JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2001 | Volume:18 | Issue:60|Papers Count:18

Since relationship and importance of stress in many diseases have been proven, evalution of the effects of noise polution, which is a stress and a problem of the modern societies, on blood pressure seems to be important and essential. More over, the effects of stress on elevation of blood pressure and the point that blood presure is one of the main factors of the mortality amongst the patients with cardio-vascular disease, we decided to conduct an intervening study in this area of research.In this project 10 rats divided into two equal groups as an experimentals and controls. The rats of experimental group exposed to sound impulses of 300, 500 and 1100 Hertz with 20 decible strength. This treatment continued for 45 days. After this duration of time the blood pressure of individual rats in the experimental group compared with that of the control ones.The results showed that noise polution could be an important factor in developing different diseases specially those related to cardio-vascular and urinary(Kidny) systems.

Fibromyalgia is a syndrome with an overall prevalence of 2% which often affects women. There is presently no effective, reliable and complication-treetreat ment for fibromyalagia. Thisstudy aims at comparing the results of physical& drug therapy administered for women with fibromyalgia & depression.This was a clinical trial involving 62 women who had presented to the rheumatology clinic of Isfahan Alzahra general hospital in the second half of the year 1379. The patients were randomly dibvided into two groups, each with 31 patients. One group underwent physical therapy and the other received drug treatmnt. Admission criteria in the study included showing characteristic symptoms of fibromyalgia and depression, and rule out of secondary fibromyalgia & no history of receiving anti-depressant and muscle relaxant agents during the preceding 6 months. The patients were evaluated for severity of depression & number of tender points over a period of 4 months. SPSS softwave package, Fridman & chi-square tests were used for statistical analysis.Comparing the two methods of treatment showed that both were effective in reducing depression and number of tender points. However reduction of tender points at conclusion of the 4th, 8th & 12th weeks of treatment was more evident in the group undergoing physical therapy. Reduction in severity of depression at the end of the 12th week of treatment was 58% in the group andergoing physical therapy & 19.3% in the group receiving drug treatment.Althogh both methods were effective in reducing depression and number of tender points, physical therapy seemed more effective and reliable in treating patients with fibromyalgia. We propose that physical therapy substitute or be administered prior the drug treatment.

In this prospective study, we evaluate patients that suffered from eye effects & injuries due to observing the eclipse over isfahan in August 1999.609 patients with suspected eye complications following observing eclipse referred to Feiz Eye Hospital. All patients were examined 5 times (1 week, 1 month, 3 months & 6 months after eclipse) and their complications & eye findings recorded in special chart.The most frequent age group was 16-40 years old (73.5%). 215 patients (35.2%) had used eye protective devices. 495 patients (81.28%) had symptoms such as itching, tearing and photophobia, reduce vision was detected in 42, visual scotoma in five and matamorphopsia in two patients. External symptoms resolved in 1 week to 1 month after eclipse.37 patients of reduced vision cases improved to 20/20 during 6 months after eclipse & remaining 5 patients had 20 reduced vision 1-3 lines of snellen chart.These patients had not used protective devices and watching eclipse relatively long time.Funduscopic examination revealed macular burn in 54 patients that their flurescein angiography was normal, in all of whome this finding had no significant effect on their visual acuity.According to the results of this study eye effects and injuries from eclipse watching is not frequent and most of the cases will improve within several weeks

For a long time medicinal plants had application for treatment of different diseases. Therefore medical sciences need to know more about these plants and their derivatives. In this survey, effects of garlic extracts were examined on Syphocia. obvelata (as a nematoda model) and Hymenolepis. nana var. fraterrna (as a tapeworm model).Garlic powder were prepared and perculated in ethanol and distilled water separately. For elimination of alcohol effects and right concentration of extracts, vacume evaporation was acheived in such way that each mililiter of extracts had one gram of garlic powder. Different concentration and volume of extract were tested for intubation. At last, four groups of suri mice infected with S.obvelata and H.nana var. fraterna were selected and intubated for four days (0.5ml oj.d) by 5% and 20% of garlic hydroalcoholic and aqueous extracts. Fisher test was performed and probability of P<0.05 was regard significant in each group.The application of alcoholic and aqueous extract (5% and 20%) cured 57.1%, 85.2% , 14.3% and 28.8% of mice infected with S.obvelata. Same concentration of alcoholic and aqueous extracts cured 20%, 25% , 20% and 40% of mice infected with H.nana var fraterna. Alcoholic extracts had more effects than aqueous one (P = 0.036).However alcoholic extract showed better effects than aqueous extract on H.nana var fraterrna, both extracts had no significant effects on mentioned tapeworm. Garlic alcoholic extract cured more than 55% of infected mice with S.obvelata and had better effects than aqueous extracts. The improved effects of alcoholic extracts may be due to better resolution of active ingredients in alcohol. With more clinical studies alcoholic extract of garlic can be used in parallel with chemotherapy in treatment of oxyuridae (as a nematoda) infections.

Chronic otitis media is one of the most common middle ear diseases which causes irreversible pathologies in the middle ear. Usually, surgery is necessary to treat it because of its resistance to antibiotic therapy; The benefits of prophylactic antibiotic thrapy after operation of these paitents is now debated. The aim of This study, is to compare effects of using and not using prophylactic antibiotics after chronic otitis media surgery. Patients who met the inclusion criteria (112 patients) were randomly assigned to antibiotic treatment group (to whom 48 hours IV antibiotic and then one week by mouth) and control (to whom no antibiotic administered). Patients were followed postoperatively and observed for clinical evidences of infection and graft failure. Considering the findings of this study, the use of prophylactic anbibiotics in surgery for chronic otitis media is not recommended.

A 20 years old pregnant woman several times had coliky abdominal pain and vomiting since seventh month of pregnancy.At term the patient developed acute abdominal pain and bloody vomiting abrutpely. 24 hours later she deliveried dead fetus while abdominal pain continued. At laparatomy she had primary extensive volvulus of small bowel with gangrene. Small bowel resection and anastomosis was carried out, now patient is well.  

The goal of this study was to evaluate the quality of warfarin utilization in three teaching hospitals of Isfahan.We did a cross sectional retrospective study of 300 medical charts of patients who had received warfarin during their hospitalization. A data collection form was designed as well as an indication list with the threshold limits set using various related articles.The indicators representing the starting dose, the maintenance dose, the patient's PT/INR two days before discharge, the starting day of warfarin relative to heparin and drug interactions were all below our accepted limits and percentage of cases with hemorrhage was above our accepted limit. Therefore, the physicians' performance in different aspects of warfarin management needs improvement.

Postoperative headaches are common problems after general anesthesia, some of the reasons are migrain headache, tension headache, vascular headache and caffeine withdrawal headache.Since the severity of headaches after general anesthesia, is carried out for the first time, therefore we decided to announce it.In this prospective, randomized double blind clinical trial study of 160 ASA grade I and II patients, (aged 40-60 years) undergoing cataract surgery were surveyed to compare the effects of Acetaminophen, Indomethacin or Ergotamine C versus placebo on the incidence and severity of postoperative headaches until 6 hours after general anesthesia on the base of visual analog scale procedure.The groups were similar with respect to demographic data and potential confoundings variables.The incidence of postoperative headaches were 56% and the severity of headaches were 20.37±24.7mm.The incidence of such headaches for placebo and Acetaminophen groups were 72.5% and 62.5% but the Indomethacin and Ergotamine C groups had a lower incidence of headaches 42.5% and 47.5%.The average severity of headaches were different in each group and had a meaningful correlation (Pvalue=0.005) based on visual analog scale.The average severity of headaches in Ergotamine C, Indomethacine, Acetaminophen and Placebo groups were 16.5±21mm, 11.5±16.25mm, 24±25.99mm and 29.5±30.2mm respectively.Indomethacine is an effective prophylactic analgesic in reducing postoperative headaches in cataract surgery.

Rheumatoid arthritis is a chronic multisystem disease of unknown etiology with a prevalence of 1% in the population. Rheumatoid nodules have been known as one of the characteristics of RA. The prevalence of rheumatoid nodules in patients with RA has been studied versus age, sex, ESR, rheumaoid factor, platelet count arid intensiy of disease.During this two year long study, 1500 patients with RA who had presented to Isfahan's outpatient rheumatology clinic were clinically examined.The prevalece of rheumaoid nodules in patients with RA was 2.53%, wich is markedly different from a prevalece of 20% in other studies.Rheumatoid nodules have a greater prevalencce in male patients (3.6% in males - 2.2% in females). However, the prevalence of RA in women was 3.5 times greater than men (78.2%were female-21.8%were male). Rheumatoid nodules had the greatest prevalence in the age group 41-50 years. Also RA had the highest prevalence in the same age groups (41-50 years).We did not notice a clear relation between rheumatoid factor, ESR and platelet count in the two age groups, with or without nodules. By contrast RA had a greater severity in patients with rheumatoid nodules.It can be concluded that RA in the Iranian society has a better prognosis compared to other societies.

In regard to hospitalization of many first gravid pregnant women at latent phase in one year it is tried to shorten the period between the beginning of the induction to delivery with the above protocols. This study is a clinical trial which took one year in Beheshty and Alzahra hospital in 1378.Sixty primigravid women with unfavorable cervix and medical induction for delivery who were assined to receive either 20 mg hydrocortisone in saline solution or saline solution only administered extera amniatically through on intracervical inflated foley ballon catheter. This was done with folley catheter and after 4 to 6 hours it was extracted and the ordinary induction was begun with 6 mIu/min to 42 mIu/min oxytosin.On the basis of statistical methods T-Test the duration of latent phase and the active phase to delivery in two groups were compared and it was appeared that in hydrocortison group the period between induction to delivery was about 2 1/2 hours (p.value<0.001) shorter. Also the period between induction to active phase in case group was about 1.4 hours (p.value<0.05) shorter than control group.Induction of labor with use of an intracervical foley ballon catheter and extraamniotic corticosteroids reduces the time interval from induction of labor to delivery.In respect to results it is clearly defined that the period between induction to delivery and active phase will decline in extraamniotic hydrocortison injection and because of safety it may be a good method in shorthening the delivery process.

The coronary artery disease has been of the significant causes of mortality in most countries and electrocardiogrephy is a rapid, certain, cheap and accessible diagnostic instrument for acute myocardial infarction. 120 patients with acute myocardial intarction, reffered to Noor hospital, were studied from october 1998 to may 1998. The rate of ST elevation in elecctrocardiogram was evaluated with complications of acute myocardial infarction. The average age of searched patients was 58. 24±11 years old for male and 63.12±11 years old for female. The average of ST elevation with different stages of heart failure was 3.61±1.81mm and without it was 3.31±1.52mm, In cases with pericarditis was 2.7±0.9mm and without it was 3.14±1.6mm, and in patients with ventricular tachycardia was 5.3±2.24mm and without it was 3.28±1.31.In this study, there was no meaningful relations between the average of ST elevation and complications of acute myocardial infarction such as heart failure, ventricular tachycardia, pericaditis, heart blocks. (P>0.05).

Acute mania attack is one of the most common features of bipolar disorder, resulting in loss of control and harmful state .In view of the complexity of the phenomenon, this study was designed to examine the effect of three mood stablizers including lithium, carbamazepine and Na Valproate. In this clinical trial 213 patiens with acute mania attack were placed into 5 therapeutic groups: 40 patients with sodium Valproate; 36 patients with lithium; 36 patients with carbamezapine; 38 patients with lithium and carbamazepine; and 37 patients received combination of sodium valporate and lithium. The illness intensity was recorded daily .Reduction of symptoms to half numerically during the first day of hospitalization was viewed as Positive response to treatment.Data were computer analyzed using ANOVAStatistically the shortest duration to become symptom free was reported by those who received combination of lithium and sodium Valproate (i.e.,7.1 days) and longest treatment duration was seen in those who were treated by carbamzapine alone (Le.,12.6 days). The efficacy rate of sodium Valproate, lithium, carbamazepine, lithium & carbamezpine and lithium and sodium Valproate was respectively, 80, 89, 69, 87 and 92 percent.Among the common mood stablizers combination of drugs such as lithium and sodium valporate is more effective in the management of acute mania attack among patients with bipolar mood disorder.

To determine the effect of rHuEPO therapy on 11sensitizedpatientson dialysis, we measured the level of HLA (human leukocyte antigen) antibodies (percentage panel reactive antibody or %PRA) before and after 13 ± 2 months of rHuEPO therapy.A control group of 11 patients matched for gender, age, duration of dialysis, previous blood transfusions and sensitization status were also included in this study. The control group did not recieve the drug during this time. The percent of panel reactive antibody (%PRA) was at least %25 in all patiens in the begining of study. The level of HLA antibodies were determined using the microlymphocytotoxicity method of NIH (national institute of health) and twenty different lymphocyte panel cells.After 13±2 months of using rHuEPO, in the case group the mean of %PRA declined ramatically from %54.09 to %10.9 and 5 of them were succesfully transplanted while in the control group the changes of mean PRA was only %1.8 during a comparable time interval (P<0.01).These data indicate that in sensitized dialysis patients, rHuEPO may lead to decreased sensitization. The decrease of HLA antibodies in rHuEPO treated patients may be the result of reduced administration of blood transfusions, and also direct effect of the drug on the immune reactivity.

The enzyme have different molecular of forms that called Isoenzyme. Isoenzyme catalized very similar reaction, but they have different PHi so we can separate them by electrophoresis. Creatin Phosphokinase of Intra cellular enzyme, has three forms that called CPK-isoenzyme.Type one: CPK-BB is found in neural tissues of intestine, kidney and thyroid galnd. Type two: CPK-MB is found in the cardiac muscle and skeletad muscle. Type three: CPK-MM is found in all of tissues specially skeletal muscles.This investigation is descriptive observational study on patiants confined to bed in CCU in Tehran hospital and the results are conclued from data analysis.