JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:16 | Issue:53|Papers Count:21

Background and purpose: Post operation pain is seen in 30-70 percent of patients. Using local anesthetic is a safe, easy and cheap method for post opration pain management. In this study, the effects of lidocaine and bupivacaine lavage on post operation pain are assessed. Materials and Methods: In this double blind randomized control clinical trial, 90 healty women between 15-60 years old randomly allocated in 3 groups, lidocaine, bupivacaine and normal salin. After abdominal hysterectomy the medicine or placebo (in uniform package) is Administered in peritoneal cavity by surgeon and, 0, 2, 6, 12, 24 and 48 hours after the surgery, the rate of pain was checked. Consumption of morphin and frequency of vomiting were measured and compared between groups using SPSS 12 software. Results: Post operational pain relief was significantly lower in lidocaine group compared with bupivacaine and normal saline, however, morphin consumption and frequency of vomiting were the same in three groups. Conclusion: Based on the results, it can be concluded that intraperitoneal lidocaine provides significant pain relief for 12 hours after abdominal hysterectomy.

Background and purpose: Alopecia areata is the rapid onset of total hair loss in a sharply defined round area. No definite cause is known for this disease but stress is an effective factor. Different treatments are available but no cure is yet known. The purpose of this study is to determine the efficacy of garlic gel in treatment of alopecia areata. Materials and Methods: The method of study is placebo controlled. The study was performed during summer 2004-5. The subjects were recruited from dermatology clinics in the city of Sari, according to inclusion criteria. They were randomly divided into 4 blocks and received gel and placebo. Garlic gel was used twice dayly with topical corticosteroid. The results were compared together after 3 months. The data were analyzed by ANOVA and Tuky-test using SPSS program.   Results: Twenty patients were given the garlic gel and placebo was administered to the other 20 patients. The average age of the patients (55% male) was 24±15. Scalp was the most common affected area in patients (72.5%) and majority of them had one patch (70%). Positive familial history was noted in 22.5 % of the patients and 25 % of them had the atopic. Stress was observed in 35% of the patients. There was no difference in decreasing the size of patches in the first two months, between the two groups. However, the increase in the number of hair between the two groups were significant in the third month (P<0.05). Conclusion: The garlic gel can stimulate hair growth in patients with Alopecia areata. Therefor this effective and low cost treatment is recommended particularly for limited forms of the disease.

Background and purpose: Despite growing list of antifungal agents, their clinical value has been limited by their relatively high risk of toxicity, the emergence of drug resistance, and insufficiencies in their antifungal activity. This situation has led to an ongoing search for potent broad spectrum antifungal agents with low side effects, which can be administered both orally and parenterally. This paper describes synthesis and structural characterization of 2-methyl-3-triazolyl chromanone oxime ethers as potential antifungal agent. Materials and Methods: Bromination of 2-hydroxyacetophenones with copper (II) bromide followed by reaction with 1, 2, 4-triazole gave the corresponding α-triazolyl-2-hydroxyacetophenones, which separated as regioisomers. Ring closure of α-triazolyl-2-hydroxyacetophenones with acetaldehyde in acetic acid gave the corresponding 2-methyl-3-triazolyl chromanones predominantly in the trans configuration. The target compounds (oxime ether derivatives) were prepared by reacting corresponding 2-methyl-3-triazolyl chromanone derivatives with O-benzyl hydroxylamine hydrochlorides in methanol at room temperature. Results: All of the target compounds were characterized by their 1H NMR, IR and mass spectral data. Conclusion: A convenient and efficient synthesis and structural characterization of 2-methyl-3-triazolyl chromanone oxime ether as potential antifungal agents has been achieved. 1H-NMR spectra were generally used to assign the stereochemistry of the isomers (E or Z form) of oxime ethers.

Background and purpose: Low extrapyramidal symptoms, weight gain, increased fasting blood sugar and cholestrole are some of the side effects of antipsychotic drugs that can be dangerous for patients. Atypical antipsychotics like olanzapine have little extrapyramidal side effects, but they may induce weight gain and increase FBS. Materials and Methods: In this simple randomized double blind chincal trial, 80 admitted patients of psychiatric wards of Noor hospital were randomly divided in two groups, 40 in each. Patients who had past history of diabetes melltus and family history of DM in the first degree relations and/or had undergone diabetogenic drugs thrapy from 15 days before this research or had fatness (BMI>28) were excluded from study. These two groups were statistically matched for age, sex and diagnosis. Primaly FBS was measured 24 to 48 hours after admission and secondary FBS is measured 1 month after the beginning of the treatment. Results: Mean FBS increased in both groups. In typical antipsychotics group, the mean of primary FBS was 89.3±11.1 and the mean of secondary FBS was 94.9±12.6. Paired t-test showed that this difference is statistically significant (t=206 , p=0.01) and in olanzapine group the mean of primary and secondary FBS were 94.9±14.35 and 101.8±22.4 respectively. Paired t-test showed that this difference is statistically significant too (t=2.44 , p=0.01). Medium and high potent typical antipsychotics and olanzapine showed significant changes in FBS, however, the differences were not meaningful between these two groups (t=0.38 , p=0.7). Conclusion: Although both typical antisychotic (medium and high potent) and olanzapine show significant difference in increasing FBS but the difference between these two, groups for increasing FBS were not meaningful. Therefore, case reports are not sufficient for assessing the effects of olanzapine on fasting blood sugar.

Background and purpose: This study was designed in order to compare the effects of spinal and epidural analgesia on labour and also several maternal and fetal factors in vaginal delivery. Materials and Methods: The study was a randomized clinical trail and participatnts were 120 gravid 1 and gravid 2 women in the active phase of delivery, admitted to the labour room of Fatemieh Hospital in Hamedan in 1381-1382. Sixty patients were randomly divided into two groups of 30, analgesia was induced by single spinal sufentanil injection in one group and, bupivacaine plus lidocaine injection in the other group. Maternal vital signs and pain score were recorded (VAS) at 1, 5, 15 and 30 minutes after administration of analgesia and every 30 minutes thereafter. Fetal heart rate every 15 minutes, vaginal examination every hour, urinary output every 4 hours after delivery and the incidence of headache and back pain, one week after delivery were the variables under study. Results: Both groups were matched regarding demographic, gravida and Parity factors. There was no significant difference between groups regarding pain score, (based on VAS), duration of the first and second delivery phase, the incidence of fetal distress, meconium excretion, apgar scores at 1 and 5 minutes after delivery, abnormal laboar, operative or assisted delivery. Average analgesic duration was longer in spinal analgesia than single epidural injection analgesia. Conclusion: Considering the difficulty of the technique, the need for anaestheticianHs supervision and injection repeatition in epidural analgesia, it seems that spinal analgesia is a suitable replacement which is more practical, less expensive, easy to perform and induces a desirable analgesia.

Background and purpose: Despite progresss in the techniques of surgery, there is still a lot of controversy about selection of the best technique and suture material. Many post operation complications such as infection, wound dehiscence, pain and sinus formation are related to the type of the suture used. In this study we compared the complications due to the absorbent suture (PDS) with a non absorbent suture (nylon) in laparotomy operation. Materials and Methods: This clinical trial was performed on 120 patients referring to Imam Khomeini hospital, Sari, 2003-2005 for laparotomy. They were randomly divided in tow groups of equal number. The incision was repaired with PDS sutures in case and with nylon suture in control group. All patients under study were followed up for one year. Data about chronic pain,wound dehiscence, infection, hernia and sinus formation were recorded and analyzed using SPSS software and Chi-square test. Results: In this study 120 patients (60 in case and 60 in control groups) were enrolled. After laparotomy, the incidence of chronic pain and sinus formation in case group was significantly less than the control group. There were no significant differences between the rate of infection, hernia and wound dehiscence in the two groups.Conclusion: No significant differences in the rate of infection, hernia and wound dehiscence between two types of suture materials were observed. However, application of PDS leads to less pain and sinus formation. Therefore, it can be a better choice in surgical incisions.

Background and purpose: The aim of the present study was to identify the true extent of non-responsiveness in children vaccinated against Hepatitis B virus (HBV) ten years ago at birth whom were serologically susceptible to HBV, and had poor antibody response to booster HBV vaccine. Materials and Methods: Twenty low-and non-responding 11.5 years old children recuited in by another study received three additional doeses of HB vaccine 4-6 weeks apart. Anti-HbS antibody titers were assessed before and 4-6 weeks after each dose of vaccine by using ELISA method. Results: All children showed anamnestic antibody responses after receiving the first additional dose of vaccine. There was no significant differences between the mean concentration of antibody after the first, second and third doses of vaccine. Conclusion: Study results showed that those children who did not respond to booster does of the HB vaccine may not be real non-responder.HB vaccine at infancy induces long-time immunologic memory which provides seroprotection by exposure to HBs-Ag.

Background and purpose: Leptospirosis is a zoonotic spirochetal disease caused by coming into contact with water or soil contaminated with urine of the infected animals such as sheep, hours, cow, rat and etc. Farmers, animal husbands, veterinarians and those practicing aqua sport are at risk. Materials and Methods: This study was undertaken in 13 villages of Ghaemshahr City (September 2004) in which because of previous epidemiological observation the probability of this disease was high. Study was descriptive cross sectional with randomized case selection. Five ml of venous blood was taken from each case and tested using an ELISA method. Information about age, sex, job, area of living, symptoms such as fever, headache, mialgia, diarrhea, nausea during this or past summer were gathered. Results: Serological data showed that prevalence of leptospirosis was 29.4% .There is no relation between sex and positive serological results (54.8% women & 54.18% men). Conclusion: Leptospirosis in studied area is epidemic and due to its high morbidity, mortality and economical impact,heath education to people would help to control the disease and chemoprophylaxis can also be used.

Background and purpose: The increased prevalence of pediatric obesity in Iran, and its associated morbidity, with its proven correlation with abdominal adiposity, is assessed by waist circumference (WC). The purpose of this study was to identify predictors of obesity among macronutrient intakes in a group of Tehranian children. Materials and Methods: 343 children aged 5-13 years (194 boys, 149 girls) were randomly recruited among participants of the Tehran Lipid and Glucose Study. Body size was measured based on the McCarthy et al. survey. Children with WC of over 90th percentiles were considered overweight. Dietary intake data were assessed by trained interviewers using two non-consecutive 24-hour recalls. Under-reporters of energy intake were excluded from the study. Dietary composition was assessed in terms of calorie-adjusted amount of macronutrients intake and absolute dietary intakes. They were entered in multiple regression models controlling for confounding variables and mutual effects of other macronutrients. Results: The average WCs of children 5-8 y and 9-13 y were 52.9±5.6 and 62.9±10.1 cm, respectively. Prevalence of overweight in girls did not differ significantly from boys. Absolute and adjusted dietary protein intakes were positively associated with WC in 5-8 y old boys and girls, respectively (ß=0.63, p<0.001 and ß=0.55, p<0.001). In girls, only the absolute amount of fat intake contributed to WC (ß=0.32 p<0.001 and ß=0.3, p<0.01). Energy-adjusted and absolute amounts of carbohydrate intake were found to be negatively associated with WC in boys (ß=-0.23 up to -0.3, p<0.001). Conclusion: The results demonstrated a positive association between protein intake and WC in 5-8 y children, whereas only absolute amounts of fat intake were positively associated with obesity in girls. Pediatric abdominal obesity was found to be inversely correlated with carbohydrate intake.

Background and purpose: Imperforated anus is a disease that requires surgery in the first days of life therefore, association with other diseases or anomalies is of great importance. This study aims to determine the prevalence of Congenital Heart Disease (CHD) in patients with imperforated anus. Materials and Methods: This is a descriptive study on patients with imperforated anus referring to Booali hospital of Sari, IRAN from 1996 to 2003. Previous patients medical records was reviewed and physical examination and concurrently echocardiography were done for new patients. The data were subjected to descriptive statistical analysis using SPSS software. Results: Ninty patients with imperforated anus were entered into the survey. Echocardiography revealed that 26 patients including 14 Female (57.2%) and 12 Male (42.8%) had CHD. 22 of CHD patients (84.6%) had imperforated anus(IA) of high type and 4 (15.3%) had IA of low type. CHD types consisted of: 7 patients (26.9%) ASD+PDA, 6 patients (23%) ASD+PDA+TR, 4 patients (15.3%) PDA, 4 patients (15.3%) MR, 1 patient (3.8%) TF, 2patients (7.6%) VSD and 2 patients (7.6%) ASD. Conclusion: Considering the high prevalence of CHD in IA, it seems that echocardiography is necessary in all those with IA particularly to predict outcome of surgery and prevent probable complications.

Background and purpose: Vaccination is the most effeetive method of prophylaxy in high risk group of hepatitis B. Some individuals faile to respond to triple doses of vaccine which is potentially dangerous. Therefore, immunogenecity of triple doses recombinant hepatitis B vaccine was evaluated in a high risk group (medical sciences students). Materials and Methods:193  healthy medical sciences students immunized with triple doses of recombinant hepatitis B vaccine (0, 1, 6 months). 1-2 months after the last dose, serum anti HBS antibody was determined by ELISA method. According to the antibody titer of the vaccinees (IU/L) they were classified into none responder, low, intermediate and high responder. The none responders were recommended for re-vaccination. Results: Three students (1.6%) were detected as non responder. (<10 Iu/L anti HBS antibody), 23 (11/4%) as low responder, 141 (73%) as intermediate responder and 26 (13.5%) as high responder. Conclusion: The prevolence of non responders to triple doses of recombinant hepatitis B vaccine in medical sciences students was very low.

Background and purpose: Leptospirosis is an uncommon widespread spirochetal zoonoses caused by the members of the genus leptospira. Human disease is acquired by coming into contact with urine or tissues of infected animals, or through contaminated water and soil, thus is an occupational disease particularly in farmers, slaughterhouse workers and fishermen. The goal of this study was to evaluate the clinical and Paraclinical findings of leptospirosis cases in Mazandaran. Materials and Methods: In this cross-sectional descriptive study, patients with high suspicion to leptospirosis presenting to Imam Khomeini and Razi hospitals of Sari and Qaemshahr from June to September 2004 with positive serology finding (MAT) were enrolled. Demographic, clinical and Paraclinical data for each patient were recorded. Results: From 63 patients suspicious for leptospirosis, 36 had positive serologic test. The mean age of the positive patients (25 male, 11 female) was 34.2±13.77 (range 14-64 years old). Most cases (86.1%) were farmers and 83.4% villagers. 55.6% of the patients presented in July. Fever and chills were the main complaints in 42.9% of the cases and fever, weakness, headache, anorexia and mialgia were seen in 96.6%, 96.6%, 93.1%, 89.7% and 85% respectively. Thrombocytopenia and leucopenia were noticed in 45.7% and 33.4% of the patients respectively. AST & ALT in 51.7% & 55.2% of patients were above the normal upper limit. Weil's syndrome and ileus occurred in 7 (19.5%) and one (2.8%) cases respectively. Conclusion: The classic history of fever, weakness, headache, anorexia and mialgia in villagers and farmers in warm months should raise the possibility of leptospirosis.

Background and purpose: With respect to the high prevalence of goiter in Semirom before the initiation of National Program for Elimination of Iodine  Deficiency Disorders (NPEIDD), the impact of the program on the prevalence of goiter in 8-12 years old students of Semirom was investigated in this study, after 15 years of sucessful execution of  NPEIDD. Materials and Methods: After excluding students with any clinical evidence of hyper- or hypo-thyroidism, 1817 students aged 8-12 years were recruited based on a cluster sampling method. The participants were examined for the presence of goiter by experiencd endocrinologists. Urinary iodine was measured in 182 examined students, too. Chi-Square statistical method was used to analyze the data. Results: Goiter was detected in 36.7% of the students (grade 1: 30.4%, grade 2: 6.3%). The median urinary iodine was 18.5 and mean was 19.37±9.22 μg/dl in collected specimens. Conclusion: The adequacy of urinary iodine in students of Semirom confirms the success of NPEIDD, however, the higher than expected prevalence of goiter in the region suggests the probable role of other goitrogenous or autoimmune factors. Further studies should be performed to investigate the possible causes.

Background and purpose: Pregnancy may cause hypertension in normotensive women or aggrevate preexisting hypertention. The incidence of Preeclamsia is 5-10%, and is an important contributor to maternal and fetal mortality and morbidity. According to many predisposing factors in pathophysiology of preeclampsia, the role of lipid preoxides, is also important. In this study attempts are made to show the relationship between inceasing of plasma lipids and hypertension in pregnancy. Materials and Methods: This is a case-control study on pregnant women reffering to Sari Imam Khomeini Hospital, From Oct. 2003 to Oct. 2004. Case group include 100 preeclamptic pregnant women and for control group 100 normotensive pregnant women were recruired. (preeclamsia: BP>=140 /90 mmHg, or Proteinuria>+1 0r >=300mg/dL in urine 24 h ) . Total TG, cholestrol, HDL and LDL were measured by enzymatic methods. Statistical analysis were performed using T-Test and Pearson's method. Results: The most important results are as follows: The mean of TG in case group was 45 % more than that of the control group (P<0.001, sig). The mean of cholestrol level in case group was 15 % more than control group (P<0.01, sig). The mean of LDL in case group is 5 % more than that of the control group (NS). Conclusion: As the levels of plasma lipids in preeclamptic women were more than normotensive women; measuring of Plasma lipids also can be a marker for predisposing to Preeclampsia.

Background and purpose: Although there are many studies on the relationship between mental health and exercise, it is not clear how exercise improves the mental health of students regularly engaged in non professinal athletic activities. The aim of this study was to evaluate and compare the level of mental health in athletic and nonathletic students of Mazandaran Medical University using Scl-90-R questionnaire (Symptom check list-90-Revised). Materials and Methods: A historical cohort study was designed and all athletic students at Mazandaran Medical University (with at least 2 years physical activity) and nonathletic students matched for age, sex, marital status, educational course, semester, job and dwelling completed the Scl-90-R questionnaire and other demographic questions. The data were analyzed using SPSS release 10 and statistical analytic tests. Results: Seventy athletic (34.3% female) and 70 nonathletic students (control) were enrolled in the study. The mean score for each dimension according to the Scl-90-R questionnaire in athletic group was less than the control, but the difference was only statistically significant for depression (p=0.047) and paranoid thinking (p=0.012). In comparison of general scales [Global Severity Index, PST Positive Symptom Test PST and Positive Symptom Distress Index PSDI], the level of mental health of athletic group was better than nonathletic group (p=0.00). Conclusion: Physical activities have a positive effect on mental health, especially in students who are engaged in regular physical activity.

Background and purpose: lack of information about anaesthisia and fear of post operation contiousness, pain, nausea and vomiting increases the patients' anxiety. There are various reports about patiens' desire for preoperation information in Iran and other countries. However, there is no study related to anaesthesiologists' view about patients' needs before anaesthesia and operation in the literature. Materials and Methods: This descriptive (cross- sectional) study was done in 2005 on 110 anaesthesiologists working in hospitals of Mazandaran province. Questionnaire containing 4 questions about demographic and 18 questions related to anaesthesia was prepared. Attitude of the anaesthesiologists was divided into 5 categories based on Likert rating scale as follows: completely agreed, agreed, partially agreed, not agreed, completely not agreed. Chi-square test was used for the statistical analysis of the data. Results: Results of this study showed that the most positive attitude of anaesthesiologists about patient teaching was related to the proper explanation about duration of N.P.O before operation (%97.3). %52.7 of anaes the siologists were against giving explanation of the duration of N.P.O and post operation possible problems. In this regard no significant difference was observed between educational and non educational hospitals (P<0.018). No significant difference in terms of attitude was observed between anaesthesiologists at different level of education (P<0.07). Conclusion: Considering the positive attitude of the anaesthesiologists towards education and preoperation of the patients, it is recommended that such education be implemented and the patients be charged for preoperation consultation in order to give explanation about anaesthesia at proper time, when needed.

Niemann Pick type A is a very rare hereditary disease with an incidence 1 in 20000-40000 live birth, which is calassified as a shingolipidoses. The disease is marked by the abnormal accumulation of sphingomyelin in most tissues, secondary to sphingomylinase deficiency. The most clinical manifestations are: Splenohepatomegaly–cherry red maculae-neuropathologic findings . This is a case report of an infant with clinical manifestation of Niemann Pick disease type A.

Non-penetrating injuries have become one of the leading causes of death as the number of accidents involving motor vehicles iscreases every day. Dissection of the descending thoracic aorta is the most dangerous injury in trauma surgeries and because of its numerous clinical presentations it mimics various medical and surgical conditions. Paraplegia is one of its rare presentations and has been reported in only 0.3% of cases. Distinguishing this condition from other common traumatic lesions with paraplegia is very important as the treatment differs greatly. In this article, a case of paraplegia due to traumatic aortic dissection is presented.