Journal of Shahrekord University of Medical Sciences
Year:2009 | Volume:10 | Issue:4|Papers Count:27

Background and aim: In spite of many side effects of corticosteroids on patients, they are commonly used for vernal keratoconjunctivitis (VKC) treatment. Corneal morbidity along with steroid related complications may lead to permanent visual impairment. Therefore, the aim of this study was to evaluate the effect and safety of low dose of topical mitomycin C (MMC) on VKC. Methods: In this randomized clinical trial study, 25 cases of vernal kerato conjunctivitis that had been referred to ophthalmology clinic of Shahrekord Medical University were selected and divided into two groups. Group 1 received mitomycin C 0.01% (n=13) and group 2 received placebo (n=12) 3 times per day for two weeks. Symptoms (Itching, foreign body sensation tearing, photophobia, discharge) & signs (hyperemia punctuate kereatitis, trantas spots and limbal edema) were recorded on the day of presentation, 2 & 4 weeks after treatment period. Mann Whitney test was used to evaluate severity of symptoms and signs in 2 groups. Results: No statistically significant difference was observed in severity of symptoms and signs at the time of presentation between two groups. After two weeks treatment, patients in the MMC group showed significant decrease in photophobia, tearing, foreign body sensation, discharge, hyperemia, punctuate kereatitis, limbal edema and trantas spots compared to the placebo group (P<0.05). No adverse effect of MMC was observed after two weeks. Conclusion: Short term usage of low dose of topical MMC is an effective and safe way to control acute exacerbations in patients with severe VKC.

Background and aim: The anestheic drugs used in electroconvulsive therapy (ECT) have some defects such as pains and edema at the site of injection or short thiophantal is sometimes used. Duration of convulsion, premature ventricular construction and sinus bradycardia. This study was performed to compare the effects of ketamine and thiopental on duration of convulsion, homodynamic changes, and recovery time in patients undergoing ECT. Methods: This randomized double blind clinical trial was conducted on 16 patients in Noor Medical Center in Isfahan Iran. In the first time of ECT, ketamine 1 mg/kg ketamin (K group) as well as midazolam was administered. In the second time of ECT, 2.5 mg/kg thiopental (T group) was injected instead of thiopental. (Half patients received thiopental at first sescion and the others ketamin). The duration of convulsion observed with EEG monitoring, and systolic blood pressure, diastolic blood pressure and pulse rate before intervention and also immediately after ECT and 3, 5, 10, 15 minutes after ECT were recorded in all patients. Data were analyzed using t test, Chi square and ANOVA. Results: The mean convulsion time in group T was 26.3±5.8 and group K was 32.4±6.4 seconds, (P<0.001). The duration between ECT and awakeness in T group was 5.40±1.3 and in K group was 7.5±2.5 minutes respectively (P<0.01). In group K, Systolic blood pressure. 3 and 5 minutes after ECT were significantly higher than the group T (P<0.05). Conclusion: Ketamine for anesthesia in electroconvulsive therapy can increase duration of convulsion. Elevation of arterial blood pressure and heart rate was seen after ECT with ketamin. Recovery time also prolonged after anesthesia with ketamine. Thus, ketamine may be used for anesthesia in psychological patients with intractable response to ECT.

Background and aim: Hearing loss is the most common sensorineural disorder in human. Despite the contribution of several different genes in causing deafness, mutations in the GJB2 gene have been involved in deafness in many populations. This study aims to investigate genetic epidemiology and frequency of GJB2 gene mutations in 45 big deaf pedigrees. Methods: In this genetic epidemiology study we have investigated 45 big deaf pedigrees concerning inheritance patterns, consanguinity and diversity of deafness severity among siblings using data collected by questionnaires and audiograms. We examined also the frequency and profile of GJB2 gene mutations in 45 probands using direct sequencing strategy. Results: Our study revealed 73% of consanguinity in the deaf pedigrees studied. The most common type of first cousins marriage was found between first cousins who were the children of two brothers. We found autosomal recessive and X-linked recessive pattern in 94-97% and 3-6% of the pedigrees studied respectively. Regarding molecular analysis, GJB2 mutations were found in 11% of population studied including 35delG, 167delT, 299-300delAT and 363delC. Conclusion: A high rate of consanguineous marriage determined in this study could raise the rate of autosomal recessive patterns up to 94-97% of the overall pedigree and would be the main cause to prepare the way for congenital deafness. This study revealed a low contribution of GJB2 gene mutations in causing deafness in Chaharmahal va Bakhtiari province.

Background and aim: Electroencephalogram (EEG) is the most commonly used main preclinical diagnostic method for epilepsy. However this method has high false negative results (up to 40% in some cases). Therefore different activity methods have been proposed to reduce these false negative results. In this study we aimed to compare the EEG in epileptic patients with ordinary state and different models of activation. Methods: In a clinical study, 114 epileptic patients with normal EEG out of 500 epileptic patients referred to neurology clinic of Hajar hospital in Shahrekord were selected and divided into five equal groups as fallows: control group (without any activation), hyper ventilation (HV), photic (light) stimulation (PS), sleep and sleep deprivation. Then new EEGs were obtained from the patients. Data were analyzed using Chi-square (χ2) and Fisher test. Results: Patients with normal EEGs were selected for EEG activation. Fishers test showed that EEG activation was effective in finding positive EEGs (P<0.01). The c2 test also demonstrated that the amount of positive EEG had no significant difference among the activation groups (P>0.05). Furthermore our results showed that application of different models of EEG activation reduced the false negative EEGs in tonic–colonic seizure (3.3%), absence (9.5%) and other types of epilepsy (12.4%), respectively. Conclusion: Different models of EEG activation reduce false negative EEGs and increase the validity for diagnosis of epileptic patients. The best results were obtained with sleep and photic (light) stimulation that had lower positive results among all types of activation methods.

Background and aim: Fluoride is one of the most important substances which are used to prevent dental caries. Since 1988, sodium fluoride mouthwash has been distributed in primary school to use by students. This study aimed to investigate the effect of using sodium fluoride mouthwash in a population of the students (9 and 12-years old) in Shahrekord and also to determine DMFT (Decay Missed Filled Teeth) index in these students. Method: This cross-sectional study was carried out in Shahrekord in the year 2006. The simple random clustering multistage method was used to select the required sample. The data were collected using interview, questionnaires and student examinations. Data were compared with the pervious data which were collected from the same students in 1998, using Chi-square test. Results: The average DMFT value (for permanent teeth) among 9 and 12-year old students has significantly increased from 1998 to 2006 (P<0.05). In addition, the average dmft value (for milk teeth) among 9 years old students was 3.5±0.28 before using sodium fluoride mouthwash and this value has significantly increased to 5±0.059 in 2006 (P<0.05). There were no significant differences in the fluorosis cases between 9 and 12-years old students before and after using sodium fluoride mouthwash (P>0.05). Conclusion: Using sodium fluoride mouthwash seems to have no effect on DMFT index. It is suggested that other methods such as fisher sealants, water fluoridation, using high quality milk in schools and accessible dental care services should be considered in the province and the country.

Background and aim: There are contradictory results from the effect of iron and zinc supplementation on cognitive functioning of children. We investigated the effects of supplementation of iron and zinc, alone or in combination, on academic performance of primary school children. Methods: The study was a randomized double-blind clinical trial in which 101 primary school children, (61 females and 40 males) were randomly supplemented for 4 months with iron (20 mg/d), zinc (20 mg/d), iron+ zinc (20 mg of each/d), or nothing. Mean of continuous grades of dictation, mathematics, and reading were used to determine the academic performance and teacher checklist of Jon-Quay was used for validity of the method. Data were analyzed by one-way ANOVA, independent t test, and paired t test. Results: Mean of grades before and after intervention in received iron group, zinc group, iron+ zinc group, and control group were 17.29±2.47 vs. 17.95±2.35 (P<0.05), 17.70±2.8 vs.18.10±2.02 (P<0.01), 17.78±1.79 vs. 18.38±1.77 (P<0.05), and 18.31±1.85 vs. 18.40±1.60 (P>0.05), respectively. One-whey ANOVA did not show any significant difference between academic performance grade changes of groups. Conclusions: Supplementation with iron alone, zinc alone and iron plus zinc improved academic performance.

Background and aim: Gastric cancer is the most common cause of cancer death world wide after lung cancer. Genetic factors including oncogenes and tumor suppressor genes are always involved in progression of this cancer. The P53 tumor suppressor gene is believed to have a broad role in the cell such as programmed cell death and stop cell replicating damaged DNA which has been summarized as the guardian of the genome. This study aims to determine the frequency of two common P53 gene mutations using PCR-RFLP in gastric cancer in Chaharmahal va Bakhtiari province. Methods: This descriptive – lab based study describes the mutation analysis of paraffin embedded gastric samples from 38 patients in Chaharmahal va Bakhtiari province. We have investigated the frequency of P53 gene mutation in exons 7 and 8 by PCR-RFLP to detect alteration in two common hot spots in codon 248 and 282. Results: We determined no mutation in P53 gene hot spots in codon 248 and 282. Conclusion: We conclude that association of P53 gene mutations with gastric cancer is very low in Chaharmahal va Bakhtiari province. However we have examined only 38 gastric samples and more samples need to be investigated to reveal the contribution of P53 gene mutation in causing gastric cancer in this province. Also it is necessary to study the entire coding region and promoter of the gene in patients from different population and ethnic groups.

Background and aim: Schizophrenia is a severe and chronic disease that causes distress, disability, reduced productivity and lowered quality of life. The occupational therapy can help these patients to increase their self confidence and to strengthen their occupational behaviours. The aim of this study was to find the effect of occupational therapy on some aspects of quality of life in schizophrenic patients bedridden in Sina hospital of Farsan city in Charmahal va Bakhtiary province, Iran. Methods: In this clinical trial study all schizophrenic patients (62 patients) bedridden in Sina hospital were selected and their qualities of lives were assessed by Schizophrenic Quality of Life Scale (SQLS). Schizophrenic patients were divided randomly into case (32) and control (30) groups. Occupational therapy was performed in case group for a period of 20 hours in week for 6 months and then they were assessed again. Quantitative analysis of data was undertaken by using Independent- Student t test. Results: Our results demonstrated that quality of life mean score was not significantly different between two groups in the beginning of the study. Our evaluation in the end of the study showed that occupational therapy had significant effect on some psychosocial aspects of quality of life in case group compared to the control group (P<0.001). Conclusion: Occupational therapy has positive effect on some psychosocial aspects of quality of life in schizophrenic patients, such as motivation. It is essential to use other treatments to control symptoms and signs in these patients.

Background and aim: Infection by drug resistant organisms such as Extended-spectrum beta lactamase (ESBL)-producing Escherichia coli have caused major therapeutic problems. In this study, prevalence of ESBL positive Escherichia coli in clinical specimens was studied and their antibiotic-resistant patterns were evaluated. Methods: In a descriptive analytical study, 278 clinical isolates of Escherichia coli were obtained from Alzahra hospital in Isfahan, Iran. Phenotypic confirmatory test was used to detect ESBL-producing isolates. The antibiotic susceptibility patterns of ESBL producing isolates were determined using disk diffusion method following the recommendations of the NCCLS. Data were analyzed and evaluated by using Chi-square test. Results: Among 278 clinical isolates, 150 isolates (53.9%) produced ESBL. All strains were susceptible to imipenem and meropenem. Comparing antibiotic resistance between ESBL producing strains and non-ESBL producing strains, significant differences were obtained for quinolones, and amino glycosides. Conclusion: Our study showed high prevalence of ESBL strains (53.9%). More over, most of the ESBL strains were also resistant to quinolones and amino glycosides. Based on our finding, it is recommended that prescription of cephalosporins should be restricted to susceptible isolates. Diagnose of ESBL strains in clinical laboratory also should be considered.

Background and aim: Non-pharmacological methods in labor analgesia are better than pharmacological methods because they are safe for the mother and baby, easy to administer, have great satisfaction, do not interfere with uterine contractions and are not expensive. The aim of this study was to determine the effect of music on pain intensity in primiparous women during the active phase of labor. Methods: A single blind controlled trial was conducted on sixty primiparous women in hajar hospital of Shahrekord patients. Were randomly assigned to two equivalent groups (n=30): music and control. Data were collected by means of questionnaires and Visual Analogue Scale (VAS). First, prior to any kind of intervention, the severity of the base pain (the beginning of the active phase) was measured in two groups by means of VAS in 4 cm dilation. Again, after the experimental group had received intervention, the severity of the labor pains in 4, 6, 8 and 10 cm cervical dilation was measured and was compared. Women in the music group listened to their choice of soft music with earphones (calming or piano) intermittently each 30 minute during the active phase of labor. Data were analyzed using general linear model, the paired t test, c2 and independent t-test. Results: There was a significant difference between the severity of the pains pre and post music intervention in 4, 6 and 8 cervical dilation (P<0.001). Comparing between music and control group, to music group had significantly less pain than the control group. In 4, 6 and 8 cervical dilation (P<0.001). The mean duration of first stage of labor in music group was 353.46±67.6 minutes and in control groups was 401.5±96.5 minutes (P<0.05). Conclusions: Findings suggest that music can decrease pain during labor. So introduce music as a technique which will make the labor pains olerable, will decrease its severity without using any drugs, and will decrease unessential caesarean section.

Background and aim: Chest pain is one of the most prevalent symptoms in myocardial infarction. The object of this study was to determine the effect of complementary therapies on chest pain in patients hospitalized in coronary intensive care unit of selected hospitals of Isfahan Universiry of medical sciences college. Methods: In a quasi experimental research, 90 patients were selected by simple method and were divided into 3 groups of 30 (back massage, sound replacement and no intervention groups). Questionnaire was used to gather information. All three groups were interviewed at the beginning of the research and the questionnaire was completed in admission. In the massage group, massage was applied for two days, two times per day. In sound replacement group, cassette tape was broadcast two times per day for two days. The questionnaire was completed once more at the end of first 48 hours of admission. The research data were analyzed by inference and descriptive statistical methods SPSS software. Results: There was no statistical significant difference between the three groups in the case of chest pain at the beginning of hospitalization (P>0.05). However, there was statistical significant difference in the frequency of chest pain after 48 hours between the three groups (P<0.01). Also there was a significant difference in the frequency of chest pain alteration in admission and after 48 hours (P<0.05). Conclusion: Back massage and sound replacement for the patients hospitalized in coronary care unit, is an effective method for reducing chest pain of the patients.

Background and aim: Hearing loss is a heterogeneous disorder and may be due to genetic or environmental cause. A novel gene, DFNB59 encods pejvakin has been very recently shown to cause neural deafness. This study aims to determine the frequency of DFNB59 gene mutations in exon 2 and 4 in 100 patients negative for GJB2 mutations in Chaharmahal va Bakhtiari province. Methods: In this descriptive-lab based study we investigated the frequency of DFNB59 gene mutations in exon 2 and 4 of the gene. DNA was extracted from all patients following the standard phenol chloroform procedure. The two mutations T54I and R183W was determined using PCR-RFLP procedure. Results: The AF1III restriction enzyme digested the related restriction site in all of the 100 samples examined. Also, SsiI restriction site were digested in all of the 100 samples. These data indicate that no T54I and R183W mutations were not detected in deaf individuals tested. Conclusion: Based on data from the present study and previous study, we conclude that DFNB59 gene mutations have a very low contribution to deafness in patients in Chaharmahal va Bakhtiari province. However, we examined only 2 DFNB59 mutations in 100 patients and to determine the role of this gene in developing deafness the entire coding region and promoter of the gene need to be investigated in more samples.

Background and aim: Tubal ligation (TL) is a popular, safe, reversible and effective method of birth control. However it has some side effects. In this study, psychological and sexual consequences of TL and other contraceptive methods in women who had referred to Shahrekord health centers in a period between 2005 and 2007 were compared. Methods: In this descriptive and analytical study a total of 384 women (174 in TL group and 210 in other contraceptive methods group) were selected by simple sampling method. Data were collected by interview and demographic questionnaires, GHQ-28 and sexual disorders questionnaires (DSM-IV) at the beginning of the study and six months later. Data were analyzed and evaluated by Mann Whitney U, McNemar, t-student and Chi-square (c2) tests. Results: Psychological disorder in TL group was 31.3% at the beginning of the study and increased to 39.7% at the end of the study (P<0.05). Sexual disorders in TL group was 18.4% and 28.7% at the beginning and end of the study respectively (P<0.01). There was no significant difference in psychological and sexual disorders for the second group. Conclusion: TL group shows higher psychological and sexual disorders compared to the other contraceptive method groups. We suggest that those women selecting TL method, be informed the negative effects of it.

Background and aim: Streptococcus pneumonia is the most common cause of community aquired bacterial respiratory tract infection. It is also a major cause of acute otitis media, bacteremia and meningitis. There is little information on antibiotics susceptibility pattern of Streptococcus pneumonia in Iran. Therefore, the aim of this study was to determine the prevalence of throat carrier and penicillin resistant pattern of Streptococcus pneumonia in children with less than five years old who referred to health centers in Shahrekord. Methods: This descriptive–analytic study was carried out from May to September 2007 in Shahrekord. A total of 224 healthy children, age less than 5 years in health care center in Shahrekord city were studied. Pharyngeal samples were collected by sterile swabs and then inoculated on selected media. After 24hr incubation microbiological tests were performed and then Streptococcus pneumonia was recovered by Optochin test. Data were analyzed using Mann Whitney test. Results: 38 out of 224 children (17%), were carriers of Streptococcus pneumonia and its resistance to penicillin was 28.9%. There was significant relationship between age and sex and susceptibility pattern in the children (P<0.05). Conclusion: Penicillin is still an appropriate agent for treatment in Streptococcus pneumonia in our population.

Background and aim: Nursing and midwifery instructors have important roles in improving health in the society, by giving good education to nursing and midwifery students. Nurses and midwifes are members of a hygiene team and they need to acquire high self efficacy and best role performance from their instructors. This paper study was attempt to investigate role performance and self-efficacy perception in nursing and midwifery instructors and the factors which effect on it and then propose some strategies. Methods: The present research is a descriptive study which has been done by a problem-solving procedure. All nursing and midwifery instructors from the Shahrekord nursing and midwifery faculty who were willing to participate in the research (29 people) filled a role performance and self-efficacy perception questionnaire. Results: Most of instructors in our study believe that there is no suitable situation for them to perform their role in the clinic (score of 127.57). Regarding self-efficacy perception, the least score was given to the option of For increasing my self-confidence, I am able to have scientific discussions about my ideas and opinions with the faculty’s authorities during the courses with score of 90. The factors affecting role performance of instructors were marriage, age, work history and education. Factors affecting on self-efficacy of instructors were age and type of employment. Conclusion: Based on the data analysis from our study, the factors affecting role performance of an instructor were knowledge, work history and education and the more improvements in these factors makes more role performance and self efficacy in instructors.

Background and aim: Familial hypercholesterolemia (FH) is an autosomal dominant disorder caused mainly by mutations in the low-density lipoprotein receptor (LDLR) and apolipoprotein B (ApoB).Until now, the molecular basis of FH has been demonstrated in detail in many populations, but there is still very limited molecular data concerning FH in Iran. The aim of this study was to investigate frequency of 3 common Apo-B100 gene mutations in an Iranian population. Method: In this descriptive –lab based study a total of 30 non-related possible FH subjects from Cheharmahal va Bakhtiari were studies. All samples were tested for 3 common Apo-B100 gene mutations including R3500Q, R3500W and R3531C using PCR-RFLP procedure. Result: None of the common Apo-B100 mutations R3500Q, R3500W and R3531C were detected in samples examined using PCR-RFLP. Conclusion: Our data indicated that Apo-B100 gene mutations have not contribution to FH in samples studied here. However, we examined 3 common Apo-B100 mutations in only 30 patients, and to determine the role of mutations of this gene in developing FH in Cheharmahal va Bakhtiari province, more FH samples/populations needed to be investigated.

Background and aim: Hirsutism is a common disorder in women and is defined as increased growth of terminal hair in abnormal arias. There are different etiologies in hirsute women such as hormonal disorder especially polycystic ovary syndrome, tumoral diseases and idiopathic hirsutism. This study was aimed to delermined the hormonal profile of 127 hirsute women referred to Alzahra laboratory in Shahrekord, Iran. Methods: In this descriptive study, 127 hirsute women who referred to Alzahra laboratory in Shahrekord participated. Blood level of testosterone, DHEASO4, 17 hydroxy progesterone, prolactin, cortizol, insulin, TSH, FSH and LH evaluated with ELIZA and RIA methods. Results: In this study, most of women had 21 until 30 years old and elevation in DHEAS level 15.1% (19 person), 13% blood testeron, 11.6% (14 person) hydroxyl progesterone, 1.7% (2 person) TSH, 8.1% (10 person) prolactin, 3.2% (4 person) insulin and 0.8% (1 person) cortizol. In this study LH to FSH fraction in 28.2% of patient was equal or higher than 2 and suspicious polycystic ovary, in 8.9% of this fraction was equal or higher than 3 that indicated definitive polycystic ovary. Residual person have idiopathic hirsutism. Conclusion: According to this research finding frequency of idiopathic hirsutism was more than other types and regarding to importance of etiologic role in treatment of this disorder, careful hormonal and paraclinical approach in these patients is nessecery.

Background and aim: Internal iliac artery aneurysms are rare but potentially fatal and can be mistaken with more common medical disorders. Most iliac aneurysms occur in conjunction with aortic aneurysms and their etiology is atherosclerotic and degeneration. This kind of aneurysm includes less than 0.5% of all intra-abdominal aneurysms. Rupture is frequently associated with an exceedingly high mortality rate. Accordingly, these aneurysms are best managed aggressively. They are treated by resection and reconstruction, proximal ligation and over sewing of the distal branches, coil occlusion and endovascular techniques. Currently surgical resection and reconstruction remains the gold standard for definitive management Methods: We present a 72 year old man with an old pelvic fracture history who his chief complaint was bloody discharge from right buttock. His diagnosis in the angiography was right internal iliac artery aneurysm and during a surgery by evacuation his hematoma, the distal and proximal of artery was lighted. Conclusion: Because of their rarity and their depth in the pelvis internal iliac artery aneurysms are difficult to diagnose and tend to present late. Their symptoms easily get conflicted with other disorders and must be considered in differential diagnosis.