MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2008 | Volume:51 | Issue:3|Papers Count:13

Introduction: Postoperative abdominal pain is one of the complications of anesthetics, especially narcotic drugs. We have noticed that the incidence of this complication is very high in patients anesthetized with Remifentanil and the aim of this study was to investigate its incidence.Materials and Methods: This clinical trial performed in 2007 at Khatam-al-Anbia Hospital of Mashhad University of Medical Sciences. The study was approved by the local committee of medical ethics. A total of 100 Patients undergoing cataract surgery were divided randomly into two groups. In one group, anesthesia was maintained with Propofol (80-100mg/kg/min) and in another group with Remifentanil (0.20-0.25mg/kg/min). The incidence of abdominal pain and its quality was recorded in both groups in the recovery room. Data analyzed by SPSS software.Results: Twenty patients (40%) in the Remifentanil group complained of severe abdominal pain, while in the Propofol group, only 3 patients (6%) had vague abdominal pain. The incidence of pain had a significant difference between the two groups (p<0.001). In 14 patients (70%) of the Remifentanil group with abdominal pain, injection of IV hyoscine was effective to reduce abdomined pain, while in the propofol group, it had no beneficial effect.Conclusion: Abdominal pain is one of the complications of narcotic drugs, with a very high incidence with Remifentanil. It causes patient’s discomfort in the recovery room. It is recommended to investigate the causes and treatment modalities of this complication.

Introduction: Cutaneous leishmaniasis is an endemic disease in Iran, the pentavalent antimonials, used for treating this disease; do not show effective enough in the recent years. The cellular immune response caused by T-helper type1 (Th1) cuases protection against leishmaniasis and that of T-helper type2 (Th2) causes the progress of the disease. The aim of this study was evaluating secreted cytokines from peripheral blood mononuclear cells (PBMCs) in healing and nonhealing cases of cutaneous leishmaniasis treated by glucantime and control group to find a treatment policy for nonhealing patients.Materials and Methods: This descriptive study was conducted in 2006 on the subject of 60 cases of individuals, referred to Vila Clinic and Ghaem Hospital of Mashhad. This study was approved by the local committee of Medical Ethics. The cellular immune response in nonhealing and healing cutaneous leishmaniasis and control group evaluated by measuring the cytokine released by PBMCs when stimulated with Leishmania major antigens and mitogen for 48 h by Enzyme Linked Immuno Sorbent Assay (ELISA). Results: PBMCs of healing group secreted higher levels of interferon gamma (IFN-g) than the nonhealing patients (p<0.05), whereas the interleukin 4 (IL-4) levels were higher in the nonhealing group compared to the healing ones (p<0.005). Conclusion: The results demonstrate that secretion of cytokines that activate Th2 response like IL-4 in nonhealing patients was higher than healing cases and secretion of cytokines which activate Th1 response such as IFN-γ in the healing cases was higher than the nonhealing patients.

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation and progressive development of airflow limitation. Recently besides the typical pulmonary pathology of COPD, several effects occuring outside the lungs, for example weight loss and malnutrition have been described the so called systemic effects of COPD. In this study we evaluated body mass index (BMI), serum albumin and their relationship with pulmonary function.Materials and Methods: This descriptive study performed on 42 patients, referring to Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran at 2005, with the mean age of 62.82±10.54 years and the mean forced expiratory volume in the first second (FEV1) (1.38±0.76 lit.). This study was approved by the local ethics. Severity of disease was defined by global initiative for chronic lung disease (GOLD) guideline. BMI and serum albumin were measured.Results: BMI was lower than normal in 9.5% of patients. There was a significant negative correlation between the severity of disease and BMI (p=0.004, r=-0.43). Furthermore the correlation between the severity of disease and serum albumin was significantly negative (p=0.02, r=-0.35).Conclusion: The results of this study indicate that BMI and serum albumin decreased as the severity of disease increased. Therefore, the nutritional status is closely linked to the severity of COPD.

Introduction: Impaired lipid metabolism in diabetic patients is implicated in cardiovascular complications. The aim of this study was to evaluate the effect of glycemic control on the lipid profile of type 2 diabetic patients.Materials and Methods: This study was performed at Emam Reza Hospital, Mashhad, Iran, in 2006. A total of 357 adults with type 2 diabetes (144 males and 213 females) were evaluated. This study was approved by the local committee of medical Ethics. In the standard condition, the sera analysed for fasting blood glucose (FBG) by glucose oxidase method, and for total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) by enzymatic methods, and for HbA1c by chromatography method. The data analyzed by (SPSS, version 11.5), Pearson’s correlation test, t test and one- way analysis of variance. P values ≤ 0.05 considered significant.Results: The level of HbA1c, Triglycerides and FBG did not differ significantly between males and females, however, the level of cholesterol, LDL-C, and HDL-C were significantly higher in females. There was a significant correlation between FBG and HbA1c. A direct association of FBG and HbA1c with total cholesterol and triglycerides observed, however, they were not correlated with LDL- C and HDL-C. The level of serum triglyceride was considerably higher in patients with inadequate glycaemic control. Conclusion: This study clearly shows that, HbA1c not only is a reliable biomarker of glycemic control but also, a good predictor of the serum lipid profile in diabetic patients.

Introduction: Nearly ninety percent (90%) of skin cancers occur in sun exposed areas. In this study the awareness of senior students of Mashhad University (Ferdowsi) about the effects of sunlight on the skin plus necessity and methods of sun protection is evaluated.Materials and Methods: In this descriptive study in 2004 at Mashhad University (Ferdowsi), 802 senior students of 9 majors enrolled. This study was approved by the local committee of Medical Ethics. The standard questionnaires including 24 questions distributed among students. The students divided into groups according to their score in the 24 awareness questions: weak (score ≤ 12); moderate (score 13-17); and good, (score 18-24). Data analyzed by SPSS software variance analysis, T-test and Chi-square test. Results: The students groups were weak, with a frequency of 15.6%; moderate with frequency of 39.4%; and good, with a frequency of 45%. The average female and male scores in the 24 awareness questions were 18.31±3.32 and 14.90±3.93, respectively. The difference was statistically significant (p=0.002). There were significant differences between two sexes in the awareness of :"sunlight usefulness", "harmfulness", "effect on skin aging", "cause and increase the skin nevi", "erythema", "tanning", "carcinogenicity", "osteoporosis", "different sunlight intensity in different hours of the day", "protection of the window glass", "the necessity of sun protection" and " the effect of cap and clothes", "the sunscreen necessity in any season", "sunscreen use just in special patients", and "repeating its use during the day". Conclusion: Educated Peoples׳ knowledge, about the necessity of protection against harmful and corrosive effects of sunlight is not enough. It necessitates public education to protect against sunlight complications.

Introduction: Depression and anxiety are among the principal manifestations of chronic illness and play a central role in patients’ experience with life-limiting disease. Chronic renal insufficiency is a clinical condition with a huge impact on patient quality of life. Hemodialysis patients must confront the burdens of long-term illness and numerous treatment-associated stressors. The purpose of this study was to determine the depression and anxiety in chronic haemodialysis patients.Materials and Methods: This descriptive survey performed at Mashhad University of Medical Sciences during the year 2007. A total of 150 patients regularly treated with hemodialysis were chosen through sensor sampling. This study was approved by the local committee of Medical Ethics. Depression was measured using CES-D (The Center for Epidemiological Studies Depression Scale) and anxiety was studied by Eshpil Berger standard questionnaire.Data analyzed by SPSS software. Results: This study revealed that prevalence of depression was 64.5 percent in hemodialysis patients (Cut-off value was 16). This group had 51.4 percent prevalence of State Anxiety and 49.0 percent of Trait Anxiety. Statistical analysis demonstrated that there was a meaningful correlation between depression and history of graft failure (p<0.04), dialysis duration (p<0.01), family income (p<0.001) and working status (p<0.02). However, there was no significant correlation between depression scales and demographic factors including age, gender, frequency of dialysis and marital status.Conclusions: Our study showed that a substantial number of hemodialysis patients experienced depression and anxiety. Regarding this problem, necessity for having consulting and psychotherapy center in hemodialysis ward is emphasized.

Introduction: Gasless transanal endoscopic microsurgery of rectum promises to offer a safe and effective option for the selective treatment of patients with rectal lesions. This study describes personal experience of using a modified hand-made device for transanal endoscopic surgery to facilitate surgical access to selected intrarectal lesions with an acceptable cost, safety and effectiveness.Materials and Methods: This descriptive cross-sectional study carried out from 2003 to 2005 at Ghaem Hospital of Mashhad University of Medical Sciences. This study was approved by the local committee of Medical Ethics. Nine patients including 4 men and 5 women with rectal polyp or tumors with low likelihood of malignancy enrolled in this study. Transanal endoscopic surgery was performed and pathological studies were done on tissue specimens. Data analyzed by SPSS.Results: The location of the mass in the rectum ranged from 5-20 cm from anal verge, and tumors ranged in size from 2 to 7 cm. Mean age of patients was 65 years. Curative local excision performed in 7 of 9 patients (77.8%). The complications included wound separation (n=1), massive postoperative bleeding (n=1) and temporary incontinence (n=2). There was no mortality, either recurrence within a follow-up period of 20 months. Mean of operative time recorded 55 minutes. Two patients underwent radical operation later, because of rectal polyposis and involved tomour margin.Conclusion: Transanal endoscopic surgery is a safe and effective option for the selective treatment of rectal lesions. The used device lowered the expenses and simplified the system, using a hand-made special rigid cylinder.

Introduction: For many years superficial partial thickness burns were treated conservativly. In full thickness burns, skin grafts were applied usually 3 to 8 weeks after injury. The goal of this study is to accomplish a comparison of early excision and grafting versus conventional therapy in small full thickness burns. Materials and Methods: This Clinical trial study enrold in 2004 – 2006 at Emam Reza Hospital of Mashhad University of Medical Sciences on 65 Female burned patients with total body surface less than 20%. This study was approved by the local committee of Medical Ethics. 28 patients were treated by early excision of second and third degree burned wounds to the level of fascia within first week of admission and wound immediately covered with autografts of partial thickness meshed 2:1. In 37 Patients of the conservative treatment group the burned wound was dressed daily and full thickness burns grafted after 3-4 weeks of injury. Individual characteristics was collected in questionnaire and analyzed by descriptive statistics.Results: The mean age of patients was 33.4 Length of hospital stay in early excision and graft was 10±4 days and in conventional therapy 37±7 days, with significant difference. Mean number of produres in early excison and graft was one stage and in the other group was 1.24. Mortality in the two groups was similar. Conclusion: Small full-thickness burns, if treated by an experienced surgeon, can be safely early excised and grafted with a decrease in hospital stay, costs, and number of painful debridments and will have fewer infectious wound complications.