Journal of Mazandaran University of Medical Sciences
Year:2006 | Volume:16 | Issue:51|Papers Count:24

Background and purpose: Chronic annovulation is a common cause of infertility in women and polycystic ovarian syndrome (PCOS) is the most common cause of anovulation.Ovulation induction with clomiphene is the first line of therapy in pcos. 20-22% of the patients may be resistant to clomiphene. The objective of this study was to assess the ovulation and pregnancy rates with tamoxifen in clomiphene resistant PCOS patients.Materials and methods: This is a descriptive study on 100 patients with PCOS and resistance to clomiphene reffered to infertility clinic of Imam Hospital in Sari, Iran. Patients were given tamoxifen 40 mg/d from the third to seventh day of the cycle. Treatment was monitored by serial vaginal sonography. hCG was administered 10/000 unit IM when 1-3 follicles were >18mm.Ovulation rate based on (midluteal progesteron level >3 ng/ml) and clinical pregnancy rate were assessd.Results: The ovulation rate was 27%. gestational sac was seen in 18 patients (18%). The study showed that endometrial thickness was 10.72 mm in pregnant versus 8/16 mm in nonpregnant subjeots with significant differences (p<0/05). The number of dominant follicles >16 mm were 3/4 in pregnant versus 2.7 in nonpregnant (p<0/05) with significant differences.Conclusion: This study showed that tamoxifen is usefull in inducting ovulation and pregnancy in clomiphene-resistant PCOS patients by increasing the endometrial thickness and dominant follicle due to estrogen agonist effect.Tamoxifen can be used for ovulation induction prior to treatment with laparoscopy or HMG.

Background and purpose: Embryo co-culture systems with somatic cells have been a subject of extensive study as valuable tools to promote embryo in vitro development. The aim of this study was to evaluate, the Effects of a special kind of co-culture system in which somatic cells were cultured as polarized monolayer on mouse embryo development.Materials and methods: Human oviduct was obtained from patients who had undergone total abdominal hysterectomy. The epithelial cells were isolated and cultured either on ECM (Extra-cellular matrix) gel or plastic surfaces as polarized or non polarized monolayer respectively. Epithelial nature of cultured cells was confirmed by immunocytochemistry and the polarized condition was evaluated using transmission electron microscopy. Two cell NMRI mouse embryos were flushed and cultured on polarized, non-polarized monolayer and medium alone. The rate of development in all groups were daily determined and statistically compared. At the end of the cultivation period, trophoectodam (TE) and inner cell mass (ICM) were stained differentially and the number of blastocyst cells were counted and compared statistically.Results: Cultured cells were epithelial in nature and those cultured on ECM gel had highly columnar polarized appearance, with tight junction between adjacent cells. The cells cultured on plastic were spindle shape in sections and there was no evidence of tight junction between cells. The co-culture results showed that during cultivation period, polarized cells improved embryos in vitro development more than polarized monolayer in terms of both blastocyst formation rate and cellularity with statistically significant differences.Conclusion: Polarized oviductal epithelial cells have positive effects on embryo development compared to non-polarized cells. These effects appear as high cellular blastocyst in co-culture systems.

Background and purpose: Apoptosis or programmed cell death is a process of cell suicide. Ionizing radiation is one of the stimuli for apoptosis, acting through DNA damage. In the present study, effects of x-rays induced apoptosis in HL60 cells, as well as the protective effects of SCF (Stem Cell Factor) in inhibiting x-ray induced apoptosis have been evaluated.Materials and methods: Exposure of HL60 cells to 5 Gy of X-ray and the time effect on the percentage of apoptotic cells has been studied. One group of cells were incubated with SCF in the growth medium at 37 o C for 1 h before X-ray. Other groups of cells were incubated with SCF and MAPK, PI3K and PKC inhibitors as the cellular pathway proteins, and the x-ray induced apoptosis was studied.Results: Results of the X-ray induced apoptosis showed a graduall increase from 12h to 60h after X-ray. The SCF attenuated the percentage of apoptotic cells when cells were treated with SCF 1 h before X-ray. X-rays induced apoptosis partially attenuated by a combination treatment of SCF, PKC and PI3K inhibitor, but it was not inhibited by the SCF and ERK inhibitors.Conclusion: Our results have shown that SCF activated MAPK pathway proteins and this activated pathway leads to cell survival and resistance against side effects induced by X-ray in HL60. SCF protected cells against X-rays through the activation of MAPK pathway.

Background and purpose: In recent years, different studies have been performed regarding the influence of magnetic field on the immune system. There are many contraversies about the effects of different frequencies and amplitudes on the immune system.Materials and methods: In this experimental study, the effects of different frequencies of magnetic field (0, 5, 50, 500 and 5000 Hz) have been determined on the innate & specific C.M.I. A well known selected antigen such as SRBC was injected (108/0.1 ml) to different test and control groups (8 mice in each group). Each test group exposed to a defined frequency (0, 5, 50, 500 and 5000Hz) of magnetic field with constant amplitude (0.4 mT) 8 hours daily for six consecative days. Control groups were not exposed to any magnetic field while all other conditions were similar to the test groups. Innate and specific cell mediated immunity were evaluated by NBT and DTH respectively.Results : The NBT results showed that in all except zero frequencies of magnetic field, the level of respiratory burst were significantly reduced compared to the control group (P<0.001). The DTH responses were also decreased significantly in 500 Hz (P<0.034) and 5000 Hz (P<0.004) measured in 24 hours with no changes in zero, 5 and 50Hz frequencies, however in 48 and 72 hours no changes were measured in all frequencies .Conclusion: It can be concluded that frequencies of 5, 50, 500 and 5000 HZ reduce the innate immune response of BALBL/c mice but speceific cellular immunity remains unchanged.

Background and purpose: Hirschsprung’s disease (HD) is the most common etiology of neonatal intestinal obstruction. Definite diagnosis is based on demonstration of aganglionosis in seromuscular and full tickness rectal biopsy. Because of problems and complications of full tickness and seromuscular rectal biopsies, mucosal-submucosal rectal biopsy is prefered,but interpretation of these biopsies with Hematoxylin-Eosin (H&E) staining and even with usual Immunohistochemical staining (acetylcholinesterase) is difficult. Because neuron-specific enolase (NSE) for diagnosis of Hirschsprung’s disease is an available marker with performance on paraffin blocks and lack of data about its accuracy, this study was done to determine the accuracy of NSE staining on mucosal- submucosal rectal biopsies in diagnosis of HD and allied disorders.Materials and methods: We studied 65 mucosal- submucosal and 65 seromuscular biopsies of patients suspected of HD or allied disorders in Shafa and Booali hospitals Sari,Iran (from 23 Sep. 2003 until 22 Oct. 2004). For each patient both seromuscular and Mucosal-submucosal biopsiess were prepared. Mucosal-submucosal slides were stained by NSE and seromucular slides stained by H&E then the slides examined double blindly and the results compared with each other.Results: Sensitivity, specificity, efficeincy, positive and negative predictive value in diagnosis of HD are 100%, %84.2, %89.1, %81.8, 100% respectively (p<0.05), showing statistically significant difference with standard. On evaluation of Hypogangliononsis, we had one false – negative and nine false – positive.Conclusion: In NSE staining, finding of ganglion cell definitively role out HD but lack of ganglion cell in %81.8 confirms H.D. Thus NSE Staining on mucosal-submucosal specimens is possibly adequate for establishing the presence or absence of ganglion cells but ganglion cells should be quantified in the myenteric plexus.

Background and purpose: Hydroxy urea lowers the severity of anemia in patients with thalassemia by increasing Hb F but may cause negative effects on heart due to high O2 affinity of Hb F. Materials and methods: This descriptive study was performed on patients with thalassemia receiving Hydroxyurea during a five year period in thalassemia ward at Booali Hospital. Inclusion criteria were no none or less than 4 times transfusion in a year and using Hydroxyurea since at least one year ago (range 1-5 yr). Demographic & other data were collected through a questionare. The data were then analyzed using descriptive methods by SPSS software. Correlation of some variables was evaluated by pearson correlation coefficient.Results: This study were done on 20 patients including 13 (32%) male & 27 (68%) female aged ranging 20.87 to 3.95 . 48% of them had no cardiac problem but some had cardiac complains including 15% mild chest pain, 35% occasional palpitation & 32% occasional dyspnea. Physical examination showed grade more than 2.6 systolic murmur in 5%, S3 in 2.5% and mild edema in lower extremity in 37%. None of the patients had heart failure. According to Echpcardiography all of the patients had normal systolic function but 35% had mild diastolic dysfunction. 72.5% had normal ECG finding without arrhythmia but 15% had mild increased PR interval (max=0.2 sec) and 12.5% had nonspecific ST-T changes.Conclusion: As no significant cardiac complications were found and considering the positive effect of Hydroxyurea on Hb level in thalassemia, it could be used in these patients.

Background and purpose: It is clearly shown that ionising radiations induce various kinds of DNA damages majority of which as sub-lethal damages, are repaired but still some of them are left urepaired and lead to chromosomal aberrations. These chromosomal aberrations in radiation workers, who are occupationally exposed to radiation,could be assayed with cytogenetic evaluation methods.These cytogenetic assessments are good indicators for evaluating the health of radiation workers as well as radiation protection quality in medical radiation centers. The aim of the present study was to determine the frequency of the chromosomal aberrations using analysis of metaphase amethod in radiation workers of radiology departments in Babol.Materials and methods: Heparinized venous blood samples were prepared from 62 radiology workers and 29 individuals as control population whose duties did not expose them to radiation sources. Lymphocytes were cultured in culture medium consisting of RPMI-1640 supplemented with L-glutamine, 15% fetal calf serum (FCS) and antibiotics. PHA at a concentration of 5 μg/ml was used to stimulate division of lymphocytes in culture. Blood cultures were incubated at 37°C for 48 hours and 2 hours prior to harvesting; colcemid was added to cultures at a final concentration of 0.1 μg/ml to arrest the dividing lymphocytes in mitosis. At hour 50 the cells were collected, washed and fixed on the slides followed by staining. One hundred mitoses were analyzed for each sample and chromosomal aberrations were scored and statistically analyzed.Results: Results showed that the mean frequencies of the total chromosomal aberrations in radiation workers is significantly higher than controls (p=0.014). It was also shown that there is no significant correlation between the frequency of chromosomal aberration and age, sex and smoking of individuals in both groups. Also no significant correlation was noted between the frequency of chromosomal aberrations in radiation workers and the years of work as well as history of over dose.Conclusion: The higher frequency of chromosomal aberration in lymphocytes of radiation workers compared to non exposed controls is in full agreement with other reports and could be due to the accumulative effect of radiation induced initial DNA damage in individuals exposed to chronic and low doses of radiation which, finally leads to detectable chromosomal aberrations. Results showed that the frequency of chromosomal aberrations were age, sex and smoking independent and it was not also a function of years of work and unusual exposure. Regarding the controversy over this issue in the literature, further researches are needed to be done.

Background and purpose: Decreased balance in standing and walking is a common problem of hemiparesis following stroke. The purpose of this study was to quantify and compare the balance control between right and left hemispheric stroke patients and to determine the effect of balance, functional and strengthening exercises on both groups of patients.Methods and Materials: This clinical trial was performed in Kahrizak Charity Foundation in 1382. Thirty four hemiparetic patients secondary to stroke aged 52.41±6.19 years and 37±26.37 months since stroke participated in the study through simple non-probability sampling. Only those patients were enrolled into the study that the time since the onset of stroke was at least 12 months. Patients were assigned randomly to two groups. The balance was measured with BBS (Berg Balance Scale) and FMA (Fugl-Meyer Assessment) before and after 12 sessions of intervention. One group received only functional and balance exercises. The other group received strengthening exercises in addition to functional and balance exercises. Independent t, Mann-Whitney and Chi-square tests were used for comparison between the two groups and to investigate the relationship, respectively.Findings: There was no significant difference in balance function measures (ordinal scale) between left and right hemiparesis with mean of 50.33±9.13 and 51.69±7.67, respectively (P=0.658). Regardless of the type of exercises, no difference was seen between left (mean difference, 10.86) and right (mean difference, 10.77) hemiparesis after intervention (P=0.909). Significant difference was not seen between left (mean difference, 18.33) and right (mean difference, 15.88) hemiparesis after intervention in strengthening exercise group (P=0.448).Conclusion: Our results suggest that there are no difference in balance function between left and right hemiparesis and recovery of balance in these patients following strengthening exercises and it was not dependent on the involved side.

Background and purpose: There is still debate regarding advantages and disadvantages of regional versus general anesthesia techniques. Some studies suggested that regional anesthesia technique probably reduces postoperative morbidity and mortality.In this retrospective historical cohort study, we compared the cost-effectiveness for spinal and general anesthesia in elderly patients.Materials and methods: A total of 120 medical records of elderly participants whom underwent general or spinal anesthesia for orthopedic and general surgery in one year period at University hospitals were analyzed.The cost of anesthesia technique including the and post operative main complications were determined. The techniques were compared on the basis of anesthesia costs and complications.Results: The cost of drugs for general anesthesia was more than that for spinal (92488+/- 19871) V.S (23549 +/- 7213) rails, p<0.000). The cost of devices for general and spinal anesthesia, were (33073 +/- 7788) and (34461 +/- 8452) respectively (p<0.444).The ratio between cost and complications (such as nausia and vomiting) of spinal and general anesthesia was 2.86. We found that spinal anesthesia was more cost effective than general anesthesia for geriatric patients.Conclusion: We concluded that cost complications of anesthesia techniques largely depend on the cost of drugs and anesthetic devices. In our teaching hospitals, spinal anesthesia has economic advantages over general anesthesia.

Background and purpose: The traffic jam is the most important problem all over the world both in developed and developing countries. Iran is a country with high road accident rate.The data of traffic showed that of 9200000 accidents in Iran, 2000000 were vehicle crash (2001).The rate of death by crash in Yazd province increased from 5.9% of all death in 2001 to 12.1% in 2003 with higher involvement of motorcycles. Many studies showed the relation between the accidents and personality types. Therefor we decided to study the personality of motorcycle riders who had accident.Materials and methods: This was a cross-sectional study carried out on 305 motorcycle riders who had accident in Yazd city in 2004. The data were collected by a questionnaire comprised of two sections 1-demographic and general questions 2-standard test of personality. The questionnaires were completed by interviewers going to the home address of the subjects whom were selected from a list of motorcycle riders who had accident provided by the police station.Results: The most motorcycle riders that had accident due to unsafe practice were in 13-24 yage groups. The magarity of motorcycle rides involved in accidents were in 13-24 age group and practiced unsafe riding.More than 74% of the subjects were of personality type (A) and 74% of the accidents occurred in this group (73.8%). 72.7% of cases with personality type (A) stated that the reason of their accident was not obstacle.Conclusion: The result of this study showed that determination of personality of motorcycle riders, may be a way to prevent accidents.

Background and purpose: Adolescent girls as future mothers have a very important function to train healthy generation and it is important to focus on their nutrition status. Therefore in this survey the effects of socioeconomic factors on body mass index (BMI) (as a nutrition status indicator) was assessed.Materials and methods: The subjects were 240 adolescent girls, 14 to 18 years of age. Weight and height measurements of samples were assessed; their BMI was obtained and compared with BMI age and sex-specific growth charts from the centers for disease control and prevention (CDC) in 2000. A general questionnaire (about parent education, family economical condition and number of household) for all of the samples was completed.Results: A significant relationship between BMI status and number of household was observed but parent education and family economical condition had no significant effects on BMI status.Conclusion: Populous families could affect the household's BMI status; in addition we need wide epidemiologic studies to prepare a suitable standard for Iran to assess socioeconomic status of people.

Background and purpose: Asthma is a chronic disease that is classified in two types, Allergic and non-Allergic. In allergic type; allergens such as fungi induce asthmatic reactions. Unlike the most common allergens such as mite, pollen and chemicals, fungal spore, as an allergen is ubiquitous and present in different seasons. The aim of this study was the determine the incidence of IgE to common allergenic mold in asthmatic patients from Sari city.Materials and methods: A total of 84 asthmatic patients froms sari city were selected using sequenctial sampling method. Sera of all patients were tested for IgE total and specific IgE against Aspergillus niger, Cladosporium and Alternaria alternate using GENESIS and AlerCHEK’S Allernaria specific human IgE kit, respectively.Results: 57.14% of the patients had total IgE of more than normal range. Prevalence of specific IgE for Alternaria (20.4%) ranked the first, followed by Cladospronium (19.05%) and Aspergillus niger (1.10%). 10.71% of the patients had specific IgE to Alternaria and Cladosporium, concurrently.Conclusion: The results of this study showed that in spite of high incidence of the total IgE and specific IgE against Alternaria alternata and Cladosporium in the special age group, there was no significant relation with age and sex. Most of the patients with total IgE more than normal range, were positive for specific IgE to Alternaria alternata and Cladosporium.

Background and purpose: Vitamin A deficiency has been observed in both developed and developing countries, including the Middle East. In this study, the prevalence of vitamin D deficiency was investigated in Isfahani male and female high school students in 2004.Materials and methods: In a cross-sectional study, 318 students (153 boys & 165 girls) aged 14-18 years were selected by multistage random sampling. Data were collected by interview and serum 25-hydroxy vitamin D was measured. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D<20 ng/ml. Results: The prevalence of vitamin D deficiency in all subjects was 46.2% (72.1% in females and 18.3% in males). Vitamin D deficiency was about 4 times more prevalent in female students than males (OR=3.9, 95% CI=1.88-3.91. P<0.001). The sun exposure in males and females was 2.29±1.52 and 1.12±0.84 hour/day, respectively (P<0.001).Conclusion: Vitamin D deficiency is common in high school students, especially in girls. Avoidance of sunshine is probably the main factor contributing to vitamin D deficiency of Isfahani students.

Background and purpose: The safety of blood and its products depends on the health condition of the donors and in spite of screening tests, because of the window period there is the possibility of AIDS being transmitted through blood transfusion, and donating blood for the purpose of HIV check up endangers the safety of blood and its products. Therefore we decided to study the frequency of blood donation for HIV check up and the epidemiological characteristics of the donors.Materials and methods: This study was a cross sectional study and a four choice questionnaire was given to all volunteers who had donated at Shiraz Blood Transfusion Organization in 2003. The questionnaire contains 2 types of questions: 1) sociodemographic characteristic of blood donors 2) motivation for blood donation.Results: This survey was done on volunteers who had donated blood at Shiraz Blood Transfusion Organization in 2003. The average age of these volunteers were 34.6±11.3 and 82.4% of them were male and; 68.6% were marred.The motivation of 56.4% of the donors was helping the others, 14.8% for HIV check up, 15.2% for improving their health condition, 9/6% for health check up and 4% for being curious about donating blood. Blood donation for HIV check up was significant in men, singles, and first time blood donors (p<0.05) Blood donation for HIV check up didn’t correlate with job, education level and age. (p>0.05)Conclusion: In this study 14.8% of the blood donations was for HIV check up, and donating blood for this purpose can be dangerous to the safety of blood, therefore we should provide HIV test free of charge, to avoid blood donation for HIV check up.On the other hand, providing proper training about the possibility of AIDS being transmitted during the windows period would prevent blood donation for this purpose.

Background and purpose: It is now clearly acknowledged that unjustified prescription habit can lead to ineffective or incomplete treatment and may extend the course of illness or time to recovery. At present, there is no taught course available on prescription writing method specifically for common illnesses. Consequently, students learn through experience. In these circumstances, it seems essential to teach medical students the prescription techniques and insight into national pharmacology. Therefore, this study aims to evaluate diagnosis, treatment and prescription writing capability of graduating interns for common clinical scenarios.Materials and methods: This was a cross sectional study assessing the prescription writing ability of 41 interns for 10 common clinical situations based on an Objective Structured Clinical Examination (OSCE).Results: In every station, average action was 1.57. From this, 68% were correct performance. Average number of medicine for each prescription was 1.8, with 70% appropriate medicine. From correct prescriptions, 59% had accurate dosage and 44% with precise course of treatment. On average, there were 1.4 right and 0.29 wrong medical advices per prescription. Over all, 82.7% of recommendations were correct.Average score of interns in all stations was 56.4%. There was a correlation between prescription writing ability and the average mark of interns. More than half of the interns had average ability in writing prescription and there was no relation between their ability and age, sex, marital status, or their medical exam (G.P.A) score at pre-internship exam.Conclusion: Generally more than a third of prescriptions written by students graduated from Sari Medical School were wrong and only 5% of them were absolutely accurate. Conducting practical educational programs of pharmacology, as WHO pattern, seems reasonable.

Background and purpose: Tuberculosis (T.B) is an important cause of morbidity and mortality in renal transplant recipients. The incidence of mycobacterium tuberculosis in renal transplant patients compared with normal papulation is high specially in developing countries.Materials and methods: This study is a retospective review of the records of 700 renal transplant recipients 10 of whom developed post-transplant T.B. . Demographic information, interval between transplantation and T.B diagnosis, T.B site, graft survival and patient outcome were analysed.Results: From 700 renal transplant recipient we found 10 documented cases of T:B (1.4%). Mean age was 37.9 years and mean time for diagnosis of post-transplantation T.B was 15.7 months. The most common forms were pleuro-pulmonary T.B. (60%) followed by milliary pattern (20%) and bone and joint involvement (20%). Two patients (20%) died and rejection occurred in 3 patients (30%).Conclusion: The incidence of T.B in renal transplant recipients is relatively high and its presentation usually atypic, thus a high index of suspicion should be retained in the long term follow-up of these patients, given the importance of early diagnosis and specific treatment to the chance of graft and patient survival.

Pulmonary alveolar proteinosis (PAP) is a nlre pulmonary disease and is rarer in children in which abnonnal accumulation of surfactant in alveoli, causes pulmonary signs and symptoms which gradually progresses to pulmonary fibrosis and respiratory insufficiency. There are some modalities for treatment of PAP but its only effective treatment method, is whole lung lavage (WLL) under general Anesthesia and one lung ventilation. Because of some technical difficulties, it is some times impossible to do one lung ventilation in children to perform WLL hence in these situations the only pIeffered way for WLL is doing it under cardio pulmonary Bypass (CPB). In this report we present 2 pediatric cases with PAP in whom WLL was done successfully under CPB for the first time in IRAN. We recommend this technique for such conditions for treatment of PAP in children.

Group A streptococci (GAS) are rare causes of myositis and myonecrosis involving adult patients in tropical regions.Streotococcal myositis is associated with a wide clinical spectrum, ranging from a subacute localized form wit.1} good prognosis to a serious acute presentation involving rapidly progressive disease, shock, multiple organ failure and a high case fatality rate (80-100%).In this paper we present a 59 years old woman who was in good health before her last 5 days. Her illness presented with a very severs progressive pain of left arm. Her conditions progressed and worsened, despite of right diagnosis and beginning of treatment she died of multi organ failure. Postmortem biopsy of primary lesion of left arm revealed a diffused muscle necrosis with scattered microbial (cocci) cluster between muscle fibers. Culture of primary blister was sterile but streptococcus group A was grown in blood culture.