Journal of Mazandaran University of Medical Sciences
Year:2006 | Volume:16 | Issue:52|Papers Count:24

Background and purpose: Von Willebrand Disease (VWD) type 1, is the most common inherited bleeding disorder caused by defect in Von Willebrand Factor (VWF) gene with 178000 nucleotide length. Different methods are available to detect unknown mutations in a genetic study. The fluorescent conformation sensitive gel electrophoresis (F-CSGE) was designed for the VWF gene by using fluorescent dyes in this study and two methods of CSGE (manual and fluorescent) were compared to detect VWF gene mutations.Materials and methods: The VWF gene in 7 index cases with type 1 VWD and one normal control were amplified using 52 exons, exon-intron boundaries and 3' region of the gene using 56 different PCR. The PCR fragments were analyzed using both manual and fluorescent CSGE and the fragments with bandshifts were sequenced.Results: In total, there were 125 PCR fragments with bandshift using F-CSGE and 101 fragments with bandshift using M-CSGE. Five different mutations were identified using both techniques including three new mutations, glycine 19 to argenine (G19R) in exon 2, Argenine 1315 to histidine (R1315H) in exon 28, cystin 2304 to lysine (C2304Y) in exon 40 and two known mutations,prolin 1266 to Lysine (P1266L) and Serine 1285 to Prolin (S1285P) in exon 28. In addition, 45 different polymorphisms were detected using F-CSGE and 39 were detected using M-CSGE. 192 different PCR fragments were analyzed in each run using F-CSGE and maximum 40 samples were analyzed using M-CSGE.Conclusion: Although F-CSGE is more time consuming and more expensive than M-CSGE, but it is a rapid, more sensitive and high-throughput method to identify unknown mutations in VWF gene compared with M-CSGE.

Background and purpose: Polymorphisms found in genes encoding some of adhesion molecules reported to be associated with severity of atherosclerosis. Little is known about the role of L-selectin polymorphism in atherosclerotic inflammaory process. The aim of this study was to assess L-selectin Phe 206 Leu polymorphism in subjects with clinical and instrumental evidence of coronary artery disease (CAD).Materials and methods: A total of 149 (108 men and 41 women) patients with atherosclerotic disease in one or more vessels documented by angiography were studied. Also 215 subjects (128 men and 87 women) without atherosclerosis according to angiographic findings were considered as control. All subjects were genotyped for L-selectin Phe 206 Leu gene polymorphism by polymerase chain reaction with sequence-specific primer (PCR-SSCP). To assess the disease severity, all patients were classified by number of coronary artery with ≥50% stenosis.Results: A significantl increased frequency of the 206Leu mutant allele was observed in patients with CAD compared to those without CAD. The 206Leu allele frequency in the patients with CAD compared to individuals without CAD was 25.9 vs 14.6%, P<0.05. However, no association between L-selectin Phe206Leu polymorphism and the disease severity was found (P=0.35).Conclusion: Our findings suggest that L-selectin 206L/L genotype could represent a genetic risk factor for CAD in the Iranian population.

Background and purpose: Differentiating acute tubular necrosis (ATN) from prerenal azotemia is crucial for selecting the appropriate treatment. Since urinary diagnostic modalities are usually unreliable because of premedications, a rapid and accurate diagnostic modality is needed. This study was conducted to evaluate the diagnostic value of Doppler ultrasonography in differentiating ATN form prerenal azotemia in children.Materials and methods: A total of 50 oliguric or anuric children with previous normal renal laboratory data entered in this study. Doppler examination and calculation of resistance index (RI) were performed within 24 hours of admission and in the recovery phase of ARF. Based on history, clinical follow-up and laboratory studies, diagnosis of underling cause of ARF was made and appropriate treatment started. The sensitivity and specificity of RI in differentiating ATN from prerenal azotemia were assessed.Results: At the cut off points of RI=0.75, the sensitivity and specificity of RI in differentiating prerenal failure and ATN were 91.3% and 85.2%, respectively.Conclusion: Doppler ultrasonography is helpful in differentiating ATN from prerenal azotemia in children. The cut-off value of 0.75 has the highest accuracy in diagnosis.

Background and purpose: Toxoplasma gondii is an obligate interacelullar parasite that infect a wide variety of nucleated cells in its intermediate hosts. Tachyzoites of Toxoplasma gondii in able to multiply in mouse macrophages. Inducible synthesis of nitric oxide (NO) by macrophages is an important mechanism of the host defense against interacelullar infection in mice. The 1.25 dihydroxy vitamin D3 is a potent modulator of immune system and may be beneficial in the treatment of some diseases. Recent evidence suggests that, 1.25 dihydroxy vitamin D3 may increase production of nitric oxide. Otherwise 1.25 dihydroxy vitamin D3 acts to suppress the Th1 immune response that effect on antigen presenting cell and increases production of Th2 cell. The aim of present study is to determine effective concentration of 1.25 dihydroxy vitamin D3 for stimulation of nitric oxide production. The effect of 1.25 dihydroxy vitamin D3 on multiplication of Toxoplasma gondii in macrophage of Balb/c mice in vivo and in vitro were also studied.Materials and methods: Mice were injected with different doses of 1.25 dihydroxy vitamin D3 and/or Toxoplasma gondii interpretoneally. Then infected macrophages were cultured in RPMI-1640. Culture supernatants were collected for nitric oxide assay following 18 hours, then every 24 hours intervally. Nitric oxide was measured by Griess method. Infection levels were assessed microscopically by counting the numbers of tachyzoites in macrophages.Results: This results indicated that there is a decrease in the number of T.gondii in macrophages following treatment with 1.25 dihydroxy vitamin D3 dose dependent (P<0.05). In addition, injection of 1.25 dihydroxy vitamin D3 plus INFγ in medium culture inhibited the multiplication of T.gondii. High level of production of nitric oxide may relate to dose of 1.25 dihydroxy vitamin D3 plus INFγ.Conclusion: In the dose of 1000 microgram of vitamin D3 the highest killing effect of macrophages were demonstrated.

Background and purpose: Leptin and insulin are secreted from fat and Pancrease tissues respectively. They decrease food consumption and regulate homeostasis of body weight via central nerous system. Metformin is an anti hyperglycemia which is used for treatment of type 2 diabetes. The aim of this study was investigating correlation between leptin and insulin levels before and after treatment with metformin in type II diabetic patients.Materials and methods: In this clinical trail, 25 cases type II diabetic patients with BMI greater than 30 Kg/m2, (mean age 52±12 years) were selected. They received treatment with metformin (1000 mg twice daily) for one month, then a fasting blood sample was taken and analyzed.Results: Results showed a significant changes in mean of glucose (P<0.05), cholesterol, triglyceride (P<0.05) and LDL in the patients under study before and after treatment (P<0.05). There was no significant change in mean of weight and BMI, (P>0.05); fatty mass, free fatty mass, leptin and insulin (P>0.05) before and after treatment.Conclusion: The statistical analysis showed that there is a correlation between these two hormones before treatment (P=0.0, r=0.76), while disappears after treatment probably via making the insulin receptors sensitive and through the other probable mechanisms, decreases glucose and changes the function and the effect of insulin that appeared in non-correlation condition of these two hormones.

Background and purpose: Clozapine is an atypical antipsychotic with the least extrapyramidal side effects and more agranulositosis than typical antipsychotics. Clozapine has the unique effects on the treatment-resistant schizophrenia but with threatening side effects on the patients. Thus we did this prospective study in order to identufy the side effects of clozapine in Iranian treatment-resistant schizopherenic patients at Razi psychiatric center, Iran.Materials and methods: We selected 80 treatment-resistant schizopherenic patients on the basis of DSM-IV. After 2 weeks drug free period, the aptients received Haloperidol for 6 weeks and then 40 patients were selected with BPRS score above 45. These patients took clozapine with the similar way which increased to 900 mg/day. They were assessed by internal side effects, EPS questionnaires and laboratory examination weekly followed for 20 weeks.Results: The results showed that 8 patients were excluded from study due to severe side effects. The most prevalent internal side effects were fatigue and sedation and were siallorrhea the most prevalent extrapyramidal symptom. The difference between the mean of WBC, RBC and hemoglobin and the score of EPS in the early and late stages of treatment were not significant statistically, but significant for platelet.Conclusion: Careful clinical monitoring of the physical status and specially hematological status during treatment with clozapine and education to the patients and their care givers carers can prevent fatality by early recognition of severe side effects.

Background and purpose: Despite the introduction of an effective vaccine, more than 30 years ago, measles is a public health problem worldwide. This project was designed and conducted to determine the incidence and characteristics of measles cases in Mazandaran province.Materials and methods: Reported measles cases to the health center for diseases control and prevention from March, 2000 to March, 2002 were reviewed. Demographic data, vaccination status and the relation in occurrence of the disease and serological confirmation of the reported cases were analyzed. Age specific incidence rates calculated based on health center census data.Results: In this period, totally 729 cases (280 females), were reported. From ~ 1/3 serologically tested cases, 135 were confirmed. Age specific incidence rates were: 9.2%, 8.5%, 18.4%, 42.7% and 21.2% in each age group of < 1 , 1-4 , 5-9 , 10-19 and >20 years, respectively.The annual incidence rates were: 7.1, 11.9, and 12.7 for each 105 population. Also 46.5% of the cases occurred in full vaccinated subjects and 39.9% of the cases had not been vaccinated.Conclusion: Because of the high incidence rate of measles in unvaccinated 10-20 years old individuals, paying more attention to vaccination status of children at school entry, increasing vaccine coverage especially for children in suburban areas, case survey, confirmation of reported cases by serological methods and catch-up immunization for increasing immunity are recommended.

Background and purpose: Back pain is prevalent world wide. Chronic low back pain is a complex condition produced by multiple factors. This study investigated the psychological aspects of low back pain in patients with radiculopathy and without any clinical signs.Materials and methods: A total of 112 subjects participated in this descriptive study, of them 56 patients (33 female and 23 male) had low back pain without any clinical signs and a control group of 56 subjects (22 female and 34 male) had low back pain with radiculopathy. Psychological aspects were evaluated by the Persian version of symptoms check list-90-revised (SCL-90-R) and demographics questionnaire. SPSS was used for analysis of the collected data and variables were compared by t-test.Results: In this study, Psychiatric problem was significantly higher in females (X2=4.32, df=1, P=0.03). From marital point of view, the significance between the groups was important (X2=9.33, df=1, P= 0.002). Level of education and profession was not important between the groups. The patients had higher score in all scales of SCL-90-R.A (P=0.000). Collected data were analyzed by t test.Conclusion: These findings indicate that low back pain patients without any clinical signs have an increased occurrence of coexistent psychological distress.

Background and purpose: Screening and preventive programs are the important components in reduction of breast cancer morbidity and mortality.Materials and methods: In this cross-sectional descriptive study, above 15 years old females were selected and were randomly divided in 6 stratums based on the determined aims.Results: We collected 400 questionnaires per stratum and totally 2400 cases with mean age of 25.01±8.78 years and age range of 15-78 entered in this study. Also 46.9% were married, 86.7% had a medium to high education, 23.5% were housewives, 54.2% students and family history of breast cancer was reported in 25.8%. Knowledge about breast cancer prevention was good in 28.5%, low in 67.3%, and poor in 4.2%. It was shown that 37% of the females 20 to 40 years and 48.8% above 40 years performed breast self-examination. But only 17.1% did it monthly. Approximately, 13.12% felt very confident about their correctly done self breast examination. Also 82.6% of the women 20 years and older did not referee to specialist for the last 2 years. Among women 40 years of age and higher, approximately 65.86% refered specialist once and 47.3% did mammoggraphy in the last two years and 61.07% have had at least one mommography in their life time.Conclusion: The Iranian female population need for planning health the education interventions and population-based specific regular screening programs to improve cancer prevention.

Background and purpose: Sleepiness is a major public health problem. Several reasons such as shift work, long time studying, etc, are the cause of sleepiness in medical students, which affect their academic performance .The aim of this study, was to assess the level of daytime sleepiness in medical students.Materials and methods: A descriptive study designed to evaluate the daytime sleepiness of 100 medical students (25 from each group of basic science, physiopathology, stager and intern) by using Epworth sleepiness scale (ESS) questionnaire. The collected data were analyzed using SPSS 10, and analytic tests.Results: From 100 participants, 48% male, 81% single and 58% living in their own house, with mean age of 23.3±3.3 and 8% were drug addicts. It revealed that, 53% of the students had enough sleep (score up to 6), 23% had moderate daytime sleepiness (scores 7, 8) and 24% had daytime somnolence (scores 9 and over 9), 53 % were sleeping less than 8 hours at night. There was no statistically significant correlation between the level of sleepiness and age, sex, marital status, education and accommodation condition. However significant relationship was observed between sleepiness and substance abuse (p<0/05).Conclusion: Almost half of the students suffered daytime somnolence. Therefore further investigations with more cases in order to find the other possible factors are recommended.

Background and purpose: At present CABG is the most common method of surgery. It is necessary to find a good conduit with a longterm patency. Therefore, radial artery harvesting was introduced by Dr. Carpentier and because its patency is much better than saphenous vein. This study was done to show local complications of radial artery harvesting.Materials and methods: Among 1700 patients underwent CABG in a period of two years in Shariati hospital, radial artery was harvested from dominant hand in 400 patients and from both hand in one patient. Modified allen test was done in all patients and radial artery harvesting was done in the patients showing negative test. After harvesting, sensation of volar aspect of hand and radial aspect of arm was tested in different period of times.Results: In 1700 patients who underwent CABG, allen test was positive unilaterally in 8.9% and bilaterally in 10.1%. There was no infection in wound. There was a case of local necrosis of wound edges. The most common complication was neurosensory seen in 10 % of the patients. There was one case of bleeding from drain pipe and one case of hematoma.Conclusion: Radial artery harvesting after modified allen test with 10 second cut off point is a safe procedure. As we know, there would be complications, because of near sensory nerves; the procedure must be done by expert surgeons.

Background and purpose: Medical procedures can be unpleasant experience for children, their parents, and health care workers. Preparing the child and their parents for procedure may help to increase the comfort of children, parents and hospital staff. The aim of this study was to know the practice of nurses in pediatric hospital of Tabriz university of medical sciences about communication on children during procedures.Materials and methods: The subjects under study were 36 nurses, 46 parents and 46 children hospitalized in pediatrics’ hospital in the Tabriz city. Selection of nurses was done through census and of children and their parents through the medical records, randomly. The questions aimed to obtain information on knowledge, attitude and practice of pediatric nursing staff about communication with children during procedures, and the reasons of inadequate communication with children.Results: Knowledge of nurses about communication with children during procedures was fairly high, in that, more than 85% of them were aware of necessity of children own toys reachy in the ward, importance of operating painful procedures out of bed, necessity of using distraction techniques, and showing the instruments to the children, and importance of not pointing out to the procedures as a punishment. Most of nurses dressed site of painful procedures after but nurse's practice about operating procedures out of bed, operating procedures on doll with children, and matching for sex of teenager patients and nurses was poor. Finding reveals that the reasons of inadequate communication of pediatric nurses with children are as follow: inadequate staff in the each work shift, inadequate time for communication, tiredness of nurses.Conclusion: Though pediatric nurses are busier than ever, but time should be spent for this important aspect of patient care and the decision makers and programmers should pay special attension to this issue.

Background and purpose: Neonatal icer is one of the common problems in neonates caused by different etiologies. Because of CNS complications which cause mortality or mental relardation, neonatal icter is very important. According to the role of knowledge and attitude of the mothers and inappropriate referral of the neonates to physician, effectiveness of treatment and prevention of serious complication, we studied the knowledge and the sttitude about neonatal icter among mothers in Sari.Materials and methods: This was a decriptive crossectional research. Study population was mothers of neonates at the public and private hospitals. Sampling method was stratified and simple. The tool for data collection was questionnaire consisted of demographic variables, 16 questions for knowledge and 14 questions for attitude about neonatal icter with 16 and 28 scores respectively. Validity of the questionnaire was confirmed by experts' consultant and reliability by test method. After data collection and definition of level of the knowledge and attitude, analysis was performed by SPSS software using X2, t test abd ANOVA.Results: Totally 400 mothers were studied. Age of them was 25.81±4.88, 4.25% of them were at the high risk age for pregnancy, 52% were urban and 4.5% were illiterate. Also 42.3% had prenatal care, mostly (64.4%) by specialist physician. Most of the mothers were in the low (42.3%) or moderate (23.3%) socioeconomic status, 76.5% of the mothers had low knowledge, 23.3% moderate and only 1.3% have high level of knowledge about the neonatal icter. This knowledge significantly was related with elder age mothers, higher level of education, higher socioeconomic state and history of icter in the pervious child (P=0.000). The attitude about neonatal icter was inappropriate in 19.3% of the mothers, relatively appropriate in 60.3% and appropriate in 20.5%. This Attitude was significantly related with elder age and higher level of education of the mothers, living in urban areas, higher socioeconomic state and higher number of childs (p=0.000).Conclusion: Most of the mothers had low level of knowledge and attitude about the neonatal icter. Therefore serious attention and designing of appropriate intervention for improvement of the knowledge on attitude about neonatal icter are essential.

Background and purpose : The susceptibility of three wild strains of B.germanica collected from different hospitals (Shafa, Kerman darman and Shahid bahonar) affiliated to Kerman university of medical sciences were evaluated using Pirimiphos methyl, Propoxur and Lambadacyhalothrin.Materials and methods: The method of testing was followed according to method of WHO, through contact procedure. The relationship between mortality and concentration was plotted. The LD50 and LD90 values were measured by probit analysis.Results: Findings indicated that in comparison with the sensitive strain with LD50 values of 0.42, 48.47 and 115.42 for lambbacyholathrin, propoxur and pirimiphos methyl respectively. Shafa strain with LD50 values of 1, 56.71 and 88.82 and with the resistance ratio of 2.38, 1.17 and 0.77 fold were resistant to lambdacyholothrin and sensitive to propoxur and pirimiphos methyl, respectively. Kerman darman strains with LD50 values of 0.60, 54.20 and 86.38 and resistance ratio of 1.42, 1.12 and 0.75 fold respectively were sensitive to all three insecticides.Conclusion: The LD50 values of three wild strains were lower than the LD50 value of the susceptible strains. This result showed that all of the wild strains were negative cross resistance to Pirimiphos methyl.

Background and purpose: Addiction is one of the four world problems, with psycho somatic disorders along with cultural, social and economical complications. Aim of this study was to determine the psycho social condition of addicts in 2004.Materials and methods: This was a descriptive study done on 747 addicts living in Sari Township using questionnaire comprising questions on social-individual features, with standard test of SCL-90-R. The data were analyzed using descriptive and analytical tests and SPSS software.Results: It was found that 14.8% of the cases under study were workless, 40.42% labour and farmer. Also 89.4% were suspect of mental disorder. The most common mental pathology based on the 9 cateorgories in the cases under study was as follow: Anxiety, depression, paranoid, obsessive compulsive, somatic complication, phobia, aggression psychosis. Significant difference on mental health between unmarried, divorced and married was observed. Same result was obtained between the above groups in all aspects, except phobia (P<0.001).Conclusion: Addiction is present in all age groups and all socioeconomical classess. Suspect mental disorder in the addicts in high. Therefore it is suggested that more psychiatric consideration be paid to the addicts who are prone to mental disorders. Also the mentally disorders be under more primary preventive care.

Background and purpose: Overweight and obesity are generally considered to have a negative impact on longevity because of their association with many diseases, such as hypertension diabetes, coronary artery disease, osteoarthritis and cetain types of cancers. This study was conducted to determine the prevalence of malnutrition (obesity and underweight) and some of their associated factors in elderly.Materials and methods: This cross-sectional study was done on 1700 (733 male and 969 female) elderly people (60 years and over), in Isfahan during spring and summer 2004. Elderly were selected using a cluster sampling methodology, each containing 30 clusters. Also 58 elderly were selected randomly from each cluster. Respondents were asked to reply the questionnaire. Anthropometric measurements were taken using digital scale and tape. Data were analyzed by usinf SPSS Ver 11.5 and using χ2 test, analyze of variance and correlation coefficient.Results: Background variables like age, sex, education and occupation were found to be associated to BMI for elderly. There was a significant negative correlation between age and BMI for elderly. There was statistically significant relationship between cigarette smoking, watching TV and BMI for elderly. Based on BMI: 12% of males and 28.9% of females were obese, 5.9% of males and 4.1% of females were underweight; based on WHR: 45% of males and 87.1 % of females were obese and based on WHTR: 75.3% of males and 83% of females were obese.Conclusion: Our results indicate that increasing the knowledge of the elderly people about balanced diet and aerobic sports proportionate to their age, seems to be necessary for the prevention of obesity. According to our observations, changes in life style such as, decreasing of sedentary activities and avoidance from cigarette smoking are important measures for the prevention of malnutrition. In all, efforts should be directed toward influencing those underlying factors decreasing obesity in the elderly.

Background and purpose: The methodological aspects, as well as the quantity of papers have been published in a scientific journal are important factors regarding its periodic evaluation. The study was conducted by Mazandaran Thalassemia Research Center, Sari Iran.Materials and methods: This descriptive study was conducted on all issues which were published to the date. A questionnaire consisted of 48 items was prepared according to authors instruction of the journal and educational workshops and the reference booklet. Validity of the questionnaire was achieved through expert consultations. Reliability by test –re test method. Four hundred and seven papers were evaluated in 2 groups. The 1st group (No: 43) was consisted of papers were published in volumes 1-12, from 1992-1995. The second group (No.364) was divided in two subgroups each consisted of 182 articles, according to dates of publications. Descriptive statistics was used to show the data.Results: Papers in the 1st group were mainly case reports, translations and nonsystematic reviews. Original researches were exceptional. In second group, however, descriptive, clinical trials and experimental designs were mainly used by researchers. The time gap between the research and issue date in 3 periods were 1±1.6, 1.34±1.5 and 1.22±1.3 years respectively. The number of references of each article was significantly more in the recent period (P<0.000) but the number of Farsi references was the same in 3 periods. The number of articles in each issue was 5.8±3.2, 9.8±2.9 and 14.5±3.6 respectively. The first author affiliation during the years was MUMS.Conclusion: Quantity and quality of papers of the journal were growing during the years of activity.

Background and purpose: The master patient’s index (MPI) card is the key to locate the patient’s record in medical records department. Use of MPI in hospital information systems is important. An accurate MPI is noted in evaluation and accreditation program. Our study was done on MPI at medical records department of teaching hospitals in Mazandaran medical university in respect of using indexing rules and arrangement of cards for filing.Materials and methods: This survey was done for inpatient cards in 5 teaching hospitals of Mazandaran medical university and 1999 MPI cards were checked. A part of data related to using indexing rules and filing was gathered with checklist and factors associated with management of department collected in questionnaire. Data processed with SPSS software and analyzed with descriptive and inference statistics.Results: Findings showed that 20% of staff responsible for indexing and filing of MPI was technician (post diploma course) in medical records. In 100% of hospitals, guide card and cross-index card wasn’t use. Indexing error increased with the increasing the number of admitted patients (p=0.003), low experience (p=0.001) and degree and no course study relation of medical records department managers (X2=9./03, p=0.000). In addition, indexing error increased in staff with no academic training (X2=3.84, p=0.05). Also results showed that there is 64.2% indexing error and 9% of cards are misfiled.Conclusion: According to the findings, staffing professional personnel, training them with up dated knowledge, periodic control of issued cards, creating needed rules and regulation based on new scientific materials, exact indexing and filling rules suggested.