JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2010 | Volume:20 | Issue:76|Papers Count:14

Background and purpose: Heat is a common type of energy that is produced during industrial processes in many work places. Workers who are working in hot areas may be exposed to heat stress. The aim of this study is to evaluate the effect of a designed cool spot on reduction of Mean Radiation Temperature (MRT) and Wet Bulb Glob Temperature index (WBGT) on a group of furnace workers.Materials and methods: First, MRT and WBGT indices were measured to evaluate heat stress in a furnace workplace. Then a suitable cool spot was designed and constructed using a double layer insulator. Finally MRT and WBGT were measured and then compared between inside and outside cool spot simultaneously to ascertain the effect of cool spot on control of heat stress.Results: We found that mean MRT (43.8oc) and mean WBGT index (29.5oc) were both higher than threshold limit value (28oc) recommended by ACGIH in workers' position. There was a significant difference between inside and outside cool spot in mean WBGT (22.8 vs. 29.6oc) and mean MRT (28. 6 vs. 43.8oc).Conclusion: Furnace workers who are exposed to radiation and convection heat may suffer from heat stress and we found that a cool spot in workplace is a suitable and feasible method to reduce heat stress.

Background and purpose: The cuff of tracheal tube is important and secures the airway during anaesthesia. This study evaluates the effect of endotracheal tube cuff pressure after tracheal intubation during general anesthesia.Materials and methods: This is a descriptive observational study that recruits 500 ASA physical status I and II patients undergoing elective surgery under general anaesthesia. The tracheal cuff pressure was asessed using manometer instrument 10 min after tracheal intubation.Results: It has been observed that at a mean intracuff pressure of 92±131 cm H20 more than 95% of patients were over-inflated. There was no significant association between the cuff pressure and how experienced were the anaesthesiologists (p<0.05).Conclusion: Routine method to inflate the tracheal tube cuff is not suitable during induction of anesthesia, because it results in over-inflation.

Background and purpose: Previous studies have shown that morphine consumption during pregnancy could delay placental and embryonic development or could cause abnormal function of nervous system. The present study evaluates the effect of oral morphine consumption on choroid plexus ependym cells of central nervous system development in Wistar rats.Materials and methods: Wistar rats (170-200g) were used in this study. The experimental groups received 0.05 mg/ml of morphine by tap water while after pregnancy, the control group received water only. On 14th and 17th days of pregnancy, the pregnant animals were anaesthetized by chloroform and the embryos were removed surgically. Then, embryos were fixed in formalin 10% for 4 weeks.Embryonic tissues were harvested, processed, sectioned and stained using hematoxylin and eosin (H&E.) Choroid plexus cells of central nervous system of embryos were studied using light microscope and MOTIC software.Results: Our results show an increase in the choroid plexus area and number of the ependym cells among experimental group in comparison with controls.Conclusion: Taken together, oral morphine consumption can inhibit choroid plexus cells to develop and function naturally. This defect may postpone the function and development of choroid plexus cells.

Background and purpose: It has been found that the use of different drugs for laryngoscopy preparation and tracheal intubation results in controversy. The aim of this study is to compare the haemodynamic effects of remifentanil with fentanyl for tracheal intubation in patients undergoing coronary artery bypass grafting (CABG).Materials and methods: This is a randomized and double-blind study. We recruited 64 patients undergoing coronary artery bypass surgery. Subjects received in 3 separate groups: remifentanil, 5 microgram/kg, Fentanyl, 8 microgram/kg, and routine medication respectively.Systolic and diastolic blood pressure, heart rate and mean arterial pressure were measured during, before and after tracheal intubation and immediately, 1, 3, 5, 10, minutes after intubation. Patients were monitored for haemodynamic changes using electrocardiography.Results: Sixty four patients were enrolled in the study. Twenty four patients age at 66±5.7 (60-84) years, received remifentanil, 23 patients with mean age of 65.7±6 (60-80) years made up the routin group, and 17 patients with mean age of 65±4.8 (61-76) years received fentanyl. Blood pressure and heart rate decreased after induction of anaesthesia in all groups. SBP and DBP significantly decreased in remifentanil group in comparison with other groups (p=0.01, 0.03).It was pssoble to control hemodynamic response to tracheal intubation in all groups, although it was better in remifentanil group than other groups.Conclusion: Although the incidence of hypotension was higher, 0.5 microgram/kg of Remifentanil 8 microgram/kg of fentanyl and routine method (sufentanil) were all effective to attenuate patients’ blood pressure in response to tracheal intubation up to 3 minutes after intubation.

Background and purpose: Dermatoglyphic patterns and nervous system share a common stem and genetic basis. Accordingly the aim of this study was to investigate the relationship between schizophrenia and bipolar disorder, and dermatoglyphic patterns.Materials and methods: The fingerprint patterns of 100 patients with bipolar I disorder (BID), 100 patients with schizophrenia (SCH) and 100 healthy controls (Control Group: CG) were analyzed and compared in this case-control study blindly.Results: The frequency of whorl pattern was higher in BID group than in CG group (P<0.03). The frequency of arches in SCH group was less prevalent than that in CG (P<0.002). Dermatoglyphic analysis showed only significant differences in the 2nd and 3rd finger of the left hand between BID and CG (P<0.02 and P<01 respectively). The difference was also significant in the 1st and 4th finger of the right hand as well as in the 4th finger of the left hand between SCH and CG (P<0.04, P<04, and P<02 respectively).Dermatoglyphic pattern of the BID and SCH patients was not significantly different.Conclusion: Higher whorl pattern in the 2nd and 3rd finger of the left hand and lower arches in the 1st and 4thfinger of the right hand as well as in the 4th finger of the left hand may be associated with BID and SCH respectively. There is no significant difference between dermatoglyphic pattern of BID and SCH for clinical use.

Background and purpose: Premature rupture of membrane (PROM) is a common and challenging issue in obstetrics. Early diagnosis of PROM and the consequent infection has a pivotal role in proper management of patients. The detection of PROM is easier in a case with visible vaginal fluid, but is difficult when trivial amount of vaginal fluid presents. In this study, we aimed to assess the diagnostic value of LDH and creatinine in vaginal fluid for detecting PROM.Materials and methods: Pregnant women were recruited in the third trimester (28-42 weeks) when attending prenatal care unit at Kowsar Educational hospital, Ghazvin, Iran during 2008. Under sterile condition, vaginal fluid was collected using speculum. Fern test was performed and adequate vaginal fluid was aspirated from posterior fornix to measure LDH and creatinine.Results: 223 pregnant women with mean age of 25.4±5.5 (16-43) years were recruited into this study. The mean of gestational age was 37.6±3.2 weeks. Visible vaginal fluid was detected in 72 (32.3%) while Fern test was positive in 56 (25.1%). Visible vaginal fluid detected by a specialist is considered as a gold standard test. Using ROC curve analysis from SPSS, we have found that a cutoff point of >180 U/L for vaginal fluid LDH level is a reasonabl diagnostic value for PROM at sensitivity of 85%, specificity of 80% PPV of 66.3%, NPV of 91.6% and an accuracy of 81%. The same analysis on vaginal creatinine using a cutoff point of >0.9 mg/dl showed diagnostic value with sensitivity of 72%, specificity of 35%, PPV of 34.7%, NPV of 72.6% and accuracy of 47%.Conclusion: Vaginal fluid LDH at a cutoff point of >180 U/L is clinically a useful diagnostic test for detection of PROM.

Background and purpose: There are several studies that hypothesize presence of a connection between psychopathological status and creativity. In this study we compare the creativity and intelligence quotient in bipolar parents and their offspring (all euthymic) with healthy control group and their offspring.Materials and methods: Twenty patients with bipolar disorder and twenty of their offspring (all euthymic) matched for sex, age, socioeconomic and educational levels together with twenty normal control subjects and twenty of their offspring were recruited. All participants completed creativity randsyp questionnaire (an objective measure of creativity) and Wechsler adult intelligence scale test sheets. Mean scores on these instruments were compared across groups.Results: Bipolar parents showed significant decrease on Wechsler adult intelligence scale (p<0.05). compared with healthy control parents. Total intelligence quotient scores of bipolar offspring and healthy offspring of healthy controls showed significant difference.Conclusion: We found that bipolar disorder patients and healthy control subjects had similar creativity on creativity randsyp questionnaire. In Contrast to some studies, we did not find high creativity in bipolar offspring, of course there was important limitation in our study: all case and control groups had low socioeconomic and low education and might have it caused these results. Intelligence quotient scores were lower in bipolar parents than healthy control subjects. We also conclude that bipolar disorder maybe associated with significant and persistent cognitive impairment. Intelligence quotient may also be affected at least in some recovered bipolar patients.

Background and purpose: Nowadays over 153 million women use IUD worldwide as contraception. Long-term durability, high efficacy, and cost effectiveness are advantages of this method.This study compares the side effects and continuation rate of TCu380A and CuSafe (300, +300) IUDs during a 6-month period in Taamine Ejtemaee clinics, Hamadan, Iran.Materials and methods: This was a description study. By using a continued method, 250 candidates applied for IUD were randomly placed in two groups of IUD. The side effects and continuation rate were recorded in the following 1,2,3,6 months. Statistical analysis was performed using Students t-test, fisher and chi-squared test where appropriate. The method for data collection was using some information record whose reliability and validity had been approved by the authorities in the field and after data collection they were analyzed statistically.Results: Vaginal bleeding was the most common consequence during the first month of implantation in both groups, however in months 1, 2, and 6 vaginal bleeding was significantly less prevalent in Cu safe group. At all intervals Cu safe users were complained for pain and infection significantly less than that in the TCu380A group. The continuation rate was significantly higher in the 3rd month for Cu safe users. No other major differences in spontaneous expulsion and contraceptive failure were found between the study groups.Conclusion: According to our findings, the side effects included bleeding; pain, infection and spontaneous expulsion were less incident in Cu safe users than TCu380A. Therefore, the use of Cu safe IUD is recommended.

Background and purpose: The core of the health information system in the hospitals lies within medical records. It is a means of communication between the care providers. Good medical record documentation is essential for effective clinical care. This study is designed to evaluate the condition of documentation of the data for diabetic patients and its effect on treatment in educational hospitals of Mazandaran University of Medical Sciences through the years 2006 and 2007.Materials and methods: This is a descriptive study and the subjects recruited were medical records of diabetic patients from Imam Khomeini and Bou Ali educational hospitals in Sari City, Iran 2006-2007. The collected data were analyzed using SPSS software version 17.Results: Of total 270 diabetic records, 16 records (5.92%) belonged to Insulin-dependent diabetes mellitus (IDDM), 14 records (5.19%) to non-insulin-dependent diabetes mellitus (NIDDM), 50 records (18.52%) to gestational diabetes and 190 records (70.37%) to unidentified type of diabetes. 201 patients (74.44%) were women and 69 (25.56%) were men and of 227 patients 84.7% were married.Conclusion: Despite of efforts made in recent years in context of improving the documents of admitted patients and contrary to all practical training that physicians received on the basis of basic requirements for international classification of diseases (ICD), still, there are major problems in record of main data. We conclude that more attention must be paid by medical administrators, physicians and medical record staffs to this matter. We suggest health authorities must reform the system of recording and more training courses must be funded to improve involving staffs’ awareness.

Background and purpose: Several previous studies have shown the direct and indirect effects of statins on supraventricular and ventricular arrhythmia. The purpose of the present study is to determine (1) whether Simvastatin modifies the rate-dependent properties of the AV node, (2) to what extent such changes are related to effect of Simvastatin on the basic properties of AV nodal conduction and refractoriness.Materials and methods: AV nodal refractoriness (AVERP & AVFRP) and rate dependency protocols Fatigue and Facilitation were used to assesse the electrophysiological properties of AV node.We used an isolated perfussed rabbit with AV nodal preparation in one group (N=8). The stimulation protocols were carried out during control phase and in the presence of various concentrations of Simvastatin (0.5, 0.8, 1, 3, 10 mm).Results: Simvastatin in concentration-dependent manner successfully prolonged effective and functional nodal refractory period (AVERP & AVFRP). Also an increase in Wenckebach cycle length was observed. Simvastatin in high concentration (3, 10 mm) increases the arrhythmia threshold. Various concentrations of simvastatin increased fatigue, but it reached to significant level only at 30 mM.Conclusion: Simvastatin has potential anti-AVNRT effects by elevating arrhythmia threshold and prolongation of nodal refractoriness.

Background and purpose: Penetrating eye injury is one of the most frequent trauma admitted in ophtalmological emergency rooms. The major concern when treating such a trauma is increased intraocular pressure and vitreous loss as a side effect of Succinylcholine and endotracheal intubation with no appropriate substitute drug available yet.This study is aimed to determine whether the use of Propofol can prevent the increase intra-ocular pressure caused by succinylcholine injection and endotracheal intubation.Materials and methods: 46 cases were selected and classified on the basis of American Society of Anesthesiologists’ Physical Status I, II (ASAPS I, II). Before induction of an aesthesia, intra-ocular pressure was measured for each individual case using Schiotz tonometer. Then, anaesthesia was carried out using Propofol (mean: 3 mg/kg) and succinylcholine (mean: 1.2 mg/kg) while endo-tracheal tube being placed in the trachea. Intra-ocular pressure was measured using the same method immediately and 2 minutes after intubation.Repeated measurements test and correlation co-efficient was used to compare the mean difference and correlation between measurements. SPSS version 16 and SAS-9.1 were used to conduct all statistical analysis.Results: 33 patients, of them 13 female cases (39.4%) and 20 male (60.6%) cases have shown a mean intar-ocular pressure of 12 mmHg prior to induction. After intubation, their immediate and two minutes intar-ocular pressure were 10.69 and 9.93 mmHg respectively.Conclusion: Our study shows not only the intra-ocular pressure is not raised but also it is decreased by rapid induction of Propofol followed by injection of succinylcholine and endotracheal intubation.

Mycetomas are chronic granulomatous fungal diseases that involve cutaneous and subcutaneous tissues. Mycetomas are caused by fungi (Eumycetoma) or fungus-like bacteria (Actinomycetoma). The exogenous causative agents are geophilic organisms which introduced by traumas.We review 90 cases of mycetoma in Iran from 1972 to 2009. There are rare reports of Mycetomas from Iran with most cases (66.3%) being male (male to female ratio of ~ 2:1). It has been found that the highest incidence of Mycetoma is between the ages of 31 and 50 years (60%) while most of the patients were farmers (44.4%).In Iran, foot is the most common site of affection (73.8%) followed by leg and arm (4.8% each).The most common agents causing actinomycetoma are Actinomadura madurae (23.5%), Nocardia asteroids (20.6%), Nocardia caviae (13.2%), and the most frequent causative agents of eumycetoma is Pseudoallescheria boydii (10.3%). The majority of reported cases are Northern (36%) and Southern (27%) provinces of Iran. Mazandaran has the highest prevalence (59.4%) among the Northern provinces The most common prevalent agents in Northern Iran is Actinomadura madurae (47.8%) that caused 68.8 % of Mycetoma in Northern Iran.