Medical Journal of Mashhad University of Medical Sciences
Year:2001 | Volume:44 | Issue:71|Papers Count:27

Objective: To assess the efficacy of teaching practical skills to medical students in Mashhad University of Medical Sciences, Medical School and to present the result to the educational decision makers in order to improve the quality of teaching.Materials & Methods: This is a descriptive cross-sectional study performed through a questionnaire. Results: We received a total of 95 answered questionnaires from the students. According to the results, a great majority of the students have expressed the university's curriculum for Practical skills is not satisfactory.Discussion: The study indicates that the practical qualities of the students are far from acceptable condition and the students have not learned the required skills well and under supervision. This is an important indication that must be of great concern to the educational decision markers.

One of the major pollutions of human environment that is very important in normal behavior of people is sound pollution. This pollution not only have a harmfull effect on hearing but also on normal functional behavior in communication.In this study we measured the sound pollution in various department of Imam Reza and Ghaem Hospitals. The results showed that: The noise level in incubators of Imam Reza Hospital were ranged. 58.1-74.4 dB and in Ghaem Hospital 61.4-68.1 dB, that were higher than permissible limits (60 dB).The noise level in various wards of Emam Reza and Ghaem Hospitals ranged 52.7-68.0 and 56.2-66.2 dB respectively, that were higher than American and British standards (50 dB). The noise level in operating room of Emam Reza and Ghaem Hospitals ranged 64.4-70.0 dB and 54.7-58.8 dB respectively, that were lower than what was reported in other articles (77+1dB). Noise level in ICU, CCU, emergency rooms and library were all higher than permissible limits.

IUI is an inexpensive procedure used in the treatment of infertility. Design: A retrospective analytic study from 1997-1999 in the IVF center of Mashhad university was performed. Materials & Methods: for IUI treatment.Eight-hundred twenty six women were assested as suitable candidates for IUI treatmentResults: Form 820 women, 29.7% were classified as cases of unexplained infertility, 29.9% I were classified as famale factor. These patients were the most common causes of doing our IUI procedure and tubal factor was Least common.We classified patients for age and duration infertility. Women who were younger 25.4 years in comparasion with women 27.7% years, had better outcome P<0.03. The patients with less than 6 years of infertility in comparison with patients with more than 7.4 years of infertility had better outcome P<0.015. In female infertility the pregnancy rate was highest for ovarian factors 26.4% and the least for mulitfactor 6.6%. The reccurent procedure not I alter outcome this method.Conclusion: IUI is a avaluable procedure which can be used in any center in treatment of infertility.

This study was carried out on patients with signs or symptoms attributable spinal disorders. In 1980 CT scan largely replaced myelography as the initial evaluation of spinal imaging modullity. MRI has since assumed a premier role in the assessment of spinal disorders and CT scan remains a popular method. But myelography has become almost a rarity in medically sophisticated circules. Researches conclude that MRI combined with plain films provide an accurate and non-invasive technique for imaging study of spinal lesions. A review of 250 patients studied with myelography, CT scan and MRI in the results studied with MRI and plain film showed similarity. We use T1, T2, P, D (spin echos) & surface coils for MRI of spine including Cervical & lumbar region.

Mental development almost reaches its peak at the end of childhood (about the of 16-27). Nevertheless it seems that this process never stops entirely, and some hazardous Factors can damage it, in adults.CNS infections are among the most important of these hazards. In this study, we chose 23 adult patients whom had been treated completely then determined their IQ. We compared their mean IQ with a control group.One Patient (4.3%), had an IQ compatible with mild MR (IQ=61), and we also found that the pyogenic meningoencephalitis group, when compared with the other groups of patients, and with our control group, had a statistically significant lower mean IQ.These results can suggest that the influence of the environmental hazards (such as infections) upon mental status is not confined to childhood, and we should anticipate it even in adults.

As radiologand studies definded ovelaping of "mu" and plpha two receptors distribution in the basal nuclei of the brain (locus ceruleus), and anterior horn of the spine, in fact, simoltaneous administration of opiate and alpha two agonist have a sinificant synergetic effects on reducing pain. Therefore Itwos found out by using an alpha two agonist such as clonidine, I could prolong the anesthesia and painless period, without need to increase doses of morphine related compounds. As a result, patients will be protected from terrible side effects of these drugs.Method: This study is done on 60 patients with different sex and age, who had to be operated on orthopedic, surgical and urologica1 problems under epidural anesthesia. They were divided at random in two groups of A and B. Definite doses of anesthetic and morphin related drugs were administered to the both group, but an additional dose of clonidine was given to the group A only.Conclusion: According to the above table, with nearly equal conditions in both group; (age, sex, HR and SBP), I noted the effect of drugs were more prolong in group A (338 min) who recieved clonidine, than group B without it which revealed a shorter period of drug effect (116 min). Knowing Clonidine has a synergetic effect on morphin related drugs, as a reasult makes the anesthetic and painless period much longer than the time it is not being used. Therefore, I recommand Clonidine to be used when a longer anesthetic and pain lese state is needed. It also prevents of using epidural catheter and more important than that heare is no need to increase the dose of morphin related drugs as a reasult keeps us on the safe side as far as the respiratory depression and other opiate side effects are concerned.

In order to analyse the clinical profile, indications, complications and outcome of the babies requiring mechanical ventilation, we have designed this retrospective study and the following results were obtained:198 neonates required intermitent-mechanical ventilation during the two years period (1994-1995). Respiratory distress syndrome (RDS) was the commonest indication for ventilation followed by birth asphyxia, septicemia, pneumonia, meconial aspiration syndrome (MAS), idiopathic apnea of prematurity (IAP). congenital heart disease (CHD), congenital diaphragmatic hernia (CDH), lung hopoplasia, postoperative apnea, necrotizing enterocolitis (NEC) and pulmonary hemorrhage. Pneumothorax was the most common complication, followed by infections (septicemia and pnemonia).Survival rate increased with increasing birth weight. The highest survival rate was for postoperative apnea and MAS. None of the patients recived surfactant.In conclusion ventilatory facilities must be avaliable with optimal or near optimal care of ventilated infants.

In this century one of the commonest causes of death is hypertension which is preventabale by it's proper treatment.Although 95% of patients suffer from essential hypertension and the remaining 5% are classified as secondary hypertension, which are completely cureable, by treating the underlying disease.The recent group of hypertensive patients atracted my interest to have a retrospective study on their hospital charts from view points of, prevalence, age, sex, intensity of blood pressure, laboratory .attempts, underlying disease and final treatment. Out of 2395 hypertensive patients who were admitted in different department of EMAM REZA hospital, such as internal medicine, genicology, cardiology and pediatric, only 157 cases had secondary hypertension which were sub divided by underlying causes of their hypertension as folow:8 cases of out-patients of pheochromocytoma had permanent hypertension, who recieved antihypertensive drugs from 2 months to 3 years. The majority of patients, who had pheochromocytoma complained of headache, tachycardia and diaphoresis. The ultimate treatment was surgery on them.The second group of secondary hypertensive patients were implicated by cushing syndrome who were 19 cases. They were between 31 to 45 years of age. 100% of them had a high systolic pressure which was controled by dexamethason test. This test is very beneficial in diagnosing of cushing syndrome.The third group were 4 cases of hyperparathyroidism with hypertension. They were mostly above 30 years of age. The fourth group were 8 cases of hyperthyroidism whose age were above 45 years, The female to male ratio 4:1, that lower than is in the literature (7:1) and mostly had a mild high systolic pressure.After all, we came to a conclusion to advise the young physicians, should always keep in mind the possiblity of secondary hypertension every case of high blood pressure.

Tuberculosis has remained one of the most important causes of mortality among infections worldwide. CNS involvement is the most disastrous event of the disease. Neurotuberculosis is a medical emergency and microscopic examination of the spinal f1uid for acid-fast bacilli is the most familiar procedure for a definitive early diagnosis. We chose a ten-years period (1989-1999) for a retrospective study of neurotuberculosis at the Montassarieh Hospital in Mashhad. We analysed our demanded CSF parameters in 314 patients with CNS TB. We divided them into two groups. One group whose CSF smears was negative for AFB; and the other group with positive ones. The examiners had applied the Stewart method for searching the specimens. We compared these two groups on the basis of their CSF parameters; and found a significant accompaniment between hypoglycorrhacia/high ANC/high protein content in CSF; and the chance for detecting the organism in CSF; by application of the Stewart method.

A two-year survey for posttraumatic meningitis in a Neurosurgical trauma center with an annual admission of 8500 patients, showed 24 cases of posttraumatic meningitis (PTM) in 1.6 cases per 1000 admission per year. Among the cases; 16 were male and 8 were female (sex ratio of 2:1). PTM appeared earlier than 7 days in 17 cases (early PTM) and in 9 other cases-later than 7 days (delayed PTM).42% of the cases were in their first decade of life. The most common cause was motor vehicle accidents; 13 patients (54%) had positive CSF culture (29.7% Streptococcus pneumonia; 20.8% Staphylococcus aureus; 4.1% Kelebsiela). In 46% the CSF cultures were negative.Fever was the most common symptom (79.1%) and CSF leakage was present in 8 cases (33.3%). The most common finding in skull was linear fracture (25%); the most common finding in CT Scan was pneumocephalus (20%). Therapeutic regiment was penicillin and chloramphenicle for 37% of the cases. Mortality rate was 12.5%.

In a prospective study during 17 months (Since March 1998), 1074 neonates were evaluated for cerebral hemorrhage in the Imam Reza Hospital NICU.23 cases of intracranial hemorrhage were diagnosed by CT scan. Male to female ratio was 1.5 to 1.74 percent of neonates were fulterm, with 77 percent of normal vaginal delivery, and 23 percent with cesarian section.The most common clinical symptoms were seizure, apnea, anemia, renal failure and bulged fontanel. 48% of hemorrhage were subarachnoide, 35% interventicular. Mortality rate was 43%, most of those with interventicular. Most of subarachnoide hemorrages dischaged without any complication. More than 50% of intracranial hemorrages are seen during the first 48 hours of life.

Introduction: During 11 years (1988-1999) a total of 368 patients underwent renal transplantation in Imam Reza Hospital. Method: Neurolept Analgesia with phentanyl or subphentanyl and Deropridol was performed in all patients (donors and recipients). Pancronium in donors and Atracorium in recipients were selected as muscle relaxants. For induction of maximal hydrostatic pressure in the kidneys, warmed normal saline and Ringer solution (3-4 litres) were infused rapidy (20 minutes before removing the kidney from donors and 20 minutes before removing the clamp in the recipients). In addition we infused manitot (500cc) and Furosemid (50mg) 20 mintes before nephrectomy in donors. About 4 liters Normal saline with manitot (500cc) and furosemid (200mg) were perfured in recipient 20 minutes before removing clamp. Results: In all cases but 3 patients, diuresis was established in less than 5 minutes after removing vasular clamp. In all cases before removing clamp. The systolic blood pressure" was 125mmHg and despite using large quantities of fluid (4-7 Lit). There was no fluid and electrolyte imbulance in clinically or paraclinically in donors or recipients.Conclusion: Proper anesthesia with overhydration and maintain systolic blood pressure over 125mmHg before donor nephrectomy and removing clamp in recipient and using appropriate diuretics induce immediate diuresis in renal tnansplantation. Immediate diuresis enables the surgeon to have a rapid assesment about his operation and graft.

Background: Descematocele is one of the most important consequences of corneal disease which may result in blindness. Responding to the following questions is the purpose of this research:1- What are the causes of descemetocele?2- What are the risk factors of this disease?3- How is it cured?4- What are the cosequences of this diseas?Materials and Methods:This is a descriptive research. Fifty medical records belong to patients who have descematocele and admitted in Imam Reza Hospital are inspected in this research. Incomplete medical records or diagnoses were exclusion criteria.Results: Most of patients had V.A. < 2.6 m cont finger (C.F.) descemetocele had diameter < 3 m in 66%, 3-5 mm in 28% and > 5 mm in 6% of cases.Risk of perforation increases with size of descematocele. Central location in 58%, peripheral in 42% with more risk of perforation for central location. Infiltration and acute ulcer accured: 74% of cases (with most likelihood of perforation). Abscess formation and necrosis accured in 18% resolution and opacity in 8%, AC reaction and hypopion 46%, Fibrinoid reaction 8%, cellular reaction 30%, No reaction 16%. Perforation 46%. Etiologic agent according to clinical findings were herpes symplex 18%, lid deformity 18% and 3 cases descematocele occured after corneal graft.Treatment results: conjunctional flap: 66% with failure rate: 12.1%, corneal graft: 12%, medical treatment: 22%. These last two methods had no failure.Conclusion: Almost all the patients who had descemetocele with diameter<2mm were cured by medical management. Patients with descemetocele >2mm required conjunctival flap.

In a Prospective study over one year 326 infants with jaundice admitted in chilren Hospital of Gorgan.19 of 326 jaundiced newborn had G6PD deficiency. Thus the incidence being 5.83%. The male/femae ratio is 17.2. Jaundice began in the first 24 hr of life in 5.88% of patients and the mean maximal total serum bilirubin concentration, was 16.25 mg/dl and mean minimal Hb concentration was 15.05 g/dl. All of the patients recieved phototherapy only and none of them need exchange transfusion for treatment of hyperbilirubinemia.In conclusion G6PD deficiency should be considered in he differential diagnosis of hyprebilirubinemia in the first 48 hr of life in the spite of normal Hb concentration, and the incidence of G6PD deficency here is less than that was reported in jaundiced newborn in Ahwaz city in south of Iran.

A prospective study performed during one year from 94.1.21 to 95.1.20 in patients with stroke in emergency department of Ghaem Hospital in Mashhad.A total of 805 patients with stroke were seen (396 Men and 409 women). The youngest patient was 12 years old girl and oldest was 100 years old man. The maximum range of stroke was between 61-70 (34.4%) old Age. 38% of patients were alert and others had degrees of unconsiousney. All patients were evaluated for hypertension - diabetes mellitus - lipides leves, smoking and cardiovascular disorders. Hypertension was most common risk factor.In 60% of cases CT Scan performed, the results were 14% normal 41% ischemic - 34.5% hemorrhagic and subarcnoidal hemorrhage (SAH) was 9.7%. The mortality rate amonge our patients was 24%.

58 patients with hydatid disease of craniospinal axis underwent 87 operative procedures during a 15-year period. 43 cases of primary cerebral hydatid cysts, 8 cases of unusual hydatid cysts of craniospinal axis (orbit: 2; spinal cord: 1; cerebellum: 1; cranial epidural: 1; bilateral hemispheric: 3) and 9 cases had more than one operative procedures summed up to 29 operations. In 43 patients with primary cerebral hydatid disease the frequency of signs and symptoms were as follows:headache 77%; vomiting 35%; convulsion 49%; visual defects 30%; opticatrophy 16%; papilledema 14%; behavioral changes 16%; sensory defects 33%; dysphsia 19%; motor defects 74%; and skull deformity in 5% of the cases. In 63% of the cases the cysts were in the left hemisphere of the brain (parietal 66%; frontal 19%; temporal 7% and occipital lobe 9%), 11 cases were male and 32 cases were female. The youngest patient was 3 years old and the oldest case was 56 years old. The article presents 43 cases of primary cerebral hydatid cyst and discusses ethiology, pathogenesis, sign and symptoms, diagnostic modalities, treatment, methods and prognosis of hydatid diseas.

Myasthenia gravis (MG) is a chronic autonimmune disease, appears in three forms in childhood; 1) Jevunile MG, 2) Congenital MG and 3) Neonatal transient MG (N.T.MG).The eithiology of disease well established and is due to antibodies which are generaly IgG, but may be IgM against acetychloine (Ach) receptors proteins. Transient neonatal MG is the rare form and occurs in neonates born to mothers with MG, and may be caused by placental transmission of blocking antibodies for Ach receptors that disappears after 2 months of age. Early diagnosis and treatment prevent complication and decrease mortality rate especially due to respiratory failure.During 7 years, we report 4 cases of myasthenic mothers and her newborns with two cases of symptomatic transient MG, others were asymtomatic. There wasn't previous study in Iranian Medical Journals.

We have studied 47 patients who had macroscopic Hematuria. All of these patients have had TUR P at least one year ago.We evaluated them for etiologic cause of hematuria with physical examination, Urine Analysis, urine culture and ultrasonografy. We found that the most common cause was Recurrent of "B.P.H." and second cause was infection.

From April 1999 to February 2000, 800 patients for ureteral calculi underwent ureteroscopy and pneumatic lithotripsy. Age rang was between 32 months and 74 years. The over-all stone free rate was 93 percent. Major complication in our patients was negative. We suggest that ureteroscopy and pneumatic lithotripsy should now be considered as a simple and safe technique) with minimal morbidity and low cost in treatment of lower and middle ureteral stones.

Mycotic Keratitis is an important disease of cornea which may cause blindness. Many genera of filamentous fungi & some yeasts are involved in the group of etiologic agents. Trauma and surgery are the main predisposing factors. In this paper, a 55 years old farmer man with mycotic keratitis is reported. He had previous history of small crush due to forigen body in his eye while working in his .farm. Chemotherapy by amphotracin B & Natamycine was not successful, but the patient obtained his vision after penetrating keratoplasy. This is the first report of fungal keratitis due to fuzarium species in Khorasan.

Persistant Mullerian Inhibitor Substance (MIS) is a rare condition of pseudohermafrodism that has been reported arround 150 cases in the world. In our study 2 brothers evaluated and presented with criptorchidism.After clinical evaluation and laparatomy, one of them had bilateral tumor diagnosis was and confirmed by pathology report as a classic seminoma, Both of cases had a uterine-follopian tube and cervix in our evaluation.Although MIS deficiency is a rare finding, more evaluation for neede to exclude this syndrome.

Leiomyoma is the most common benign uterine tumor. Degeneration of uterine leiomyoma is rare and usually occurs during midpregnancy and the puerferium. Rupture of uterus is very rare which accurs during degeneration or rupture of superficial dilated vessles.Although ultrasonography may assist in recognizing the characteristics of the pelvic mass, laparatomy is required for diagnosis. From 1966 to now five cases of perforating myoma were reported by internet. We present a rare case of spontaneous perforation of degenerative leiomyoma in a norpregnant woman.

Fasciolosis is a parasitic infection of the liver and biliary tract due to fasciola species. It is a common parasite of herbivores and one that is cosmopolitan in its distribution. It is a rare sporadic disease in Khorasn. A rare chronic case of fasciolosis with good prognosis is presented in this paper.Our patient was a 63 years old man with history of 5 years abdominal pain of right upper quadrant region and weakness. Fasciola hepatica ova were seen in stool examinations and duodenal aspiration for several times. Bithionol is the drug of choice for toe treatment of human Fasciolosis, but it is not available in Iran. Therefore, chloroquine was prescribed. After two weeks of treatment, stool examinations for several times were negative and patient's symptoms reduced.The authors believe that chloroquine can be used as an effective, inexpensive and available drug for the treatment of Fasciolosis.