm delivery.

Background and purpose: Lower limb trauma with popliteal artery injuries is associated with a high rate of amputation. This study was conducted to evaluate the predictive value for amputation and disability of popliteal artery injury.Materials and methods: Patients with popliteal artery injuries over a period of five years (2004-2009) were identified from Imam khomeini Teaching Hospital in Sari. Demographic data, mechanism of injury, vascular examination, ischemic period, methods of arterial repair, venous repair, fasciotomy, amputation rate and Functional Independent Measure (FIM) and locomotion score were studied. Severity of lower extremity injury was quantified using the Mangled Extremity Severity Score (MESS).Independent T-test, X2 and Pearson Correlation Coefficient were used for data analysis and P<0.05 was considered as significant level.Results: Of 50 patients, 49 (98%) were males. There were 17 amputations (34%). The mean length of hospital stay in amputated patients was 15.83±11.28 and in limb salvaged patients was 30.95±21.80 days. The average MESS in amputated patients was 6.94±1.64 versus 5.15±1.56 in limb salvaged patients (P<0.05). There was also a significant correlation between nerve injury and rate of limb amputation (P<0.05).Conclusion: Severity of limb injury, as measured by the MESS and FIM Locomotion Score, is highly predictive of amputation and disability.

Background and purpose: Cancer patients are usually suffering from severe pain and disrupted life style and using a proper analgesic seems to be the best option. Pain management failure or improper dosages of analgesics may lead to drug abuse or substance dependency in cancer patients. The purpose of this study was to determine the prevalence of drug abuse and substance dependency among cancer patients.Materials and methods: In this study, all cancer patients referred to Mazandaran University of Medical Sciences for opioid analgesics prescription were interviewed to evaluate the substance abuse and dependency. A demographic questionnaire and a structured reliable and valid clinical interview for Axis I disorder in DSM IV and SCID I were used for data collection.Results: Among 238 studied cancer patients, 27 patients (11.3%) had drug abuse and 24 patients (9.9%) had substance dependency. There was a significant correlation between age and duration of cancer with the prevalence of drug abuse and substance dependency (P<0.05 in both cases). The predominant opioid analgesic and substance prescribed and abused were methadone and opium.Conclusion: The results of this study indicated that the drug abuse and dependency in studied cancer patients is considerably high. In addition to chemical dependency, it seems that the prescribed analgesic dosages were not adequate to relive the pain which in turn leads to use another substance with stronger analgesic effects.

Background and purpose: Sucrose can be used as a marker for gastric ulcer as healthy gastric tissue is almost impermeable to sucrose. The aim of this study was to determine the plasma and urine sucrose level in patients with gastric ulcer compared with the control group.Materials and methods: A cross-sectional study was performed on 30 patients with benign gastric ulcer (based on endoscopy and pathology reports) and 30 healthy subjects as the control group.Plasma and urinary sucrose levels were indirectly measured by acid hydrolyze method using a spectrophotometer at 510 nm. Data were analyzed with Fisher's exact and T-test using SPSS, and P<0.05 was considered as significant level.Results: The mean plasma and urinary excretion of sucrose in patients were 22.17±1.85 and 4.51±2.5, respectively, whereas in the control group, they were 6.62±2.31 and 2.83±0.63, respectively.These differences were statistically significant between the two groups (P<0.05 in all instances).Conclusion: Determination of sucrose can be used as a non-invasive method in the diagnosis of benign gastric ulcer.

Background and purpose: Prostaglandin E2 and intracervical catheter are two categories of cervical ripening before induction of labor. The aim of this study was to compare the effectiveness of the intracervical foley balloon catheter and 3 mg prostaglandin E2 tablet in preinduction of cervical ripening.Materials and methods: In this clinical trial study, 89 primigravid women hospitalized for induction of labor with a Bishop score of less than 5 were randomized to receive either an intracervical foley catheter (n=45) or prostaglandin E2 tablets (n=44). Cervical ripening, frequent use of oxytocine, mode of delivery and maternal morbidity were the main outcome measures. Fisher's exact test, Mann-Whitney, paired T-test and T-test were used for data analysis using SPSS version 15.Results: The mean age of patients in prostaglandin E2 and intracervical catheter groups were 23.3±3.8 and 23±3.4 years, respectively (P>0.05). There were no significant differences in primary mean Bishop Scores between the two groups (P>0.05). Bishop Scores (mean±S.D) after ripening were (5.8±1.4) for the foley catheter and (6.4±1.6) for the prostaglandin groups (P>0.05). Use of oxytocin were more frequent in the foley catheter group (P<0.05). The rates of Cesarean section in prostaglandin E2 and intracervical foley groups were 40.9% and 33.3%, respectively, however, this difference was not statistically significant. No significant difference was found in terms of maternal morbidity rate between the two groups.Conclusion: Efficacy of Prostaglandin E2 and intracervical foley catheter were the same in preinduction of cervical ripening.

Background and purpose: Because of the importance of early diagnosis of cervical cancer and high false negative results of conventional smear method, several studies have been performed to find a more appropriate test in recent years. Fluid-based methods especially thin prep are considered to have the highest potential to reduce the false negative results and to increase the adequacy of specimens. The purpose of this study was to compare the Papanicolaou fluid-based thin layer smear with conventional pap smear in term of adequacy of specimen.Materials and methods: In this prospective study, the results of 120 thin layer smears were compared with 120 conventional pap smears. Cervix brush was used to prepare the samples of papanicolao and thin prep. The smears were interpreted using Bethesda system.Results: The number of SBL (Satisfactory but limited) in thin layer method and conventional pap smear were 11.9% and 39.2%, respectively. The number of unsatisfactory was 4.2% in the thin layer method compared with 9.2% in the conventional method. The reduction of satisfactory in thin layer method was not statistically significant (P>0.05), but the reduction of SBL (P<0.05) and increasing of satisfactory in thin prep method was statistically significant (P<0.05).Conclusion: The results demonstrated that fluid-based thin layer method may improve the adequacy of specimen and in turn lead to reduction of unsatisfactory and SBL cases.

Background and purpose: Cardiovascular diseases and more importantly the ischemic heart diseases (IHD) have been the most serious health problems during the late 20 th and early 21 st centuries. The purpose of this study was to determine the effect of education on modifying the life style of patients with IHD in Imam Ali Hospital, Khatamolanbia Hospital and Tamin Ejtemaie Hospital in Zanhedan city.Materials and methods: A randomized controlled clinical trial was carried out on 180 patients with IHD recruited through simple random sampling method from the intensive care units of Imam Ali (AS), Khatamolanbia and Tamin Ejtemaei hospitals in Zahedan city. Patients were assigned into an experimental group (n=90) and a control group (n=90). The standardized Rose questionnaire was used for data collection.Results: The education was effective on modifying life style of the patients with IHD. Statistical analysis indicated that the knowledge of the patients about heart diseases, life style, body mass index, blood triglyceride level, blood cholesterol level, blood sugar level and blood pressure in the experimental group was increased after education. The mean knowledge score of patients about modifying life style significantly differed after education between the two groups (P<0.05).Conclusion: Education is an effective approach in modifying the life style of patients with IHD.Therefore, it is suggested that education should be considered as an important program in the treatment of patients with IDH.

Background and purpose: Phenol is an organic pollutant that is found in industrial effluents and is very toxic to human and the environment. The purpose of this study was to use the ostrich feathers ash as a natural absorbent to remove phenol from aqueous solution.Materials and methods: For this study, ostrich feather ash was used as a new adsorbent in removal of phenol at different doses (0.2, 0.3, 0.5, 0.7, 1, 1.5, 2 and 3 g). Changes following the effect of contact time, pH, adsorbent dose, temperature and initial phenol concentration have been recorded. Then, the adsorption data were described with Langmuir and Freundlich adsorption isotherms and Excel software was used for data analysis.Results: There is a dose-dependent relationship between phend adsorption by absorbent at doses ranging from 0.2-2g. The adsorption of phenol decreases following an increase in the pH of the solution.Also, it is observed that the contact time significantly affects the rate of phenol adsorption (77%) from solution.Conclusion: Generally, the studied adsorbent was applied successfully for treating industrial water samples and aqueous solution.