JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2005 | Volume:15 | Issue:47|Papers Count:21

Background and purpose: High serum lipid levels are a major risk factor for the development of cardiovascular diseases. Therefore, it’s earty diagnosis and treatment can reduce morbidity and mortality. In this case- control study serum lipid levels in panic and non panic anxiety disorder and normal population were compared. Materials and methods: Serum cholestrol, TG, LDL, VLDL and HDL levels were measured in 30 patients with panic disorders and compared with 30 non panic anxiety disorder and 30 control subjects. Results: The mean cholesterol and LDL levels of the patients with panic disorder was significantly higher than other groups (P<0.05). No significant differences in TG, HDL and VLDL levels were found between the three groups. Conclusion: The findings of this study indicate that increase of noradernergic activity alone may not be responsible for elevation in lipid levels in patients with panic disorder.  

Background and purpose: This study was undertaken to determine the effects of high dose IV desferal on symptoms, LV size and function in thalassemic patients. Materials and methods : 15 thalassemic patients with cardiomyopathy all of whom were on cardiotonic drugs for at least one month, aged between 15-25 yr, with ferritin> 1200ng/ml and Hb>9gr/dl were included in the study. They recieved IV desferal of 130mg/kg/day (max 5gr) during 10-14 hr for 5 consequtive days. Cardiac evaluation including history, plysical exam, ECG and Echocardiography were performed just before recieving desferal, 2 days and one month after completing the regimen. In additon visual and auditory consultations were done before and after the intervention to detect probable side effects. Results : By administering high dose IV desferal, the cardiovascular symptoms reduced considerably and systolic function showed significant improvement so that a reduction in LVEF from 49.1 ± 1.8% to 58/8 ± 2.9% at first follow up and to 57.8 ± 2.1% at second follow up was observed. EPSS decreazed from 9.6 ± 0.8 mm to 6.7 ± 0.8 mm at first follow up and to 6.5 ± 0.6 mm at second follow up (p<0.001). However, there was no significant effect on diastolic function, ECG and physical findings. No remarkable visual and auditory side effects were demonstrated. Conclusion: Based on the data it can be concluded that high dose IV desferal has improving effects on thalassemic cardio myopathy with high ferritin level.  

Background and purpose: Apical residual air space and prolonged air leakage are not uncommon entities following resection of upper lobe of the lung. This study was carried out to observe the efficacy of the pleural tenting in preventing complications. Materials and methods: This is a case series study that compared with historical control. Pleural tenting after upper or upper and middle lobectomies was performed in 10 patients. In another 12 patients who underwent upper lobectomy or bilobectomy, pleural tenting was not performed. Both groups were compared with respect to duration of post operative air leak, drainage and hospital stay and need for any additional intervention for prolonged airleak. Results: Age, sex, pathology and pulmonary function test of two groups were similar. Duration of the chest tube air leakage was shorter in those pleural tenting was performed on when compared to whom pleural tenting was not performed (2.6 ± 1.1 days versus 9.1 ± 8.1 days). Mean hospital stay was shorter in tented group (5.2 ± 1 day versus 10.8 ± 7.5). Conclusion : Pleural tenting following upper lobectomy or bilobectomy of the lung shortens the duration of the chest tube drainage and hospital stay and it prevents apical residual airspace and related complications. Pleural tenting is a safe and relatively simple procedure, which has no associated morbidity.  

Background and purpose: Currently, there is only one sewage treatment plant in Sercan City in Hamadan province. Extended aeration activated sludge is the main process of the plant and untreated effluent and disposal sludge are used for agricultural activities. The main objective of this research is to evaluate the stabilization degree and reuse potential of disposal sludge from the plant. Materials and methods: This study was undertaken over a 12 months period from March 2001 to March 2002. In this project some indexes of sludge stabilization and reuse including VS/TS ratio, pH, SOUR, floatation, color, odor, coliform and fecal coliform were determined. Results: The annual average ratio of VS/TS and SOUR in disposal sludge from this plant were 0.73 and 3.37 mg02/gr.vs.h, respectively. The average pH was about 7. The disposal sludge was septic and had dark brown color and floated after a short time. Also the annual average of fecal coliform density in disposal sludge was 8.97 ´ 107 MPN/g.ds. Conclusion: The disposal sludge was raw and destabilized. The microbial quality of disposal sludge was lower than the class B of USEPA regulation. Therefore, this sludge can not be discharged to environment or reused.  

Background and purpose: Preeclampsia is a hypertensive disorder in pregnancy and is known as a specific syndrom of pregnancy. Several studies have been done to asses the indicators of preeclampsia for early detection of the disease. Uric acid is considered by some investigators as one of the most sensetive indicators in preeclampsia. In contrast some researchers have found it not useful in prediction of preeclampsia. Hence, more studies are needed about the role of uric acid levels in diagnosis of preeclampsia. The aim of this research is to compare the serum uric acid levels in preeclamptic and normal pregnant women and its sensivity as an indicator of preeclampsia. Materials and methods: In this case-control study 304 pregnant women were enrolled in the study at Fatmeh Zahrah Hospital of Sari. Among them, 151 preeclamptic women were allocated in case group and 153 healthy pregnant women in control group. SPSS were used for analysis of data and variables were compared by Chi square, ANOVA, Pearson correlation index, and sensivity and specifity were calculated. Results: Difference in the number of term delivery and primi gravidity between the three groups (normal, mild and severe preeclampsia) were significant (P<0.05). Considering maternal and fetal outcomes, only Decolman (two cases) had no significant difference between 3 groups. Mean of uric acid levels differed between three groups (P<0.0001). Severe preeclampsia had the most significant difference with normal group. Elevated uric acid (defined as up of 5.5 mg/dl) was observed in 34/2% in hyperuricemia group, 71.2 % in preeclamtic and 28.8% in control group (P<0.0001) The sensivity of uric acid levels for determining the preeclampsia and its severity elevated with increasing in concentration of uric acid but the specifity decreased. Conclusion: Results showed that the sensivity of uric acid levels in diagnosis of preeclampsia is moderate and measuring uric acid can be used in determining the severity of preeclampsia, maternal and specially fetal outcomes (LBW, preterm, IUGR, low apgar).  

Background and purpose: Chromium deficiency leads to impaired glucose and lipid metabolism. Chromium supplementation in type II diabetic patients improves glucose and lipid profiles. Organic chromium, such as found in brewer’s yeast, is much better absorbed than inorganic chromium. In this study, the effect of chromium supplementation in the form of brewer’s yeast on glucose and lipid profile of diabetic patients was evaluated. Materials and methods: In a clinical trial study (before and after) forty (32 women and 8 men) dyslipidemic diabetic patients without liver and cardiovascular diseases, 40-68 years old and BMI ³ 28 were randomly selected. Each patient received brewer’s yeast tablets containing 14.4 microgram chromium per day for 4 and 8 weeks. Fasting blood glucose, total cholesterol, HDL-C, LDLC and triglycerides were measured at the beginning and the end of 4 and 8 weeks after consumption of brewer’s yeast. A 24 hr dietary recall before and 4 and 8 weeks after consumption of brewer’s yeast were analyzed using Nutrition III software. Data were compared using paired t-test and x2-test as appropriate. Results: There were no statistical significant changes in body weight, BMI, energy and macronutrient intake before and after brewer’s yeast tablet. Mean total cholesterol (p<0.05) and fasting blood sugar levels (p<0.04) were significantly decreased after 8 weeks consumption of brewer’s yeast tablets. Mean LDLC and triglyceride level were significantly (p<0.001) decreased after 4 and 8 weeks consumption of brewer’s yeast tablets. Mean HDLC level was significantly (p<0.001) increased after 4 and 8 weeks consumption of brewer’s yeast tablets. A negative relationship was found between total cholesterol, LDLC, HDLC and TG of primary concentration and percentage of changes during study for each parameter. Conclusion: Improved glucose and lipid profile was noted in patients following 4 and 8 weeks consumption of brewer’s yeast tablets containing 14.4 microgram chromium per day. Also low chromium levels in diabetic patients, prevents diabetic patient from cardiovascular disease.  

Background and purpose: NLD obstruction causes chronic or acute Dacryiocytits resistant epiphora. Current treatment is DCR for persistent connection between lscrimal sac and nasal cavity. Vasocontrictor drugs are used facilitating the operation. Materials and methods: Being approved in the ethics committee of the Mazandaran University of Medical Sciences the study performed on 57 patients ASAL, II whom were divided in to two groups; Adrenaline group, no=23 and non adrenaline group no= 34. 10-15-ml adrenalin 1/200000 was injected at surgical area, before surgery in AG. BP, PR and bleeding were recorded during before and 1, 3, 5, 10,… min during the surgery. The results were analysed using t-test, and paired t-test at a significance level of< 0.05. Results: Maximum BP was measured at 3 minutes after adrenaline injection. The average of bleeding in adrenaline group was 38.3 ml and in nonadernaline group was 49.16 ml (P=0.007). The time of surgery in adrenalin group is shorter than non adrenaline group (P=0.003). Conclusion:  Althragh adrenaline decreased the bleeding during surgery and facilitated the procedure, it is potentially dangerous for patients with cardiovascular disease during DCR surgery.  

Background and purpose: Infertility with an incidence of about 15% has mainly been one of the community burdens that have even been threatening to the continuity of the family life. One of the most prevalent causes of women infertility is ovarian causes particularly PCOS. The aim of this study was to determine the outcome of IVF & ET in women with PCOS in comparison with tubal factor. Materials and methods: This was a historical cohort study performed from 1997 to 1999, at Royan Institute. 33 patients with PCOS (without any other causes of infertility) who failed standard ovulation induction treatment with clomiphen citrate (≥6 cycles) underwent 33 cycles of IVF & ET. Controlled group include 76 patients with only tubal factor infertility. Long protocol with Buserelin (GnRHa)/HMG were used in this study. IVF & ET cycle characteristics were compared using students t-test and χ2 and Fisher’s exact test. Results: The results of this research showed that there were statistically significant difference in mean age and incidence of OHSS in two groups. Howerer there were no satistically significant differences in duration of follicular phase, the duration of GnRHa usage up to the onset of HMG, cyst number after using GnRHa, cyst aspiration percent, HMG ampoule retrieved oocyte, produced embryo per person, embryo transfer per person, cycle cancellation and pregnancy rate per embryo transfer in two groups. Conclusion: It seems that IVF & ET are successful procedures in PCOS patients resistant to other usual treatment and hormonal dysfunction of this group of patients did not affect the results.    

  Background and purpose: CAD is the most important cause of mortality and morbidity in all orer the world. Aim of this study was to determine the effect of EDTA on the process of atherosclerosis. Materials and methods: The study is a randomized clinical trial. 14 patients whom were not suitable candidates for mechanical- Revascularization (PCI or CABG), were treated with EDTA injection twice weekly (25 injections). Data including demographic characteristics, clinical status, stress test results, Echo, and angiographic findings were recorded. Paired t- test McNemar was performed to analyse the data. Results: EDTA improved the clinical status and LVEF (P<0.0S) but the effect of EDTA on stress- test capacity and severity of angiographic coronary stenosis was not significant. Conclusion: It seems that patients who are not good candidates for mechanical revasculazation are suitable for EDTA therapy.    

Background and purpose: Basal cell carcinoma is the most common malignancy of the eyelids and is frequently misdiagnosed. Materials and methods: The diagnostic accuracy and index of suspicion of basal cell carcinoma of the periorbital region for ophthalmologist were calculated by Lightstones method. Data were analyzed retrospectively from the pathology records at the Kerman Medical Sciences University. Results: The diagnostic accuracy and Index of suspicion were 72.7 % and 87.8 %. Conclusion: Diagnostic accuracy for ophthalmologist was comparable with other studies but the Index of suspicion was lower than other studies and must be improred.    

Background and purpose: Health care workers (HCW,s) are at increased risk of hepatitis viruses infection. Seroprevalence rates of hepatitis B and C viruses ( HBV,HCV) are higher among HCWs Universal precautions to prevent the transmission of infections during medical cares along with vaccination are recommended or even mandatory in most countries. The purpose of this study was to determine the seroprevalence  of anti-HAV , anti–HCV ,and  anti-HBs antibodies, and HBV vaccination status in a general teaching hospital HCWs in Sari-Iran. Materials and methods: Between June to October 2003, questionnaire was used, data extracted from medical records, and serology by ELISA method for anti-HAV, anti-HBs anti-HCV, and-HBs-Ag in those HCWs with negative anti-HBs. HBV vaccination status were recorded . Seroprovalence rates of HBs-Ag and anti-HCV antibody were compared with those detected in blood donors during the same period. Results: Totally 263 HCWs and 17 kitchen staff were participated in the study. Anti –HAV, anti-HBs, anti-HCV, and HBs-Ag were detected in 90.36%, 87.5%, 0.37% and 0.74% of the subjects respectively. HBs-Ag and anti-HCV were detected in 4.8% and 0.83% of blood donors, respectively. 61.9 % of HCWs completed their HBV vaccine series and 72.7% of non-vaccinated HCWs developed anti-HBs antibody. Conclusion: These data showed that the prevalence of HBs-Ag and anti-HCV in HCWs was lower than general population. HAV infection was hyperendemic. HBV infection was higher among non-vaccinated personnel, and more than 1/3 of HCWs did not complete their vaccination, so, mandatory HBV vaccination, is recommended.  

Background and purpose: Regarding the importance of diagnosis and proper time of treatment in patients with urinary tract infection (UTI) and vesicoureteral reflux as risk factors for scar, this study was performed to detect the probability of scars appearance in children. Materials and methods: This study was performed on 42 children with urinary tract infection and vesicoureteral reflux (detected by VCUG), referred to pediatric nephrology units (clinic and ward) of Amirkola children hospital and evaluation of scar was done by DMSA at least 4-6 month after the last UTI. Results: Of 42 patients, 29 (69%) were female and 13 (31%) were male. Among 84 checked renal units, 64 had reflux and 20 had no reflux with 62.5% and 15% of the cases with scars. In males 21 units and in females 43 units had reflux. 2.8 of renal units with reflex grade I, 13.24 with grade II, 17.23 with grade III, both renal units with grade IV and 6.7 with grade V had scar (P=0.001). Conclusion: The results of this study showed that males and age group of 1 month to 2 years have higher risk for VUR and scar. In spite no correlation was found between age of children and scar. However, prompt evaluation and proper time of treatment are very important.    

Background and purpose: Cleft palate is a common facial anomaly that is shown by free communication between mouse and nose and involves whole or part of palate apparatus. It comprises 2/3 of facial anomalies and causes difficulties in nutrition, speech, growth of teeth and hearing. Several procedures have been described for treatment of this anomaly. Post operation complications include: bleeding, infection and fistula. The latter being the most important of all. The main objectives of repairing cleft palate are fine nutrition, proper speech and avoidance of middle ear complications which may cause hearing loss. It is clear that fistula after cleft palate surgery may obstruct these objectives. The aim of this study is to evaluate the fistula rate in patients who underwent repair of cleft plate. Materials and methods: This is a review study on the medical reeords of 50 cleft palate patients reffered to pediatric surgery clinic of Booali Hospital in Sari from March 1996 to May 2003. Demographic charecterestics, type of cleft palate, associated anomalies, technique of surgery and complications after surgery such as fistula were recorded from the files. Mean, standard diviation, mode, frequency and chi-square statistical tests were used for describing and analyzing the data. Results: 50% of cases were girls and 50% were boys. The mean age of patients was 18.84 ± 9.82. Extent of clefting was described according to the Veau classification. The distribution was 6%, 62%, 18% and 14% in Veau class 1, 2, 3 and 4. Fistula was observed in 4% of the patients and fistula and other complications such as infections, hematoma or wound dehiscence were not noted in the rest of patients. No significant differences between patients with and without fistula were identified with respect to Veau classification, technique of surgery, patient sex and age at platoplasty. Conclusion: Fistula is an important complication in cleft palate repair that needs reoperation. The rate of fistula was different in different studies. The fistula rate in this study was 4% which is low compared with others reports (0-62%). This may indicate the high standard of surgery at Booali Hospital.  

Background and purpose: Instalation of protective barrier against diagnostic x-ray is generally done based on the recommendations of NCRP49. There are analytic methods for designing protective barriers howerer, they lack sufficient efficiency and considering the NCRP49 reports, designing mechanical protective barrier in order to protect the initial x-ray radiation and absorption of the ray quality of such radiation is different. Therefore, the protective barrier for each radiation is measured separately. In this study, a computer software was designed to calculate the needed barrier with high accuracy. Materials and methods: Calculation of required protective barrier particularly when two or more generators are in use at diagnostic x-ray units and or installed diagnostic equipments do not have proper room space and the limitations for other clanges in parameters which are time- consuming and impossible to be manually calculated. For proper determination of thichness of the protective barrier, relevant information about curves of radiation weakness, dose limit etc should be entered. This program was done in windows and designed in such a way that the operator works easily, flexibility of the program is acceptable and its accuracy and sensitivity is high. Results: Results of this program indicate that, in most cases, in x-ray units required protective barrier was not used. Meanwhile sometimes shielding is more than what required which lacks technical standards and cost effectiveness. When the application index is contrasting zero, thichness of NCRP49 calculation is about 20% less than the calculated rate done by the method of this study. When the applied index is equal to zero (that is the only situation where the second barrier is considered), thickness of requined barrier is about 15% less than the lead barrier and concrete barrier calculated in this project is 8% less than that calculated by McGuire method. Conclusion: In this study proper determination of required protective thickness for weakening of radiation to the permitable level is proposed. The multi radiation sources in a single room are considered and non garanteed radiation of NCRP49 hypothesis is removed. Difference between the the oritical and calculated rates this of method is X2=10-5 which indicates accuracy and high efficiency of this software.    

Glutathione transferases(GSTs) are a diverse family of enzymes found ubiquitously in aerobic organisms. They play a central role in the detoxification of both endogenous and xenobiotic compounds and are also involved in intracellular transport, biosynthesis of hormones and protection against oxidative stress. Interest in insect GSTs has primarily focused on their role in insecticide resistance. GSTs can metabolise insecticides by facilitating their reductive dehydrochlorination or by conjugation reactions with reduced glutathione, to produce water- soluble metabolites that are more readily excreted. In addition, they contribute to the removal of toxic oxygen free radical species produced through the pesticides action. Annotation of the Anopheles gambiae and Drosophila melanogaster genomes has revealed the full extent of this enzyme family in insects. This mini review describes the insect GST enzyme family, focusing specifically on their role in conferring insecticide resistance.

Kawasaki disease is an acute multiorgan vasculitis occurs mostly in children between six months and five years of age. The etiology of the disease is unknown, but superantigens may have an important role in the pathogenesis. In this case report, a 10- year old boy is presented with signs of kawasaki disease and despite receiving two high doses intravenous immunoglobulin, cervical lymph nodes continued to enlarge and finally lymph node biopsy revealed angioimmunoblastic like T cell lymphoma. Because the etiology of Kawasaki disease is unknown, if lymphadenopathy persists, other diseases like lymphoma should be considered.    

A rare case of extensive spontaneous retropritoneal hemorrhage from a reptured angiomolipoma is described. A 34- year- old woman was admitted to our department with a complaint of acute abdominal pain. Obvious right side abdominal distention, abdominal tenderness and guarding and hypovolumic shock were noted on physical exam. Abdominal ultrasonography and CT scan showed massive retroperitoneal hemorrhage with a mass in lateral of Rt. Kindney. After appropriate resuscitation, laparatomy and Rt. Nephrectomy was done. Pathological study revealed angimyolipoma. Because of hemorrhagic shock at admittance and during operation Rt. Nephrectomy was preferred.  

We report a case of paraesophageal varices presenting as a posterior mediastinal mass in a patient with long-standing portal hypertension and cirrhosis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiogram. We suggest that in diagnostic work-up of patients with cirrhosis and masses in mediastinum modern imaging techniques, such as dynamic CT, color Doppler sonography and MRI, are most helpful (because they can demonstrate the vascular nature of these masses and have multiplanar capabilities) and precutaneous needle biopsy may be hazardous.