Medical Journal of Mashhad University of Medical Sciences
Year:2008 | Volume:51 | Issue:99|Papers Count:20

Introduction: Multiple Sclerosis (MS) is a chronic disease of high prevalence of central nervous system, mostly affecting young adualts especially females. Voiding dysfunction is one of its complications, diagnosis and treatment of which will be of great value in patients' quality of life. In this study, frequency and type of urinary dysfunction in MS were evaluated and effects and side effects of two drugs of Oxybutynin and Detrusitol were compared.Materials and Methods: This clinical trial study was performed from July 2004 until July 2005 at Ghaem Hospital of Mashhad University of Medical Sciences on women with clinical manifestations of voiding dysfunction (overactive bladder). Patients were divided into two groups randomly. One group treated with Oxybutynin 5 mg bid, and the other with Detrusitol 2 mg bid, and effects and side effecto of these drugs were compared. Data analyzed using c2, fisher T-student andcochrane tests.Results: The ratio of female to male was 6 to 1. The average age of onset was 25.8. Spastic urinary dysfunction prevalence was 61.2%. The most common symptom was urination frequency. Improvements in urinary symptoms were similar in both groups. Among observed side effects, only dry mouth was statistically more frequent in patients who used Oxybutynin in comparison to those who used Detrusitol. Patients satisfaction was similar in both groups. There was a relationship between existence of plaques in periventricular white matter and urinary dysfunction symptoms.Conclusion: According to the rate of improvement, side effects and the costs, Oxybutynin is more suitable for overactive bladder treatment.

Introduction: In spite of its convenience and inexpensiveness, measurement of salivary cortisol has not gained widespread popularity. Indeed, even though its usefulness in the assessment of activity of hypothalamic-pituitary-adrenal (HPA) axis has been reported in various clinical conditions, several centers are still resistant to adopting this procedure. The aim of this study is to evaluate the correlation between salivary and serum cortisol by radioimmunoassay (RIA).Materials and Methods: This descriptive crass-sectional study carried out in September to February 2005 on 80 patients at laboratory of Ghaem Hospital of Mashhad University of Medical Sciences. A total of 42 women and 38 men aged 46±16.5 were studied. Paired saliva and serum samples were obtained after specialized protocols. Salivary and blood samples were collected at 8 to 9 A.M. Cortisol in saliva and total cortisol in serum were measured with a commercial radioimmunoassay (RIA).Results: Mean serum cortisol was 19.72±8.35 and mean salivary cortisol was 0.18±0.07 mg/dL. Significant linear correlation was found between salivary and serum total cortisol (r=0.35, p<0.001).Conclusion: Results indicate that salivary cortisol measures with radioimmunoassay (RIA) can be used in place of serum total cortisol, based on the evidence that salivary level represents the biologicaly active and free fraction of this hormone, and is non invasive and unstressful.

Introduction: There is a risk of infection with hepatitis viruses (HBV, HCV), human immuno deficiency virus (HIV), human T cell lymphoma virus (HTLV-I) in personels of cardiac catheterization laboratories. Currently, the ELISA immonologic tests are asked for all patients admitted for catheterization in Iran. The aim of this study was to determine seroprevalence and the exact need for asking laboratory tests for patients admitted for cardiac catheterization.Materials and Methods: In this simple cross – sectional expriment, we studied the results from ELISA tests in patients admitted for cardiac catheterization in Imam Reza hospital from March 19, 2002 to July 19, 2005 were studied. After data collection, they were analyzed with SPSS software.Results: From all 8122 patients, 417 (5.1%) cases had infection. No HIV+ case was detected. Most of infections were HTLV-1+ (2.59%), HBV+ (2.37%) and HCV+ (0.3%), respectively. Most of cases were from Mashhad, Neishaboor and Sabzevar cities.Conclusion: This study shows that the frequency of infections, (except HTLV-1) is the same as other parts of the country. The rate of HIV infection is zero but expensive laboratory tests are ordered for this and other viruses. There are false positive and false negative results in laboratory tests. So asking for these laboratory tests is not indicated. A universal precaution is recommended instead of asking laboratory tests which will also decrease costs for patients.In addition there is effective vaccine against the most common agent of infection, i.e HBV and we can vaccinate all the personels.

Introduction: It seems that the rate of deep vein thrombosis in Asia is low. The aim of this study is to investigate the rate of deep vein thrombosis (DVT) among Iranian patients suffering from hip fracture (proximal of femur) and pelvic fracture (acetabulum) and to analyze the risk factors associated with DVT.Materials and Methods: This clinical trial study was done in the Orthopedy Ward of Shahid Kamiab Hospital of Mashhad University of Medical Sciences during the year 2005. A total of 116 consecutive skeletal fracture patients with a mean age of 59.92 years were investigated. Patients divided into two groups of case (44 patients) and control (72 patients). Patients in the case group were treated using a standardized protocol for DVT prophylaxis (Enaxaparin; 40 mg by subcutaneous injection, once daily) within 24 hours of injury after establishing haemodynamic stability. Control group received no drugs or treatment. Duplex ultrasound was done 9 days and 3-6 weeks after admission. Personal data, previous history of general and heart diseases and radiology results were collected in questionnaire and analyzed using descriptive statistics.Results: The mean age of patients with DVT was 63.5 years (standard deviation [SD], 11.22 years). The mean age of patients without DVT was 58.64 years (SD, 14.74 years). Four patients (9.1%) showed DVT in spite of chemoprophylaxis. There was significant relation between the both groups (p=0.021).Conclusion: Results show that the incidence of DVT after acute hip and pelvic fracture in Iranian traumatized patients was high. So the use of low molecular weight heparin is recommended for above patients.

Introduction: All over the world, renal colic is one of the most common causes of referring to emergency units. The first therapeutic step is treatment of pain by using different drugs. The aim of this study is to compare the therapeutic effects of a single dose of Tramadol (100 mg intramuscular) and single dose of Voltaren (75mg intramuscular) in treatment of acute renal colic.Materials and Methods: In this double blind clinical trial study in the year 2004 at Urology Department of Ghaem Hospital, 100 patients (84 men and 16 women, mean age 35.9 years, range 18-60) with acute renal colic were studied. KUB, urinalysis and ultrasonography were done in all cases. The patients were randomly assigned to receive either 100 mg of tramadol IM (48 patients) or 75mg of voltaren IM (52 patients). The patients’ pain was evaluated before injection, 30 and 60 minutes after injection by Visual Analogue Scale (VAS) and Data was analyzed by t- test, Man-Whitney and K-square test.Results: VAS pain scores in both groups were similar at the beginning of the study (p=0.39). Within 30min; pain was markedly improved in 41 patients (78.8%) of voultaren group and 28 patients (58.3%) of tramadol group (p<0.05). After 60 minutes, 43 patients (82.7%) in voltaren group and 31 patients (64.6%) in tramadol group showed obvious improvement. No serious side effect was reported with use of either treatment. Only 5 patients in tramadol group showed nausea and vomiting, vertigo and weakness.Conclusion: Voltaren can be used effectively in treatment of acute renal colic and it has earlier onset of action and prolong effect in comparison with tramadol.

Introduction: Infection is one of the complications of chronic leg ulcers (CLU). It can also interrupt wound healing and affect the amputation rate.Materials and Methods: This prospective study was done from November 2005 until July 2007 in Vascular Surgery Department of Imam Reza Hospital, Mashhad University of Medical Sciences. Infection rate of 100 CLU on amputated limbs were evaluated. Underlying disease was arthrosclerosis in 12%, Buerger’s Disease in 20% and Diabetes in 68% of the patients. Ulcers with duration of more than 3 months were considered chronic. The patients with ulcer duration more than 1 month whose leg amputation was performed due to severe pain (Buerger’s Disease), gangrene or signs of severe infection were also included. Infection was suggested by tissue culturing from the base of the ulcer before amputation. 2-5cc sterile isotonic saline from the intact clean skin was injected to the base of the ulcer and aspirated for culturing to compare with the results of tissue culture.Results: The sensitivity of needle-aspiration test for aerobic culture was 91%, the specifity 81%, positive predictive value 95% and negative predictive value 71%. For anaerobic needle-aspiration culture, sensitivity 90%, specifity of 87.5%, positive predictive value of 94% and negative predictive value of 80% were found.Conclusion: Since the signs of infection in ischemic ulcers can be furtive and due to presence of high antibiotic resistance of attained pathogens in this study and owing to the fact of resemblance between the results of tissue culture and aspiration culture, performing aspirated culture from every CLU and the antibiotic therapy based on the results of antibiogram may be suggested.

Introduction: The incidence of pulmonary tuberculosis in our region is high. Despite the recent advances in medicine, still many patients suffer from longstanding tuberculosis. Delay in diagnosis may result in further morbidity and mortality. So, the goal of this study to evaluate the patient delay and physician delay.Materials and Methods: A descriptive study was done from 2004 to 2007 at Imam Reza Hospital on 86 patients with pulmonary tuberculosis. Those patients who fulfilled the inclusion criteria undervent a face to face interview and then the questioner's checklist was filled out. The interval between the first appearance of the clinical manifestation and first visit to the physician was considered the patient delay and the period between the patient's first visits to the final diagnosis was the physician's delay. Gathered data was analyzed with analyctic methods and T test.Result: The mean patient delay time was 14.69±10.91 with a median of 12.5 days. The mean physician delay time was 84.30±42.75 with a median of 80 days. The mean total delay time was 99±44.70 days with a median of 92.50 days.Conclusion: According to this study the patient delay in our region is acceptable in comparison with other studies, but our physician delay was long. Thus improving and upgrading the mycobacteriological courses for general physicians and specialists is recommended.

Introduction: Transhiatal esophagectomy and gastric replacement with cervical esophagegastrostomy by stapler or hand sutures is the most common surgical intervention in esophagial cancer. Anastomotic leak and stricture are the main complications. This study performed to compare the complication rate in the two methods of esophagogastric anastomosis with and without partial gastric fonduplication.Materials and Methods: This prospective clinical trial study was carried out in 2005 – 2007, at Omid and Ghaem Hospitals of Mashhad University of Medical Sciences on sixty patients with distal two third esophageal cancers, who underwent transhiatal esophagectomy. Patients divided into two groups randomly. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fonduplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. All cases were followed for 6 months and anastomosis leak and stricture were assessed by clinical exams and barium swallow study. Suspected strictures underwent esophagogastroscopy to prove benign stricture. Data analyzed by c2 test. Results: In the present study male to female ratio was 36 to 24 and mean age was 53.6±7.4 years. Squamoas cell carcinoma was observed in 76.7% and adenocarcinoma was reported in 22.3%. 77.7% of tumours were located in distal third and 23.35 were in medial third of esophagus. Esophagogastric anastomotic leakage was observed in 2 cases of fonduplication group and 3 cases of simple anastomosis technique, with no significant difference (p=0.64). Benign anastomosis stricture wasn’t reported in any of patients who underwent esophagogastric anastomosis with fonduplication but was observed in 4 cases with simple anastomosis technique, so there was a significant difference between the two groups (p=0.03).Conclusion: Esophagogastric anastomosis with partial gastric fonduplication decreased benign anastomosis stricture and appropriate leakage rate, so it is suggested as the preferred Esophagogastric anastomosis technique, although further studies are indicated.

Introduction: Delivered dialysis dose measured as Kt/V is widely accepted as an important factor affecting mortality on haemodialysis. It is currently measured relatively infrequently in most units for pragmatic reasons. The current study was designed firstly to determine delivered dose of dialysis, and secondly to determine what factors lead to failure to deliver dose of dialysis in patients with ESRD.Materials and Methods: This descriptive, cross-sectional study was performed in 2005 on 48 patients, in Dialysis Center at Imam reza Hospital of Mashhad University of Medical Sciences. DKt/V was measured and based on results, patients divideded into two groups of dKt/V >= 102 and dKt/V < 1.2. Access recirculation (AR), hemodynamic instability, weekly erytropoientin dose, negative pressure, venues pressure, urea distribution and prescribed Kt/V results recorded and analyzed by descriptive statistics and SPSS.Results: Nineteen patients (39.6%) were male and 29 patients (60.4 %) were femal. The mean kt/v was 1.05±0.36. Out of 48 patients, in 19 cases (39.6%) dKt/V was more than 1.2 and in 29 cases (60.4%) dKt/V was equal or less than 1.2. But mean pKt/V in two groups showed significant difference. The mean pKt/V was 1.22±0.25 and1.44±0.25 in groups of dKt/V £ 1.2 and dKt/V >1.2, respectively (p= 0.03).Conclusion: Low dialysis prescription, patient-related factors (i.e, hypotension, intradialytic symptoms) and technical factors (i.e access recirculation, negative pre arterial pressure) are main barriers to dialysis delivery. But among the above mentioned factors, low dialysis prescription is the most important and appreciated factor.

Introduction: Intravenous drug use is an increasing social challenge and a predisposing condition to infective endocarditis. Data on infective endocarditis in intravenous drug users in our society are limited. The aim of this study is determining the clinical features, site of involvement and bacteriologic findings of infective endocarditis in intravenous drug users.Materials and Methods: In this descriptive study, injection drug users who admitted at Infectious Diseases Ward, Imam Reza Hospital in a 5 years period (2001-2005), were reviewed and patients characteristics, the results of blood cultures, echocardiographic study, chest imaging and other standard blood testing were collected in questionnaires. Statistical analysis of data was done by SPSS-11 software.Results: A total of 38 cases of infective endocarditis occurred in 34 patients. All of these patients were men with a mean (+/- SD) age of 30.4 +/- 7.1 years. The tricuspid valve was involved in 26 cases (74.3%), the mitral valve in 4 cases (11.4%), the mitral and tricuspid valve in 4 cases (11.4%), and the mitral and aortic valve in 1 case (2.9%). The blood cultures were negative in 28.9% 0f cases; microorganisms identified in positive blood cultures included Staphylococcus aureus (77.8%, MRSA in 33.3% and MSSA in 44.4% of cases), Enterococcus (7.4%), Streptococcus pyogenes (7.4%) and Klebsiella pneumoniae (7.4%). Eight patients (21.1%) underwent surgery, and nine (23.7%) of patients died.Conclusion: Infective endocarditis in intravenous drug users affects the right side of the heart more commonly. Staphylococcus aureus is still the most frequent organism isolated from blood cultures, but the frequency of methicillin resistant staphylococci, organisms with higher resistance to medical therapy, is increasing. Thus, the suggested empirical regimen for the treatment of infectious endocarditis is a combination of cloxacillin, gentamycin and vancomycin. This regimen would be changed on the basis of the results of the blood culture and the pattern of antibiotic susceptibility.

ntroduction: Pervious studies suggested that obesity is correlated with dyslipidemia, hypertension and diabetes mellitus and it has been known as a main cardiovascular diseases risk factor. Obesity can be defined with Body Mass Index (BMI), Waist-to-Hip Ratio (WHR) and Waist Circumference (WC). The present study shows the prevalence of obesity and abdominal obesity and also their contemporaneity with other risk factors in Yazd 20-74 years old citizens.Materials and Methods: This descriptive study was performed in the year 2005 at Cardiology Reserch Center, Yazd on 2000, 20-74 years old Yazd urban population (phase I Yazd healthy heart project) by cluster sampling. Weight, height, WC and hip circumference (HC) measured by trained health providers and also BMI (weight / height2) and WHR (waist / hip) computed. WC was defined as the distance around the smallest area below the rib cage and above the umbilicus. WHR was achieved by dividing WC to greatest hip circumflex.Results: In this study the prevalence of overweight (BMI: 25- 29.9 kg/m2) and obesity (BMI >= 30 kg/m2) was 35.7%, 16.3%, respectively. The results showed a significant relationship between BMI and mean total cholesterol, TG, LDL-C (p=0.00). Also hyperlipidemia, HTN and diabetes mellitus were significantly more prevalent in obese cases and subjects with abdominal obesity (p=0.00). On the other hand inverse relationship was seen between obesity and abdominal obesity with smoking level of education. Also BMI increased with aging except in ages over 65 that obesity prevalence decreased.Conclusion: The prevalence of obesity and its association with other CVD risk factors in Yazd urban population were significant. So interventional programs for lifestyle changes and control of obesity should be the major hygienic priorities in Yazd.

Introduction: Diabetic mellitus is the most widespread illness resulted from metabolic disorders. Intake of glucose or any disaccharides containing glucose is limited or restricted in these patients. In this study changes in blood glucose of diabetic patients after eating jelly jams with fructose as sweetener and white bread (reference) were determined.Materials and Methods: In this clinical trial study in 2006 at Shahid Beheshti University of Medical Sciences on 30 diabetic patients type II of members of Endocrine and Metabolism Institute, the effect of jam on blood glucose were evaluated. To determine the glycaemic index of these jams, white bread was used as reference and blood glucose level was measured after eating each of them at different time intervals of: 0, 15, 30, 45, 60, 90, 120 minutes. Statistical analyzis was done using Wilcaxon and ManUwhiteny.Results: Study was done on 30 patients with blanced male to female ratio, with mean age of 51±17.9 years old and weighit of 72.6±10 Kgs. Blood glucose response evaluations in patients determined that glycaemic index of white bread and fructose jam was 100 and 34.4, respectively, with significant statistical difference (p< 0.001).Conclusion: According to the results of the present study, the glycaemic index of these jams is low and considering the positive clinical effects of the foods with low glycaemic index, the use of these jams in the diet of diabetic patients is recommended.

Introduction: Parsonage-Turner syndrome, an uncommon brachial plexus disorder, was first described by Parsonage and Turner in 1948. Abrupt onset of upper arm intense pain followed by weakness and atrophy after lessening of pain is a characteristic feature of this rare syndrome. A typical case of this syndrome is reported in this paper.Case Report: The patient, a 21 years oldman, was admitted in Neurology Ward at Ghaem Hospital of Mashhad University of Medical Sciences because of abrupt onset of upper arm pain and progressive atrophy and weakness in shoulder girdle after pain lessening. He had been vaccinated a few months before admission. Electrodiagnostic studies showed bilateral denervation of deltoid and supraspinatus muscles. Other causes of brachial plexus neuropathy ruled out with appropriate clinical and paraclinical studies. Partial improvement has been observed by conservative management after three months.

Introduction: Neuroacanthocytosis, a rare neurodegenerative disorder, is commonly transmitted in autosomal recessive pattern. It accompanies with several movement abnormalities such as tics, orofacial dystonia, tongue and lip biting, and absent tendon reflexes. Behavioral and cognitive changes occur frequently. Acanthocytosis with normal serum lipoproteins is a characteristic finding in this syndrome. A case of neuroacanthocytosis is presented in this article.Case report: The patient was a 37 years old man, referred to Neurology Department for progressive weakness, behavioral changes, chorea, vocal tics, orofacial dystonia, cough and fever. The diagnosis was proved by several assessments. He was treated for the complication of aspiration pneumonia and his movement disorder and recovered relatively.Conclusion: Although rare, this condition is present in our country thus it should be considered for all patients with movement and cognitive disorders.