Journal of Isfahan Medical School
Year:2005 | Volume:23 | Issue:79|Papers Count:17

Introduction: Osteoporosis, the result of an imbalance between bone resorption and bone formation, is a potential problem for patients with spinal cord injury (SCI) because of immobility commonly associated with this impairment. Bone mineral content decreases by 25% to 50% and the magnitude of this reduction is dependent on the level, completeness and duration of SCI. This study was designed to evaluate osteoporosis in war veterans with SCI in Isfahan province. Methods: In this cross-sectional study, by use of a cluster sampling frame, SCI veterans underwent-dualenergy X-ray absorptiometry (DEXA) to define bone mineral density (BMD) in 2nd to 4th lumbar  vertebrae and the neck of right femur (g.cm2).Results: The study on the femoral neck showed that 94.6% of subjects suffered from abnormal bone mineral density (84.9% osteoporosis and 15.1% osteopenia). Evaluation of lumbar spines also showed that 34.9% of veterans suffered from low bone mineral density (52.2% osteoporosis and 47.8% osteopenia). A significant difference was observed between vertebral bone density (mean: 1.23 g/cm2) and the neck of right femur (mean: 0.66 g/cm2) (P<0.05). Comparing the results in paraplegics and quadriplegics reveals no significant difference between bone density in the femoral neck and lumbar spines (P>0.05). Also, bone density was shown to have no significant relation with age, level of injury, post-injury period and exercise (P>0.05). However, a slight correlation was seen between weight and bone mineral density.Discussion: During spinal cord injury, bone mineral density in, the lumbar vertebrae is reserved significantly better than in the femoral neck.

Introduction: Nearly 25 years have passed since the investigation of Shiga toxigenic Escherichia coli (STEC). STEC is a member of enterohemorrhagic Escherichia coli (EHEC) which is able to produce Shiga-like toxins (Verotoxin) and can cause gastroenteritis, diarrhea, dysentery, and hemorrhagic colitis (HC), as well as life-threatening sequels like hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). Since the incidence of gastroenteritis due to STEC is increasing and given its important hygienic, social, and cultural aspects, it is necessary to develop rapid, specific, and accurate procedures like PCR to prevent its hazards and sequels. By means of molecular methods, we will be able to establish a diagnosis early in the course of disease using a small amount of sample or low level of contamination and will be capable of in situ detection and identification.Methods: In this study, we used the PCR method for detection and genetic identification of STEC in cultures of 44 human Escherichia coli positive feces. The assay utilized three specific primer pairs for detection of ehxA, stx1, and stx2 (including variants of stx2) genes which produced 321,348, and 584 base pairs, respectively.Results: Three Escherichia coli isolates (about 6.8%) were positive for stx2 genes, but no ehxA or stx1 genes were found.Discussion: The result of this study differs from others' due to the difference in geographical prevalence of phages carrying accessory virulence genes, environmental conditions, or physiology of host. The difference between the results shows that the excretion of Shiga toxin-producing Escherichia coli is affected by several factors like food, age, stress, and seasonal changes.

Introduction: Lipoprotein (a) [Lp (a)] is one of the cholesterol-rich plasma lipoproteins, which is a low-density lipoprotein-like particle. Lp (a) displays strong athero-thrombotic properties. In Lp (a), apoprotein (a) [Apo (a)] is covalently linked by a single disulfide bridge to apoproteinB100 (apoB100). Apo (a) is a glycosylated protein similar to plasminogen. Plasminogen is a fibrinolytic proenzyme with kringle-like sequences. Lipoprotein (a) in human plasma appears as four subspecies based on its affinity for lysine sepharose: Lp (a) Lys-, Lp (a) Lys+1, Lp (a) Lys+2 and Lp (a) Lys+3. Pathogenesis of Lp (a) as a risk factor for cardiovascular disease may depend on its lysine-binding site activity. It is suggested that Lp (a) LYS+1, Lp (a) Lys+2 and Lp (a) Lys+3 have, athero-thrombotic properties. In Iran there have not been many studiesori Lp (a) subspecies. Therefore the aim of this study was to separate Lp (a) subspecies according to their affinity for lysine, using lysine sepharose affinity chromatography. Methods: We separated four different subspecies of Lp (a) by changing pH and molarity of the mobile phase. 100 ml of pooled serum was collected.Results: The total Lp (a) was 46 mg and composed of 12 mg (24%) Lp (a) Lys-, 4 mg (8%), Lp (a) LYS+1, 23 mg (50%), Lp (a) Lys+2, and 4 mg (8%) Lp (a) Lys+3.Electrophoretic mobility of four different subspecies of Lp (a) was assessed on polyacrylamide disk electrophoresis. Purity of the separated fraction was confirmed and there was no difference in electrophoretic mobility between the four subspecies of Lp (a).Discussion: The ability to separate Lp (a) subspecies will enable us to investigate factors affecting atherosclerosis and cardiovascular diseases by studying their effect on Lp (a) subspecies in the future.

Introduction: Patient preferences for different anesthesia techniques are poorly understood. The aim of this study was to evaluate the relationship between patient preferences and some factors such as demographic data, history of previous surgery and anesthesia, and also the employed anesthesia techniques in adult patients undergoing cataract surgery.Methods: In this cross-sectional descriptive study, 300 patients scheduled for phacoemulsification were visited and informed about different anesthesia techniques using face-to-face and oral explanation the night before surgery. Demographic data and patient preference for anesthesia techniques were recorded in questionnaire. After surgery, employed anesthesia techniques and the reasons for using were determined. Data were analyzed using descriptive statistics, correlation coefficient and X2 test.Results: This study showed no relationship between patient preferences and demographic factors. There were significant differences between the frequency of patient preferences and the employed anesthesia techniques (P=0.013).Discussion: In previous studies, a positive relation was reported between patient preferences and the employed anesthesia techniques, although the present study did not address this fact. The routine procedures of anesthesia management in the operating room were the main reason for the observed difference.

Introduction: This is a report of the histopathological characteristics of a rare case of primary adrenal myxoma. A 25-year-old male was admitted to AI-Zahra Hospital due to abdominal trauma. Radiological evaluations revealed an adrenal mass without any clinical manifestation. The MRI of abdomen showed a well-defined cystic mass of right adrenal with the following differential diagnoses: cystic adenoma, cystic pheochromocytoma and metastatic lesions with cystic degeneration. Right adrenalectomy was performed and in pathologic study, the mass was grossly solid and had yellow-grayish color and gelatinous consistency in cut surface. Microscopically, it was composed of myxoid stroma with few scattered cells which were positive for vimentin but negative for CK, CEA, S100, Desmin, Actin and Melan-A in immunohistochemical staining. These findings are characteristic of primary adrenal myxoma.Discussion: Pathologically, it may be difficult to differentiate myxoma from other malignant tumors with a myxoid stroma. Further studies are necessary to clarify the origin and histogenesis of this lesion.

Introduction: The blood pressure of menopausal women is higher than that of premenopausal women with the same BMI. As hot flash is the most common sign of menopause, this study evaluated blood pressure and hot flashes using the holter monitoring technique.Methods: This cross-sectional study involved 26 menopausal women. The subjects, some with and some without hot flashes were divided into two groups of 13. They had an age range of 47-53 years. The exclusion criteria were internal disease, hypertension and the use of hormonal drugs. Blood pressure and heart rate were evaluated with holter monitoring during 24 hours. Data were analyzed using ANOVA and t-Student test.Results: Systolic blood pressure in the activation time was higher in the group with hot flashes (P<0.05); heart rate and systolic blood pressure were higher in this group at all times during the day (P>0.05).Discussion: Increase in systolic blood pressure in women with hot flashes may be due to the acceleration of central sympathetic activity. Another presumable cause is peripheral vasoconstriction and the subsequent rise of cardiac output. Both effects are the result of baroreflex activity. As hot flashes may be among the early signs of high blood pressure, we recommend a prospective study to evaluate this probability.

Introduction: Uterine bleeding is an important side effect of cesarean section due to non-contractile uterine. Many drugs have been used to induce firm uterine muscle contraction. The aim of this study was to compare the effect of IV infusion of 10% dextrose and IV infusion of 40 Iu/lit oxytocin on uterine contraction.Methods: In this randomized controlled trial (RCT) 60 women were assigned to two study groups. After cesarean section and uterine bleeding due to non-contractile uterine, each of the women randomly received IV infusion of 10% dextrose or IV infusion of 40 Iu/lit oxytocin in equal volumes intravenously and their effectiveness in inducing firm uterine muscle contractions were determined.Results: There was a significant difference between the two groups in inducing firm contractions of uterine muscle. The rate of firm contractions of uterine muscle in response to IV infusion of 10% dextrose and IV infusion of 40 Iu/lit oxytocin was 63% and 37%, respectively (P=0.003). IV infusion of 10% dextrose had better effects on high-parity women (30% to 35%), and IV infusion of 40 Iu/lit oxytocin had better effects on low-parity women (25% to 41%) (P=0.05).Discussion: According to the results of this study, IV infusion of 10% dextrose is more effective than IV infusion of 40 Iu/lit oxytocin on uterine bleeding and firm contraction of uterine muscle after cesarean section in women.

Introduction: In addition to cognitive problems, mentally retarded individuals have mental disorders. In recent years, behavioral scientists, especially psychiatrists and mental retardation specialists have focused on the relationship between mental disorders and mental retardation. The purpose of this study was to determine the frequency of mental disorders among mildly and borderline mentally retarded individuals in vocational habilitation centers in the city of Isfahan.Methods: The sample of this study consisted of 100 mentally retarded adolescents and adults including 58 males and 45 females. These individuals were randomly selected. The frequency of mental disorders was evaluated among the subjects using "self-report" and "rating by others" forms of Matson's Psychopathological Inventory for Mentally Retarded Adults (PIMRA). Data were analyzed using percentile rank, multivariate analyses and Pearson correlation coefficient.Results: Mental disorders were relatively prevalent among mentally retarded individuals. These disorders occurred at higher rates in mentally retarded women than men. The results also showed a relationship between intelligence quotient and all of the subscales in the self-report form.Discussion: This study showed that the rate of mental disorders is relatively high among mentally retarded individuals, especially women. This indicates that in addition to mental retardation, mentally retarded individuals can be challenged by mental disorders. Therefore specialists should pay greater attention to other problems of these individuals, including mental disorders.  

Introduction: Helicobacter (H. pylori) infection is the most common chronic bacterial infection at any age. It is a worldwide problem and the second commonest cause of gastric 'cancer. Humans are the main reservoir of this infection. Eradication of H. pylori infection is essential to effective treatment of peptic ulcer disease (PUD). Eradication prevents the return and complications of ulcers and also can reduce future morbidity and mortality from PUD and gastric carcinoma. H. pylori is naturally resistant to several commonly used antibiotics. We aimed to compare the efficacy of gastric emptying delay in quadruple drug regimen versus standard quadruple therapy for one week in H. pylori eradication.Methods: 140 patients with endoscopically confirmed H. pylori infection, were randomly assigned to groups A and B. Group B received omeprazole (20 mg bid), furazolidone (200 mg bid), amoxicillin (1 g bid), bismuth (240 mg bid) plus aspartam as placebo (4 tablets in 500 cc of water twice daily with drugs). Group A was treated with the same regimen plus 10% sucrose syrup: 125 cc administered 5 minutes before taking medications and 375 cc with medications. Endoscopic findings, as well as data on the presence of gastrointestinal or non-gastrointestinal symptoms were recorded in questionnaires. Side effects were documented by diary chart and interviews during treatment. All of the patients received the medications only for one week; then they were treated with omeprazole for 4 weeks. H. pylori eradication was assessed at least 2 weeks after the end of therapy using C14 Urea Breath Test. Eradication was confirmed if UBT was negative.Result: 140 patients (66 males and 74 females, mean age: 41.97 years in group A and 39.34 years in group B) were studied. 130 subjects completed the study. Four patients in group A and one patient in group B did not tolerate the regimen and were excluded from the study. Excellent tolerance was observed in 92.85% of patients in group A and 94.3% of those in group B. Severe side effects were observed in 5.71% of patients group A (severe nausea, anorexia) and 1.4% of patients in group B (headache, malaise). The eradication rate assessed by per-protocol analysis was higher in group A than in group B (92.07% [n=63] versus 85.08% [n=67], respectively, P=0.034).Discussion: Quadruple regimen containing high dose of furazolidone only for one week is effective and recommended; the use of sucrose syrup can increase the eradication rate. Excellent drug tolerance (>80%) was seen in 92.8% of patients in group A; hence it seems that the observed complications cannot limit the treatment and we recommend this therapeutic regimen for all H.pylori-positive patients who are candidates for eradication therapy.

Introduction: Insulin has profound effects on the central nervous system (CNS), in so far as some neurodegenerative diseases have been related to insulin. In this study, we evaluated the effect of insulin on the electrical activity of brain (EEG) in rat.Methods: Thirty male rats were used in this study. The rats were divided into 3 groups. Groups 1, 2 and 3 received insulin at doses of 0.1µg/kg, 1µg/kg, and 2µg/kg, respectively. After receiving insulin intraperitoneally, the animals underwent electroencephalography.Results: The results showed that a low dose of insulin increased delta waves of EEG and decreased alpha, beta and theta waves.Discussion: The results demonstrate that low-dose insulin decreased brain activity. High-dose Insulin led to reduction of delta wave in EEG and increased alpha, theta and especially beta waves. These results demonstrate the elevation of brain activity which may have been due to penetration of the BBB by insulin and its likely direct effect on the CNS.

Introduction: Atherosclerosis and coronary artery diseases are the most prevalent causes of mortality and morbidity in developing countries. The useful effect of frankincense extract on various organs has been reported. The purpose of this study was to determine the effect of frankincense extract on the wall of anterior and posterior inter-ventricular branches of coronary arteries in male rabbits fed with high cholesterol diet.Methods: Twenty white male rabbits were weighed (wt=1.780 kg) and randomly divided into two groups. For 40 days, group I (n=10) was given high-cholesterol (1%) diet with frankincense extract (500mg/kg) and group 2 (n=10) was fed with high-cholesterol diet along with distilled water. They were weighed and then the animals were sacrificed. The anterior and posterior inter-ventricular branches of coronary arteries were dissected and pathological sections were stained with H & E and studied by light microscope.Results: The weight of the rabbits before and after the experiment in both the groups showed significant difference (P<0.05). Rabbits that received frankincense extract also showed significant difference in mean pathological scoring of anterior and posterior inter-ventricular branches of coronary arteries (P<0.05). Group 1 exhibited a significant decrease in the formation of fatty streaks compared group 2.Discussion: Pathological assessment showed that the rabbits which had received frankincense extract did not develop accumulation of fatty streaks in anterior and posterior inter-ventricular branches of coronary arteries, whereas those which had received a high-cholesterol diet had fatty streaks. It was shown that Frankincense extract can significantly inhibit the formation of fatty streaks, thus preventing cardiovascular diseases and atherosclerosis and lowering serum lipids.

Introduction: The survival rates and marker of survival in children with cardiac arrest after congenital heart surgery are unknown.Methods: In this one-year study, we identified children less than 7 years old in our pediatric cardiac intensive care unit database who had a postoperative cardiac arrest. Parameters from perioperative, pre-arrest and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and non-survivors.Results: Of 529 children under seven years old who underwent corrective heart surgery, 59 (11%) sustained a documented cardiac arrest; of these 22 (37%) survived and their vital signs returned. Perioperative parameters (age, weight, pump time), ventricular physiology, O2 saturation, and HCO3 did not influence outcome. Greater use of isotropic agents was not associated with higher mortality. A significant relationship was seen between history of cardiac arrest and success of resuscitation (P<0.001).Discussion: Success rate of resuscitation in cases of hemodynamic compromise (i.e. low mean arterial blood pressure) is low. Patients with single ventricular physiology or history of cardiac arrest do not stand a higher risk of death following arrest.

We describe the typical case of a middle phalanx osteoid osteoma tumor in the hand. This is an interesting case, regarding the location and clinical presentation, as the middle phalanx is the rarest location. Furthermore, the tumor in this location usually lacks the typical manifestations of the disease. Curettage of the tumor with bone grafting of the defect was successful and there was no recurrence.