JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2008 | Volume:18 | Issue:64|Papers Count:17

Background and Purpose: b-thalassaemia is the most frequent inherited disorder in the world, especially in Iran and Mazandaran Province. It is caused by mulation in b-globin gene on chromosome 11 with more than 150 different mulations causing b-thalassaemia, has been identified in the b-globin gene to date. Hydroxyurea, is one of the drugs used in Thalassemia patient's treatment, however, it is not effective in all patients. The mechanisms of the hydroxyuea effect in not clear yet. This study compared different b-globin gene mutations in b-thalassaemia patients who were referred to the Thalassemia Research Center in Sari in two groups, good responder and non-responder, to the hydroxyurea.Materials and Methods: This was a case-control study, comparing two groups of 30 thalassaemic patients who received hydroxyurea. Two groups were included, 30 good responders to hydroxyurea treatment (control) and 30 who did not respond to the treatment (case). First, DNA was extracted from peripheral blood. Then, two different methods for mutation detection were used. In the Thalassaemia Research Center in Sari, mutations in 60 patients were identified using ARMS-PCR. Also the results were confirmed in Genetic laboratory of Amirkola, using two mutation detection methods, reverse-dot blot hybridization and ARMS-PCR.Results: In the group of good responder (control), the average patient's age were 28/1 ± 7/78 years, and the average age at the onset of blood transfusion was reported to be 8/5 ± 8/56 year. In this group, the mean comparison of the hemoglobin level and red blood size (MCV) prior and after drug consumption were statistically significant. In the group of non-responder (case), the mean age was 21,3 ± 6.43, the manage starting blood transfusions was 3.3±3.75,andthemeanof drug consumption was 2.3±0.8 months. From the mutations identified, IVSII-IG>A was the most common type in both case and control group, while of 30 of control group, 22 individuals were homozygous, and 7 individuals were heterozygous for this mutation (frequency % 42.5). For the 30 case patients, 11 individuals were homozygous, while 11 were heterozygous (frequency % 27.5). Comparison between two groups, case and control group, were statistically significance (P<0.008).Conclusion: The correlations of IVSII-IG>Amputation in good responder patients to hydroxyurea as compared to the non responder group, is significant and similar to the previous findings.

Background and Purpose: NO is a short-lived gas molecule generated by degradation of L-arg to coralline and by the activation of enzyme NOS Ca2+/calmodulin-dependent. There are multiple NOS is forms that strongly are expressed in skeletal muscle, suggesting the crucial role of NO in regulating muscular metabolism and function. In this study, the effect of L-arginine was examined at the neuromuscular junction of the chick biventer cervicis muscle.Materials and Methods: Biventer cervicis muscle preparations from chick's age of 3 weeks were set up in the organ bath. The organ bath had a vessel with volume of about 70 ml; it contained Tyrode solution aerated with oxygen and was kept at 37°C. NO levels was also measured in the chick biventer cervicis muscle homogenates, using spectrophotometer method for the direct detection of NO, nitrite and nitrate. Total nitrite (nitrite+nitrate) was measured by a spectrophotometer at 540 nm after the conversion of nitrate to nitrite by copperized cadmium granules.Results: L-Arginine at 500 mg/ml, decreased twitch response to electrical stimulation, and produced rightward shift of the dose-response curve for acetylcholine or carbachol. L-arginine at 1000 mg/ml produced a strong shift to the right of the dose-response curve for acetylcholine or carbachol with a reduction in efficacy. The inhibitory effect of L-arginine on the twitch response was blocked by caffeine (200 mg/ml). NO levels were found to be significantly increased in concentrations 500 and 1000 mg/ml of L-argentine in comparison with the control group (p < 0.001).Conclusion: These findings indicate a possible role of increased NO levels in the suppressive action of L-arginie on the twitch response. In addition, the results indicate that the post-junction antagonistic action of L-arginine is probably the result of impaired sarcoplasmic reticulum (SR) Ca2+ release.

Background and Purpose: The clinical and epidemiologic features of Kawasaki disease (KD) suggest an infectious etiology; however, the agent(s) remain unknown. Our purpose was to isolate the causative bacterial gene from peripheral blood leukocytes of patients with acute KD, by Universal polymerase chain reaction (UPCR), in Tehran Children's Medical Center.Materials and Methods: Universal polymerase chain reaction (UPCR) assay was used to amplify the bacterial16S ribosomal RNA gene (rDNA).Results: Forty three (28 boys and 15 girls) were diagnosed with acute Kawasaki disease included in this study. The median age at diagnosis was 3.5 years (range: 0.5 -9 years). Twenty Nine (29) cases had typical KD criteria and 14 patients had atypical KD at diagnosis. Two of the 43 KD patients were positive for the Universal PCR assay for 16S rRNA, prior to intravenous g-globulin therapy (IVGT), while all specimens were negative by conventional blood culture. In our study, there was fever in 100%, conjunctivitis in 62.7%, rash in 83.72%, oral mucosal changes in 76.74%, peripheral changes in 37.20%, and cervical lymphadenopathy in 39.53% cases.Conclusion: The 16S rDNA sequence was positive in 4.65% of acute KD patients; this data shows that an infectious KD agent is traced in peripheral leukocytes. The question remains as to what true frequency ofthe16S rDNA sequence in KD is.

Background and Purpose: Trigger points have been described as causing pain in clinical practice and are a common source of musculoskeletal pain. Trigger point injection can effectively inactivate the trigger points and provide symptomatic relief. Efficacy of injection in the treatment of trigger points depends strongly on the technique of trigger point injection. This study compares muscle stretching immediately after injection of methyl prednisolon vs. injection without stretching in the treatment of trigger points.Materials and Methods: Patients with trigger point pain in the gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz Medical School Clinic. Subjects under went two office visits and two phone follow-ups. All patients received injection of lidocaine and methyl prednisolon. In group A, injection was without stretching. In group B, stretching of muscle was done immediately after injection. Evaluation measure tools were 0-10NRS, VAS and BPI.Results: In respect to VAS, there was a significant statistical difference between both groups one month following injection. In respect to NRS, there was a significant statistical difference between both groups 1 month and 2 months after injection. However, there was no significant statistical difference between both groups in all measurement aspect of BPI, except mood.Conclusion: Muscle stretching immediately after injection was more effective up to two months, than without muscle stretching in the symptomatic treatment of gluteal trigger points.

Background and Purpose: Helicobacter pylori are a bacterial pathogen evolved to chronically colonize the gastric epithelium and causes gastritis, peptic ulcers, and even gastric malignancies in few infected humans. More recently, a pathogenicity island has been identified within the H pylori genome that contains a cluster of genes, including cagE. The aim of the current study was to investigate the prevalence of cagE genotypes of H pylori isolates from patients with NUD (Non Ulcer Dyspepsia), peptic ulcer and cancer.Materials and Methods: 150 Gastric biopsy specimens obtained from patients were inoculated onto a Brucella Columbia Agar containing 5% sheep for 3 to 5 days at 37°C under micro aerobic conditions (5% O2, 5% CO2, and 90% N2). After DNA extraction, genotyping of the cagE gene was performed by PCR amplification using the primers. PCR products were separated by 1% agarose gel electrophoresis and examined under UV illumination.Results: Of 92 positive cultures, 34, 28, 20, and 10 isolations were obtained from patients with NUD, duodenal ulcers (DU), gastric ulcers (GU) and gastric cancer (GC), respectively. The frequency of cagE gene was 88/24%, 100%, 85%, 100%and within isolates of patients with NUD, DU, GU and GC, respectively.Conclusion: The presence of cagE in patients with Helicobacter pylori infection is not a marker for predicting or diagnosing the resultant diseases.

Background and Purpose: Elimination dysfunction is referred to have various difficulties in urination and defecation, such as urinary frequency, delayed with difficulty in voiding or defecation. The prevalence of elimination dysfunction has been varied in different studies, as 21% of children experience elimination dysfunction during their childhood period. Presently, there are no studies pertaining to this difficulty in our country. Therefore, we carried out a descriptive study in primary schools from the Sari Township, regarding voiding and defecation dysfunction among children, and also we identified the epidemiology of the disease, in order to solve problems by implementing teaching programs and screening methods.Materials and Methods: This cross-sectional study was done on Primary school age students in the Sari Township, during 2007 through 2008. Considering the prevalence of elimination dysfunction (15-25%), confidence coefficient 95%, SE 10%, and the sample size of 2,200 were randomly and equally selected from different parts of the township among the two-sex groups. A standard questionnaire including demographic characteristics and 10 questions on voiding status, in addition to 19 questions regarding defecation status was prepared. Questionnaires were distributed to the students by responsible school personnel and then referred to parents for completion. Data was analyzed by SPSS software and descriptive statistics (Frequency, Mean, and Standard Deviation). Chi Square test (X2) and Student T-test were used to compare the Means. P<0.05 was considered significant.Results: Of 2201 primary school age students, 48.7% were girls. The mean age was 8.96±1.43 year. Voiding and defecation dysfunction was reported in 38.4% and 29% of the cases respectively. There was no significant relationship between prevalence of voiding dysfunction and other factors such as mean age, sex and level of education; however, there was a significant relationship between elimination dysfunction in other variables such as age, sex, level of education, family history, Soya and fiber diet intake and environmental stressors. The mean age of children with voiding dysfunction was less than children without this problem However; the prevalence of familial stress was higher than those involved children.Conclusion: Public Health Education is recommended to teach the different kinds of elimination dysfunction symptoms in urban and rural areas, in addition, to reduce the undesirable complications of the disease due to delay in referrals.

Background and Purpose: The role of trace elements (Cu, Zn) in chronic inflammatory states has provided interest, as many of them are co-factors in metabolic processes, involving arthricular tissues and immune system function. The purpose of the current study was to evaluate zinc and copper plasma concentration in rheumatoid arthritis (RA) patients, who were referred to the Sari Outpatient Clinics and were compared with control group.Materials and Methods: We studied plasma concentrations of Zn and Cu in 40 patients with RA and compared them with sex and age matched of healthy subjects (N=40). Plasma Cu and Zn concentrations were determined by an analysis of 100 Perkin Elmer model flame atomic absorption spectrometer (FAAS) Results: The plasma Zn concentration in the patient group was statistically lower than control group. The plasma copper was not statistically different in comparison with control group. There was no correlation between Cu and Zn concentration in patient group. In contrast to Cu, there was a significantly positive correlation between Zn and Zn/Cu ratio. However, the decrease of Zn/Cu is more influenced by decreasing the Zn concentration.Conclusion: It appears the decrease of Zn plasma concentration in patients (comparison with control group) is more important than the differences in plasma Cu concentration, but the use of Zn supplement for RA patients need’s more investigation.

Background and Purpose: Conventionally, the architecture of the artery wall is based upon the close-packed smooth muscle cells, endothelial and adventitial cells in both sides of internal elastic lamina (IEL). However, the adventitia and endothelium are now viewed as key players in vascular growth and repair. Recent work raises fundamental questions about the cellular heterogeneity of arteries, time course, triggering of normal and pathological re-modeling.Materials and Methods: Twelve wild type mice were employed. After killing with CO2 inhalation, dissected mesenteric arteries were removed and cleaned with adipose tissue. Arteries were mounted in the perfusion pressure myograph under normal pressure (70mmHg) in Krebs’s solution, which bubbled with 95% O2 and 5% CO2 to pH 7.4, at 37°C. After staining with fluorescent ligands (Syto 13) for nuclei and (DIO 1m M) for cytoplasm, arteries were scanned with the Laser Scanning Co focal Micrpscopy (LSCM) under (488nm/515nm), (484nm/50Inm) and (543nm/580nm) Argon-Helium ion laser wavelength.Results: Three dimensional images of computer observation suggest that there may be a close relationship between the helical organization of smooth muscle cells and the underlying pattern of endothelial cells (myoendothelial connection).Conclusion: Tight junctions between cells must be broken and remade during the remodeling process. This suggests a carefully controlled defensive structure for intra-cellular connections, that is capable of withstanding the acute stresses of normal function, but which must be capable of modification to adapt to a new state, when the bio-physical conditions dictate. Endothelial mosaicism related to spiral arrangements of underlying smooth muscle cells, are associated with the functional cell connections. Taken together, these issues provide an exciting new phase in understanding the physiological modeling of the vascular wall, producing a new view ofthe dynamic nature of vascular structure.

Background and Purpose: Perfused rat liver and isolated hepatocytes are useful to study specific metabolism of this organ. Traditionally, mechanical, chemical and enzymatic methods have been used to isolate hepatocytes, and it appears that a mixed method is the preferred choice.Materials and Methods: The rat liver perfused in situe in three subsequent steps, 10 minutes with Krebs-Ringer solution containing ethylene diamine tetra-acetic acid (EDTA, 2mM) without calcium and magnesium, and 1minute with the same solution, however, without EDTA in open non-recirculatory pathway. This followed by 10 minutes with Krebs-Ringer solution, containing collagens (200 IU/mL) in closed recirculatory system. The hepatocytes were isolated, collected and incubated (6-8 x 106 cells/mL) for 3-hours in Krebs-Ringer solution, under the atmosphere of O2:CO2 (95:5). The cell viability was assessed with tripan blue exclusion and lactate dehydrogenase (LDH) leakage.Results: Assay of LDH activity, the marker of cytosolic enzyme, show that more than 92% and 88% of the enzyme had been retained in the cells, with less than 8% and 12% leakage from the damaged cells in the beginning and end of incubation, respectively. Microscopic evaluation showed that the majority of the cells had intact plasma membrane without vacuoles. When the cells were stained with dye, less than 5% of vital dye included these cells.Conclusion: The results showed that perfusion of the rat liver with the solution containing calcium chealator and collagenase can yield about 10 mL of hepatocytes with a viability of more than 90%. 

Background and Purpose: Malnutrition is a major problem within intensive care units (ICU) affecting the outcome of patients. In Imam Khomeini Hospital, patients were fed with gavage solutions prepared in the kitchen of hospitals, however, its' nutritional value has not been studied at present time. The aim of this study was to analyze the gavage solution and to compare the calculated nutritional demand with the provided values.Materials and Methods: The amount of carbohydrate, lipid and protein of gavage solution has been determined with Leen ion, Gerber and Kejeldal methods, respectively. In this study, 30 patients with at least 5 days in the ICU were included. Daily metabolic needs were calculated with Harris-Benedict equation and then, calculated calorie and protein values were compared with the provided values.Results: The carbohydrate, lipid, protein and energy contents of gavage Solutions were 0.035 ±0.002g/ml, 0.0225±0.017g/ml, 0.012±0.002 g/ml, and 0.39±0.164 Kcal/ml. The calorie and protein provided by the hospital solution, in comparison to the standard enteral solution, were 32.5% and 16% respectively. Total energy expenditure (TEE) at the time of admission to ICU was 2302±633 Kcal/ per day. During week 1, 2, and 3, TEE was 2301±634, 2283±661 and 2228±790 respectively.Maximum provided energy was 600±632 Kcal/ per day. Maximum protein was provided in week 3 and equal to 22.9% of patient's needs.Conclusion: The gavage solution provided by hospitals can not meet the calorie and protein needs of patients. It is necessary to prepare solutions with enough contents of carbohydrate, lipid and protein or to provide them with standard enteral nutritional solutions.

Background and Purpose: Osteoarthritis (OA) of elbow is not common but can be disabling, if it is not responding to non-operative methods. Several surgical methods are suggested Goint debridment, ulnohumeral arthroplasty, fusion and total elbow arthroplasty). In this study, we evaluated the result of ulnohumeral arthroplasty in seven patients.Materials and Methods: Seven patients (5 males and 2 females) mean age 46 years of age (56- 43), during 1378-1385 were operated on with the same approach. Via posterior incision of elbow along with creation of a hole (17mm diameter) all of coronoid and olecranon osteophyte were removed.Results: Mean follow-up was 18 months (12-38 months). Patients were evaluated by radiographic, clinical examination and MEPS criteria. Six patients (85%) had relief from pain, and obtained good to excellent results, with an increased range of motion at about 53.5 degree. One patient had relative relief of pain and moderate MEPS. After a year, only in one patient osteophyt formation and reduction in range of motion was observed.Conclusion: Due to a good to excellent results of (85%), increased range of motion in the elbow, relief of pain against low cost and short time of hospitalization, ulnohumeral arthroplasty is a suitable method of surgery in osteoarthritis of elbow.

Background and Purpose: Hypotension during Hemoadialysis is one of the risk factors of mortality and morbidity in patients. This study was preformed at Imam Khomeini and Fatemeh Zahra Hospitals, in Sari during 2007.Materials and Methods: 100 Hemoadialysis patients were evaluated. Serum calcium and serum albumin levels were measured prior to Hemoadialysis. Patient's blood pressure was measured before, during and after Hemoadialysis and data was analyzed using descriptive statistics, X2 test.Results: Hypotension, during Hemoadialysis was seen in 28% of patients. Of the total patients, 25% had hypocalcaemia. Of 25 patients with hypocalcaemia, 39.3% had hypotension, while 19.4% had normal blood pressure, thus, showing a significant difference between the two groups.Conclusion: It is suggested to revise the calcium concentration of dialysate.

38 year old male patient presented to us with complaints of parasthesias in all four limbs with spastic quadriparesis. Magnetic resonance imaging of cervical spine revealed central disc herniation at C2-C3 level with significant cord compression. He was operated for C2-C3 Smith-Robinson anterior cervical discectomy. An autogenous tricortical iliac crest graft of 1.5×1.0 cm was snugly fitted into the disc space. Postoperative check X-ray of the cervical spine showed extrusion of the graft. The patient was managed conservatively. Repeat X-ray of the cervical spine after follow-up of 6 weeks showed resorption of the graft. The distinct strategy of management in this case along with a brief review of literature is discussed.