JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2011 | Volume:28 | Issue:118|Papers Count:19

Background: Cervical (uterine) carcinoma is the second most frequent type of women cancer. Success in early diagnosis of this disease is due to the use of pap-smear test. However, this test has both false-positive and false-negative results. P16 protein is a Cyclin-dependent Kinase inhibitor supposed to be overexpressed in cervical dysplasia and cancer. Our study was about correlation between P16 and cervical dysplasia.Methods: In this study 45 patients with dysplastic abnormalities in cervix (including Ascus-H) were sampled for papsmear (by Liquid-base method). Two smears were stained, one with papanicolau and the other (by IHC) for P16. The results were compared using t-test via SPSS15 software.Finding: Pap-stain revealed 13 ASCUS (29%), 18 LSIL (40%), 11 HSIL (24%), and 3 S.C.C (7%). Immunostaining of P16 protein was observed in ASCUS (3/13, 23%), LSIL (12/18, 67%), HSIL (11/11, 100%), and S.C.C (3/3, 100%). P16 had significant correlation with degree of cervical dysplasia in Liquid-base pap-smear (P<0.0001).Conclusion: We suggest the usage of P16-test as an optional test for cervical dysplasia according to our study.

Background: Asymptomatic bacteriuria is common in pregnant women. The aim of this study was to determine the prevalence of asymptomatic bacteruria in pregnant women with and without gestational diabetes.Methods: In this case-control study, pregnant women aged 16-40 years attended to Shahid Beheshti hospital in Isfahan were studied and the prevalence of asymptomatic bacteruria was compared in pregnant women with and without gestational diabetes. They were screened for gestational diabetes mellitus, using glucose challenge test. Asymptomatic bacteruria was determined using microscopic examination and culture of a clean midstream voided urine specimen.Finding: 172 pregnant women were enrolled in each group. The prevalence of asymptomatic bacteruria was 27.3% and 24.4% in pregnant women with and without gestational diabetes (P>0.05). The rate of asymptomatic bacteruria was higher in lower age group in non diabetic patients, but it was not different significantly in pregnant women with gestational diabetes. There was not significant relationship between history of urinary tract infection and asymptomatic bacteruria (P>0.05).The most common cause of asymptomatic bacteruria was E.Coli in both groups (76.2% in non diabetic and 70.2% in pregnant women with gestational diabetes).Conclusion: Asymptomatic bacteriuria considered as a major health problem in this region and though its prevalence was not higher in diabetic pregnant women than non diabetic ones but considering its high prevalence, screening for asymptomatic bacteruria during pregnancy seems to be essential.

Background: During recent decades, there are reports about the decrease of sperm production ability in men affected by different factors. Caffeine is one of the popular nutrients extensively used in human populations and its reproductive effects have been reported. So, present study was aimed to determine the effects of caffeine consumption during lactation on postnatal development of testis in offspring Wistar rat.Methods: Female Wistar rats were exposed to low and high doses (25 and 35 mg/kg) of caffeine via drinking water during lactation. The testes of pups were removed at 21, 28, 60, and 90 days of postnatal development, their weights recorded and the tissues were fixed in Bouin’s solution. Then, the volumes of testes were estimated by Cavellieri method.Finding: Mean body weight decreased significantly (P<0.05) in high dose group at all ages of postnatal development. Mean testis relative weight and total volume were decreased significantly (P<0.05) at 28, 60 and 90 days of age in 35 mg/kg dose group. Significant (P<0.05) decreases were seen in means of seminiferous tubules diameter and germinal epithelium at 28, 60, and 90 days of age in high dose treatment group. Also, serum testosterone levels decreased significantly (P<0.05) at puberty in high dose group.Conclusion: Present study indicates that caffeine consumption during lactation can reduce efficiency of spermatogenesis and fertility in offspring Wistar rats at puberty.

Background: Diabetes mellitus is one of the most common and important metabolic diseases worldwide. Hperuricemia is associated with kidney damage manifested by glomerular hypertrophy and sclerosis. The aim of this study was evaluation of association between serum uric acid level and proteinuria in patients with type 2 diabetes mellitus.Methods: A total of 140 patients (48 men and 92 women) with type 2 diabetes mellitus were enrolled in the study. Demographic criteria as age, body mass index, serum uric acid level and 24 hours urine protein were measured in these patients.Finding: Mean of patients age was 59.8±10 years. Uric acid level in patients with significant proteinuria (³500 mg/24 h) and mild proteinuria (<500 mg/24 h) were 6.70±1.82 and 5.06±1.46 mg/dl respectively (P<0.001). Serum uric acid level had positive correlation with 24 hours urine protein, duration of diabetes and insulin treatment.Conclusion: In type 2 diabetes mellitus, serum uric acid level has positive correlation with proteinuria; so uric acid maybe has a role in progression of diabetic nephropathy.

Background: Tonometry is one of the important parts of ocular examination. It has been estimated that more than 900000 people in the United State have visual problems due to glaucoma; however most of them are not aware of their disease. Goldmann applanation tonometry is the most common, accurate, and the gold standard method for intraocular pressure (IOP) measurement. Having considered the complications of using fluorescein, such as burning sensation, allergic reaction, pruritus, and infection, as well as its high costs and less availability, we compared Goldmann applanation tonometry with and without flourescein usage.Methods: In this study, we evaluated 250 patients (500 eyes) referred to Mofateh clinic, Yasuj, Iran in May 2008. Patients with glaucoma, sunken eyes, and narrow palperbral fissure as well as those younger than 15 years old and non-cooperative patients were excluded from this study. Tonometry of one eye for each patient was done randomly with flourescein and the other without it.Finding: 105 women (42%) and 142 men (58%) with mean age of 32±13 years were enrolled in this study. The mean IOP with and without flourescein were 12.90±2.07 and 12.60±2.09 mmHg, respectively. The mean IOP of right eyes was 13.08±1.73 mmHg with flourescein and 12.68±2.11 mmHg without flourescein. The mean IOP in left eyes was 13.12±2.04 mmHg with flourescein and 12.12±2.33 mmHg without flourescein.Conclusion: There are not any statistically significant differences between IOP measurement with and without flourescein. Further investigations are recommended in this regard.

Background: Cutaneous leishmaniasis is the endemic type of leishmaniasis in Iran especially Isfahan province. Pentavalent antimonials are the first line treatment in all kind of leismaniasis; but their high cost side effect and also injection from, shows the necessity of finding new ways of treatment with more affectivity and lower side effect.Methods: A clinical trial that was performed in autumn and winter of 1387 on patients coming to center of skin investigation and skin clinics. 90 patients entered randomizely into case and control group, 85 of control group and 75 of case group referred for follow up. Statistical analysis was done with SPSS. In this investigation the mean reduce in size of lesions in case group was -9.55 and in control group was -5.33 and p 0.001 so it was meaning full.Finding: The mean reduce in duration of lesions in case group was -5.2 and pvalue under 0.001 so it was meaning full. Complete cure in case group was %80 partial improvement %8 and no change %9 and control group cure was %52.9 partial improvement was %11.8 and no change was %35.3 compare of improvement in two groups shows That improvement in case group has been meaning fully more than Control group that can be because of the effect of terbinafin on treatment of cutaneous leishmaniasis.

Background: Matrix metalloproteinase-9 (MMP-9) has been reported as a new marker gene for several cancers. With respect to the significance function of this gene in diagnosis of cancers in the present study we compare the correlation between the plasma and serum MMP-9 levels and clinical features of breast cancer patients.Methods: In this case-control study, 120 breast cancer patients and 87 healthy controls were studded. MMP-9 level was quantitatively measured by zymography and specific kit. The results were compared with clinical features of patients.Finding: Plasma MMP-9 level was significantly elevated in breast cancer patients compared with the control subjects (P<0.001). Also there was a correlation between the plasma MMP-9 level and lymph node metastasis (OR, 3.43; P=0.019) and venous invasion (OR, 4.14; P=0.033) of the patients. There was no correlation between the serum MMP-9 level and lymphatic metastasis or venous invasion.Conclusion: according to our findings the plasma MMP-9 level in comparison with the serum MMP-9 level is a better determinant for early diagnosis, lymph node metastasis and venous invasion in patients with breast cancer.

Background: Tinnitus is one of the most prevalent causes of the patients to the ear and hearing clinics that despite widespread effort of physicians and researchers all over the world, yet no comprehensive and low complication treatment have been provided for it. This study aimed to offer a new method to treat tinnitus using transcutaneous electrical stimulation.Method: This was an interventional experimental method study in Borujerd, Iran on 100 referral patients to the ENT (Ear Nose & Throat) clinic while complaining about drug-resistant permanent severe tinnitus. After complete audiometry examination and evaluating the cause of tinnitus, these patients underwent transcutaneous electrical stimulation by transcutaneus electrical nerve stimulation (TENS) device. To do so, an electrode covered by damp cloth with 12 mm diameter was placed on the ear of the patients and electrical stimulation with 150 kHz frequency was done for 10 minutes. This was done for 5 consecutive days. The data were analyzed using SPSS software.Results: In this study, 70 out of 100 patients at least experienced two times of tinnitus for a few hours. Ten patients (10%) announced that they have achieved complete remission i.e. their tinnitus stopped completely. Twenty patients (20%) also stated that TENS device had not influenced on their tinnitus.Conclusion: Young people with short history of tinnitus with high frequency would be suitable candidates for implementing TENS. However, using TENS seems logical for those who were helpless due to tinnitus and the conventional therapies could not effect on it.

Background: The etiology of sleep disruption, psychological and physiological disorders in patients in intensive care units (ICUs) is poorly understood, but is thought to be related to environmental stimuli, especially noise. This study was conducted to determine levels and time- and place-patterns and sources of noise in the three educational hospital’s intensive care unitsMethods: This cross sectional study was conducted in three university hospitals, Isfahan University of Medical Sciences, Isfahan, Iran. Noise levels measured with SLM (cel-440) during 24hours on the every day in a week for each ICUs. The daily hours devided into seven sections and level of noise with the sources was determined separately.Finding: Noise level in alzahra (64.04 dB), Kashani (64.27dB) and Chamran (64.80 dB) university hospitals were exceeded about 40-50 dB compared with limit recommended by the EPA. Noise level was higher on weekdays than weekends with higher during mid-day hours. The most important source of noise in ICUs is staff behavior.Conclusion: Noise levels measured in our hospital’s ICUs were higher than standard permitted values for hospital’s ICUs. To counteract noise pollution in ICUs, staff awareness and sensitivity are needed.Environment design of ICU is very important in reducing noise level too.

Background: Fatty streaks are the primary lesions to form atherosclerosis. Lipid per oxidation by free- radicals, plays an important role in plaque formation. Vitamin E, as a lipid in soluble vitamin, is an important antioxidant and may prevent or delay the coronary heart disease by limiting LDL oxidation. Our goal was to evaluate the effect of vitamin E and iron on blood serum lipids in male rabbits fed high – cholestrol diet.Method: Thirty white male rabbits were weighed and blood serum samples were taken for analysis of serum lipoproteins. They were randomly divided in to 5 groups each Containing 6 rabbits for 42 days. Group1 was given normal diet, Group2 fed with high cholesterol (%2) diet, Group3fed with high cholesterol diet with iron (50 kg/mg), Group4 fed with high cholesterol diet with vitamin E (50 kg/mg) , Group5 fed with high cholesterol diet with iron (50 kg/mg) and vitamin E (50 kg/mg). These groups were again weighed and blood samples were taken for analysis of serum lipoproteins after 42 days.Results: Significant difference in cholesterol, LDL, HDL, TG, VLDL, were seen before and after the experiment in all 5 groups, (p<0/000).Conclusion: The significant difference was observed between all groups in relation to the effect of iron and vitamin E on lipid metabolism. While vitamin E has a protective role in atherosclerosis, it seems that iron has a provocation role in serum lipids.

Background: Leishmaniasis is one of the 6th important infectious diseases in the world that has been certificated as an endemic disease in Iran. The aim of this study was comparison of two methods of treatment included flouconazole with glucantime and glucantime alone in treatment of leishmaniosis.Methods: In this double blind prospective clinical trial, 100 patients with confirmed cutaneous leishmaniasis were enrolled and randomized in to two groups. Fifty patients (group A) treated with topical flouconazole twice daily along with intralesional of glucantime once weekly until complete healing of the ulcer of for maximum of 6 weeks and fifty patients (group B) were treated with topical placebo twice daily along with intralesional injection of glucantime once weekly until complete healing of the ulcer of for maximum of 6 weeks, The patients were followed for three months.Finding: In group A, 32 (64%) patients had complete cure whereas in the group B, 19 (38%) patients achieved complete cure with significantly difference (p<0.001)Conclusion: the efficacy of foluconazole along with glucantime is more than placebo along glucontime in the treatment of cutaneous leshmaniasis. Also Fluconazale decrease the time of healing and the dose of glucantime that is needed for the treatment of cutaneous leshmaniasis.Future studies are warranted.

Background: Bacterial corneal ulcer is a serious urgent and is one of the most important causes of eye morbidity; its delayed diagnosis and treatment lead to decrease or loss of vision. In some cases, conjunctive flap is the choice treatment. It has prolonged history and due to new therapeutic method, its application has reduced. It is a controversy about indication of conjunctive flap in active corneal ulcer; so we decided to investigate results of this procedure in patients with active corneal ulcer.Methods: A retrospective study was performed for 80 patients with active corneal ulcer treated by conjunctive flap in Feiz hospital in Isfahan during 2004-2005. Demographic data and results of conjunctive flap including good response, reoperation, keratoplasty was gathered from patient's files. Relation of age, gender and results was studied by chi-square test.Results: Eighty three patients were studied. The mean age of patients was 62.1±19.3 years. The range of 70-79 years old had maximum and 40-49 years old had minimum frequency. Fifty seven patients (68.7%) were men and 26 (31.3%) were women. Student’s t-test showed no significant difference between men and women mean age. In addition, no different in frequency distribution in two groups was found by chi-square test.67 patient (80.7%) had acceptable response, 12 (14.5%) needed reoperation and 4 patients (4.8%) needed keratoplasty. The mean age of those respond to treatment was 63.5±19 years, of those who needed reoperation was 57±20.6 years and of those who needed keratoplasty was 55±2 years. Response to treatment was seen in 46 men (80.7%) and in 21 women (80.8%). Eight men (14%) and 4 women (15.4%) needed reoperation and, 3 men (5.3%) and 1 woman (3.8) needed keratoplasty.Conclusion: According to our findings, conjunctive flap surgery is not recommended in active bacterial corneal ulcer.

Background: One of the issues anesthesia specialists permanently are faced with in spinal blocks is the prolongation of the surgery more what had been estimated. Provided that intravenous midazolam can increase duration of lidocaine interathecal block, it would solve the problem.Methods: This was a double-blind clinical trial study in which adults underwent elective abdominal surgery and lower extremities of ASA, I, II and studied in two 18-member groups. Midazolam group (0.03 mg/kg) underwent the intervention as Midazolam 2mg+fentanyl 1mg/kg (5 min after administration of midazolam) and the control group as normal saline 2cc+fentanyl 1mg/kg (5 min after administration of normal saline). The highest level of sensory block, duration of sensory block, duration of motor (movement) block and recovery duration were measured and documented.Finding: Mean duration of sensory block had no significant difference between the two groups; however, duration of motor block for the Midazolam group was 82.9±27.3 minutes which significantly was more than control group with 59.1±26.5 minutes (P=0.01). The median of sensory block level for midazolam and control groups respectively were T8 and T10 and according to nonparametric median test, the median of sensory block level had a significant difference in the two groups (P=0.02). The average duration of stay in the recovery, in the patients of midazolam group was 116.1±29.6 minutes and in the control group also was 87.8±24.1 minutes which significantly it was higher in midazolam group (P=0.002).Conclusion: The present study indicated that intravenous midazolam injection in spinal anesthesia with lidocaine increased the duration of motor block without any side effects (nausea, vomiting and respiratory distress), and caused more hemodynamic and saturation loss of arterial blood pressure.

Background: The gastric and duodenal ulcers are chronic disease that their incidence increases with developed modern and machinery life. Clinical Manifestation of peptic ulcer (PU) are epigastric pain, nausea, vomiting but in endoscopy some patients are normal which is named non ulcer dyspepsia (NPU).Methods: This prospective study performed on 300 patients that admitted due to dyspepsia and underwent endoscopy.Finding: In study sample 120 PU and 180 NPU were diagnosed. In PU group there were 76 (63.3%) male while it was 84 (46.6%) in other group (P=0.004). Smoking was more in PU (44 (36.6%) ver. 20 (11.1%), P<0.001). The most prevalent symptom in both groups was epigastric pain.Conclusion: While PU is more prevalent in women, NUD is the case in men. Smoking was more in PU rather than NUD. On the other hand all symptoms of these two disease are similar and definite diagnosis of each is possible only through endoscopy.