Journal of Mazandaran University of Medical Sciences
Year:2010 | Volume:20 | Issue:75|Papers Count:12

Botulism is a rare but potentially fatal disease caused by toxin produced by Clostridium botulinum.This report is intended to inform medical practitioners and students on new way of botulism transfer in some patients. The case is reported from Sabzevar, Iran. In this paper a 46-year-old woman and her two daughters were affected by botulism due to consuming Kame (a diary product). Their history and clinical findings indicated symptoms of botulism. The patient was treated by anti-toxic medicine, and the diagnosis was determined by exposure history, clinical findings and response to anti-toxin treatment. This report indicated that Kame could cause life threatening botulism. Therefore further training on the methods and duration of preserving Kame is required for prevention as well as reporting similar cases for treatment.

The most important cause of postmenopausal bleeding is endometrial cancer but tuberculosis accounts for only 1% of the postmenopausal metrorrhagia. The association of these two disorders is extremely rare. The presented case is a 58-year-old postmenopausal woman complaining of a bloody vaginal discharge and pelvic pain. The laparatomy was performed and histologic examination of the uterus disclosed an endometrioid endometrial carcinoma, grade G1 invading less than one-half of the myometrial thickness. The tumor was associated with an extensive granulomatous reaction, with numerous tubercles composed of epithelioid cells, multinucleated giant cells of Langhans type and central caseation necrosis. These granulomas were seen close to the carcinoma in the Endometrium and far from the neoplasm in the myometrium, endocervix, right ovary and pelvic lymph nodes. Although the coexistence of endometrial cancer and tuberculosis is extremely rare, it may occur in patients who live in the regions with a high prevalence of tuberculosis.

Phonophoresis is a method for topical medications to better penetrate the skin via ultrasound. Its actual mechanism has not been well defined, but it could be due to increased cell permeability from the thermal effects of ultrasound. Some indications for phonophoresis include: osteoarthritis, bursitis, neuromas, adhesions, scar tissues. Here we present a 55 year old woman who was a known case of Grave’s disease presenting with pretibial myxedema. The edema did not respond to common treatments but improved following the use of phonophoresis with clobetasol significantly improved.

Background and purpose: There are many challenges in diagnosis and treatment of patients with refractory epilepsy. The aim of this study was to survey the paraclinical findings in children with refractory epilepsy in Mofid Children's Hospital and their effect on treatment response.Materials and methods: This cross-sectional study was undertaken in 2007 to 2008. One hundred and fifty patients with refractory epilepsy in Mofid Children's Hospital were studied.Demographic, Clinical and paraclinical information of all patients were collected using a questionnaire and the date analyzed with SPSS and chi-square test.Results: The mean age of patients was 83.5±51.1 months, 43.3% were female. Idiopathic epilepsy and symptomatic epilepsy were detected in 32.7% and 57.6% of the subjects respectively. There were abnormal biochemical findings (hypoglycemia, hypocalcaemia or abnormal liver function) in 3.3% of the subjects and abnormal metabolic findings in 8%. EEG findings were normal in 2.7%, non-specific in 42.7% and abnormal in 54.6% of the children. Abnormal brain CT-scan and MRI findings were observed in 39.3% and 42.7% respectively. No response and relative response were obtained in 49.3% and 13.3% of the subjects respectively and 37.3% were seizure free. Treatment response in patients with abnormal EEG, brain CT-scan and MRI were significantly poorer than that of the patients with normal EEG (normal or non-specific), CT-scan and MRI findings.Conclusion: It seems that brain abnormality (abnormal findings in imaging) and cortical dysfunction in EEG were the factors that resulted in treatment response in patients with refractory epilepsy.

Background and purpose: Urolithiasis is one of the most common diseases of urinary tract.Abdominal colicky pain, nausia, vomiting and hematuria are the major clinical findings. Treatments including oral drugs, lithitripsy, using ureteroscope and open surgery are expensive and may result in significant complications. The aim of this research was to find medications for dissolution of urinary stones with less complication.Materials and methods: Variable concentrations of juniper fruit extract including 200, 500 and 1000 mg/ml solutions were used in vitro on urinary stones. Neutral (normal saline), positive (sodium bicarbonate) and negative (acetic acid) control groups were also prepared.Results: Significant findings were obtained on urinary stones composed of calcium oxalate (60%), calcium phosphate (30%) and ammonium phosphate (10%). The weight of dry powder of stones in normal saline of 1400 mg decreased to 1310, 1240 and 1120 mg after exposure to increasing concentrations of juniper fruit extract. Also the ratio of calcium oxalate in normal saline aqueous solution plus stone increased from 65% to 85% after using juniper fruit extract.Conclusion: Juniper fruit extract can dissolve urinary stones in vitro.

Background and purpose: Researches in the field of positive and negative effect have shown mixed results. While some have argued that positive and negative effects are two ends of a single construct, others suggested that these two concepts are independent from each other. Previous studies also support the idea that negative effects had a positive relationship with pain. According to theoretical frameworks, the aim of current research was to investigate the role of positive effect in the relationship between stress and pain, and negative effect in women with chronic pain, and possible implications of positive effect as an important psychological resource that a patient may use for coping efforts during periods of pain.Materials and methods: 104 women in textile and carpet weaving industry suffering from osteoarthritis and fibromyalgia were participated in the survey and completed the initial assessments for demographic data and personality characteristics. They subsequently completed 10 to 12 weekly interviews regarding pain, stress, negative and positive effect. After completion of the survey using cross sectional method, data were analyzed via hierarchical multilevel modeling.Results: Findings showed that weekly increases in pain and stress could predict negative effect elevations. Higher weekly positive effect as well as higher average positive effect, weather directly and indirectly in interaction with pain and stress, resulted in lower levels of negative effect. In addition, increases in weekly negative effect and higher average negative effect, related to greater levels of pain in subsequent weeks. In contrast, higher levels of overall positive effect predicted lower levels of pain in subsequent weeks.Conclusion: The current study emphasized that when individuals encounter pain or stress, positive and negative effects are not independent and therefore showed important role of positive effect in reducing negative effect related to pain and stress, which could be helpful for patients to bear pain and reducing the resulted tension.

Background and purpose: Headache is a common disorder with many potential causes. The lifetime prevalence of all types of headaches varies from 31% to 96%. Many patients and physicians are concerned that an intracranial lesion may be responsible for the headache.Neuroimaging studies are used for detection of these lesions. In this study the MRI findings of patients with headache are evaluated.Materials and methods: A cross-sectional chart and report Abstraction study was undertaken to determine the results of MRI of outpatients with headache who referred for MRI at Imam Khomeini hospital, Sari, Iran from October 2007 to February 2009.Results: Seven hundred and thirty five patients including 567 (77%) female and 167 (23%) male were included in the study. Abnormal findings were detected in 134 (18.23%) Patients including 78 (10.6%) sinusitis, 33 (4.48%) small vessels ischemia, 8 (1/1%) intra- axial space occupying lesion, 7 (0.95%) extra- axial space occupying lesions, 3 (0.4%) ventricular lesions, 2 (0.3%) vascular malformations, 2 (0.3%) mastoiditis and 1 (0.13%) brain lacunar infarction).Conclusion: Because most of the patients with headache had normal MRI results, appropriate selection to look for secondary causes is very important. Exact clinical examination has an important role for patient selection.

Background and purpose: Mucosal Immune system has a key role in homeostasis especially in upper respiratory tract in a physical activity. The aim of this research was to evaluate a few mucosal immune indices of soccer players in different positions.Materials and methods: Twenty soccer players from two teams of second league in Iran, including 8 defender (average age 21±1 yr, height 180±4.81 cm), 7 halfback (average age 22±3 yr, height 173.14±4.72 cm) and 5 forward (age 22±2 yr, height 176.19±3.57cm) participated in this study. Before, immediately and 24 h post-exercise, unstimulated salivary samples were collected.Repeated measurements were statistically analyzed using ANOVA, LSD post hoc was used for assessment of inter group changes at (P£0.05).Results: Data showed that there is not any significant difference between IgA, Cortisol, total protein, s-IgA/Pro ratio and s-IgA between experimental groups in the three stages, also there is no difference between the levels of salivary flow rate after competition but immediately after competition the inter difference was significant (defends and forward groups). LSD post hoc showed that, IgA concentration in the three groups did not change significantly in all three stages. Cortisol, total protein and salivary flow rate in three groups have been increased significantly. Salivary IgA secretion rate differences were significant in defender group only. S-IgA/Pro ratio in halfback group showed significant difference compared with defender and forward groups (P£0.05).Conclusion: It is concluded that salivary flow rate significantly decreased in three groups, but it is not true for other variables. LSD post hoc showed that a single soccer match can cause significant changes in all mucosal immunity parameters.

Background and purpose: Toxoplasmosis is a parasitic protozoan disease producing severe complications in congenital and immunocompromised cases. The enzyme-linked immunosorbent assay (ELISA) is the most common laboratory method for serodiagnosis of toxoplasmosis. Commercial kits have no unique procedure for standardization and this may influence the consistency of the results. The present study was designed to determine the reproducibility of results obtained by ELISA in different laboratories using similar commercial kits. Also, the results obtained from different commercial kits were compared.Materials and methods: Three Toxoplasma gondii IgG-ELISA kits from different commercial companies were used and the results reported by three different university laboratories evaluated. Eighty one serum samples from patients referred to a private laboratory for serologic determination of toxoplasmosis were examined. The results of the tests were reported as qualitative values (positive, negative, borderline), and the agreement rates determined using the Kappa coefficient.Results: Comparing three different kits, the results of 76 serum samples were similar and the Kappa coefficients calculated at 0.85, 0.90, and 0.97. When comparing different laboratories, the results of 80 serum samples among three laboratories were similar and the Kappa coefficients calculated at 0.97-1.Conclusion: Based on the results of the present study, it could be concluded that the ELISA test for detection of antibodies to T. gondii has the potential to produce consistent results in different laboratories while using different kits.

Background and purpose: Although foreign body aspiration in children is uncommon but it is life-threatening in children under 3 years old. The aim of this study is to review the data records on nature, location and symptoms of foreign body aspiration, diagnostic method, and prediction for improving the health care knowledge and its prevention.Materials and methods: Children with suspected foreign body aspiration were studies retrospectively from 2001 to 2009. Relevant clinical data including age, gender, place of residence, foreign materials and their location were retrieved.Results: Eighty data records of 57 males and 23 females, ages 8 to 180 months were analysed. The most common age was under 3 years old (8 months to 3 years). Thirty eight cases lived in urban areas and 42 cases in rural areas. The most common symptom was cough. Fifteen percent of the subjects had normal clinical examination. The most common foreign bodies were nuts.Conclusion: Foreign body aspiration is an uncommon but life threatening event which occurs mainly involves under 3 years old children. The most common cause is nuts. Close supervision of young children is essential as a preventive measure.

Background and purpose: Religious attitude and mental health are the categories that have advocated many researches in the world. Although mental health related studies were performed in Iranian students, there is little evidence in the religious attitude field. The aim of the current study was to survey the mental health and religious attitude in the students of the Mazandaran University of Medical Sciences.Materials and methods: This descriptive study was undertaken on 222 students of Mazandaran University of Medical Sciences (86 male and 136 female) whom were selected randomly. Data collection instruments were a 25-question religious attitude questionnaire (Golris-Brahni), and a 28-question mental health questionnaire (G. H. Q-28).Results: The finding showed that the mean scores on religious attitude in female students was at high levels (m=76.4) and in male students (m=72.2) at good levels with statistical significant differences.The average value of mental health in girl (m=20.4) and boys (m=23.8) with significant difference.Conclusion: The results showed that religious attitude and mental health scores are higher in girl students compared with those in boy students. The findings also support the idea that there is an association between religious attitude and mental health. Based on current findings, it is important to pay attention to the socio-cultural status of the students to improve their mental health.

Background and purpose: Rheumatoid arthritis (RA) is an autoimmune-inflammatory disease that may lead to joint destruction and disability. The purpose of this study was to evaluate the influence of life style, reproduction, and some external factors on the development of rheumatoid arthritis.Materials and methods: This is a case-control study, comprised of 184 cases and 184 controls.Possible etiological factors were collected by questionnaire. All variables were analyzed by T test and X2 (SPSS version 17) and P value <0.05 was considered significant. Odds Ratio (OR) for possible environmental factors was calculated.Results: There were no difference in age, smoking, asthma or allergy history, trauma, vaccination, parent death before puberty and living in city between RA patients and controls.Divorce was significantly more common in RA (P=0.04) and the level of education was inversely associated with RA (P=0.03) and OR=1.69 (CI=1.12 - 2.55), exposure to domestic animals and having more than three children were more common in RA but these differences were not statistically significant.In most of the RA patients, the onset of the disease was winter (P=0.02).Conclusion: Divorce and low education levels were associated with RA. Because of higher prevalence of RA in winter, more studies on the association of winter environmental factors and RA are recommended.