JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2011 | Volume:29 | Issue:156|Papers Count:7

Background: Bradykinesia, poor balance, tremor and abnormal walking may result in high risk of falling in patients with Parkinson’s disease (PD). It is previously shown that the kinematical abnormalities during walking are related to freezing of the gait in Parkinson’s disease. This study aimed to study the effects of kinematic dual task and arms’ position on temporal variables of walking in patients with Parkinson’s disease.Methods: Ten women with level II and III idiopathic Parkinson’s disease were recruited from local clinics as experimental group. Also a group of 14 healthy women with similar age, height and body mass index were served as control group. Using a H-Rez Motion Analysis System with three high speed Falcon cameras (240 Hz), the temporal variables of the subjects’ gait in normal walking, walking with holding a 2.5 kg mass, and walking with arms crossed the chest were recorded. Repeated measures analysis of variance (α<0.05) was used to analyze the data.Findings: The stride length and walking speed in control and experimental groups were 121.9 ± 4.4 cm and 107.7 ± 5.3 cm/s and 79.7 ± 6.1 cm and 72.7 ± 6.9 cm/s respectively. The stride length in walking speed in experimental group was about 34%, 67% smaller than in normal subjects. Walking while carrying weight resulted in stride length and walking speed were of 83.1 ± 5.8 cm and 72.7 ± 5.1 cm/s in experimental group, implying about 5% improvement on the stride length.Conclusion: Parkinson’s disease is associated with slower walking and shorter stride length as well as longer double stance phase. Carrying weight during walking improved the stride length in Parkinson’s disease. Application of this dual task is recommended for rehabilitation program in Parkinson’s disease.

Background: Preeclampsia is a vascular disease that happens during pregnancy. It is created by vasospasm and vascular endothelium activity and is one of the most important complications of pregnancy.Blood pressure disorders in pregnancy are one of the three major reasons of mothers’ mortality. The aim of this study was to determine the relation between serum caffeine and preeclampsia in pregnancy.Methods: This was a case-control study.44 pregnant women in Shiraz, Iran, aged 18-35 years, were enrolled in the study. Based on the criteria of entering, 22 women with preeclampsia and 22 women with normal blood pressure were selected by systematic random sampling from women reffered to 2 hospitals in Shiraz. Initially, demographic data and daily caffeine intake was gathered. Then, serum caffeine level was measured for all of the subjects. The data was analyzed by Student t-test and multivariate logistic regression.Findings: The mean amount of serum caffeine was 0.309 ± 0.292 and 0.468 ± 0.314 in case and control group, respectively (P=0.094). Logestic regression analysis did not show a significant correlation between serum caffeine levels and preeclampsia (OR=0.565, 95% CI: 0.013-25.42). The correlation between maternal age (OR=1.52, 95% CI: 1.08- 2.15) and gestational age (OR=1.43, 95% CI: 1.09-1.87) with preeclampsia were significant.Conclusion: There is no significance relationship between preeclampsia and the caffeine level of the serum based on our findings. Therefore, restricting the caffeine consumption in pregnant women does not seem rational.

Background: Vaginal bleeding during pregnancy is one of the important causes of maternal, fetal and neonatal death. Women who remaine pregnant after vaginal bleeding, are at risk of complications such intrauterine fetal death (IUFD), intra uterine growth retardation (IUGR), preterm labor, placental abruption, preterm pre-labor rupture of membrane (PROM), and low birth weight.Methods: This prospective case–control study was done on 120 pregnant women, 60 with first trimester bleeding and 60 control ones, in Shariati hospital in Isfahan, Iran. All women were evaluated for pregnancy outcomes including bleeding in second and third trimester, abortion, preterm pre labor rupture of membrane, preterm labor, low birth weight, intra uterine growth retardation, mode of labor, APGAR coefficient in 5 minute, and neonatal intensive care unit (NICU) admission. Data was analyzed by Student t and c2 tests.Findings: There were no significant differences between groups in number of previous pregnancies and labors, number of children, history of abortion, premature rupture of membrane (PROM), intrauterine fetal death (IUFD), mod of labor, APGAR coefficient, neonatal intensive care unit admission and intra uterine growth retardation (IUGR) (P≥0.05). But placenta accreta, second trimester bleeding and preterm labor were significantly more in pregnant women with first trimester bleeding (P≤0.05).Conclusion: According to our results and other studies from other countries, first trimester bleeding could predict maternal and fetal complications. We recommend training pregnant women about these complications and their prevention.

Background: Patients' beliefs about the necessity of medicines and their concerns about adverse effects might influence the adherence and treatment outcomes. This study was carried out to investigate the impact of patient's beliefs on their adherence to prescribed medicines in three different chronic diseases and the role of demographic factors in this relationship.Methods: This cross-sectional descriptive study was done during 2008-2009. Data was gathered through interview with 213 patients referring to educational pharmacies of Isfahan University of Medical Sciences, Iran, and suffering from one of the chronic diseases including asthma, cancer and kidney transplantation. Three questionnaires, including demographic factors, beliefs about medicines (BMQ) and Morisky's medication adherence assessment, were used. Descriptive data and correlation analysis tests were made by using SPSS17.Findings: Age, but not gender, had a significant role in patients' adherence to medication. Education level was positively correlated with adherence to medicines in patients with asthma and whom with kidney transplantation but not in patients with cancer. The patients' belief about their medicines had a significant impact on their adherence to their prescription in all three subgroups of patients; however this relationship was stronger for patients with cancer and kidney transplantation than asthmatic patients.Conclusion: Patients' beliefs about their medicines could influence their adherence with medication, especially for more serious diseases. It is also concluded that younger and higher educated patients are more adherent. It seems that educational interventions, especially for older patients and in chronic disease states, are beneficial to improve their adherence with medication.

Background: Vasospasm has been known as one of the major causes of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). This study aimed to evaluate the effect of subarachnoid injection of papaverine on mortality and morbidity in patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm.Methods: This controlled clinical trial was conducted from 2009-2010 at Alzahra University Hospital, Isfahan (Iran). Five patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm and needing ventriculostomy were included in the intervention group and undergone ventriculostomy and received papaverine (40 mg/12 h for 72 h) injection into the subarachnoid space.10 patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm (matching with age, sex, other disease, and subarachnoid hemorrhage severity) were included the control group and received standard treatment. Mortality, level of consciousness (GCS), hemodynamic and nervous system function changes were evaluated and compared before and 14 days after surgery.Findings: 9 women and 6 men were included in the study (mean age: 54.0 ± 12.8 years). The intervention and control groups were similar in baseline characteristics (P>0.05). Only one person in the control group and none of the intervention group died two weeks after surgery (P=0.667). After two weeks, mean of GCS had significant improvement in the intervention group (from 8.2 ± 1.6 to 12.8 ± 2.6; P<0.008) but no change was seen in the control group (from 8.8 ± 1.8 to 9.0 ± 1.8; P=0.729).Conclusion: This study indicated that a significant clinical improvement occurred after subarachnoid injection of papaverine in patients with spontaneous subarachnoid hemorrhage accompanied by cerebral vasospasm. This treatment has no beneficial effects on nervous complications. Future studies with larger sample size and longer follow-ups are recommended.