Journal of Ardabil University of Medical Sciences
Year:2007 | Volume:7 | Issue:4 (26)|Papers Count:17

Background & Objective: Mycobacterium leprae is the cause for leprosy which is a contagious disease in many developing countries. These diseases have always been a dreadful one for its unpleasant clinical symptoms and the disabilities it causes. It has the most prolonged cell division time of all bacteria (12-14 days). Its incubation period is long (3-5 years) even 40 years has been reported. The complications which it leaves are irreversible and it bears a heavy socio-mental burden on the individual and the society. WHO has listed 91 countries with leprosy. The goal of the present study was the early diagnosis of the disease before the emergence of unpleasant clinical symptoms and popularizing molecular method of PCR in place of the conventional method of slit skin smear which is not a precise or reliable method.Methods: In this study 40 slit skin smear and the same number of skin biopsies were taken from patients referring Bababaghi Hospital and samples from ear lobes and eyebrows were taken. Slit skin smears were stained with Zeihl-Neelsen method and examine microscopically. At the same timy biopsy specimens were extracted.Results: Of 40 samples, three slit-skin specimens (7.5%) had positive smear result, while 14 (35%) biopsies had PCR positive result. The rest (11 cases) probably had TT or borderline forms of BB, BT, BL).Conclusion: The results showed that SSS is not a precise and reliable method for diagnosing leprosy especially in TT form which is always negative direct smear. Also direct smear method and clinical symptoms are not accurate or reliable methods in estimating the rate of disease prevalence.

Background & Objective: Many risk factors are important in genesis of coronary artery disease. Their effect and prevalence are different in hypertensive patients. The aim of this study was to evaluate the predictive value of cardiac risk factors in hypertensive patients and compare those in normotensive patients.Methods: With descriptive cross sectional study and random sampling, 976 of 3000 patients’ units who underwent coronary angiography (CAG) during year of 2004 were studied.Demographic and angiographic data were collected. Data entry and analysis were done by SPSS 11.5 and EPI 6 statistical software.Results: Prevalence of patients who underwent CAG was 60.5%. Mean age of patients were 58.6 and 53.9 years and prevalence of CAD were 84 and 84.5 percent in hypertensive and non hypertensive patients respectively. Prevalence of two and three vessel disease was higher in hypertensive patients. Male gender, diabetes, hyperlipidemia and age were main predictors of CAD in hypertensive patients but in normotensive patients male gender, smoking, familial history and age were major predictors.Conclusion: Prevalence of HTN, RFs and CAD are high in patients who underwent CAG and pattern of CAD in our country follows western country patterns. Male gender, diabetes, hyperlipidemia and age were main predictors of CAD in hypertensive patients, respectively regarding to high prevalence of cardiac risk factors and their severe effect on genesis of CAD in hypertensive patients rapid health measures are needed for control of HTN in general population.

Background & Objective: Tumor-infiltrating lymphocytes (TILs) develop as recognition and defense against malignant cells by the host immune system. T cells are the most tumor infiltrating immune cells. There are controversial data about intratumor T cells and many have proposed diverse mechanisms for dysfunction of TILs. The aim of this study is analyzing Tumor Infiltrating T lymphocytes in patients with breast cancer by immunophenotyping.Methods: Sixteen women suffering from breast cancer were examined; thirteen of them were confirmed histologically to be invasive ductal carcinoma (IDC). Tissue samples from patients and matched control group were processed for analysis by flow cytometry.Results: Results indicated that human breast cancer contain variable numbers of TILs. No significant changes in the percent of intratumor CD45+, CD3+ and CD3+ / CD45+ cells were observed between studied groups. Also there were no significant differences between cancer patients (group 1 and 2) and control group in the case of infiltration and activation status of T cells subpopulations. CD4+ cells in IDC patients and CD8+ cells in patients with other tumors (ILC+AMC) were the most infiltrated TILs. Intratumor TCD8+ cells expressed HLA-DR markers significantly more than CD25 as activation marker. In this investigation we could not find any correlation between TIL and both size and clinical stages of tumor.Conclusion: An immune infiltrate is an invariable finding in breast cancers, with considering the activation marker expression, TIL may be activated, albeit partially. Understanding the insensitive and/or suppressive nature of cancer cells to the immune system may provide important insights into tumor escape mechanisms as well as the development of anti-cancer strategies.

Background & Objective: Cerebrovascular disease mortality rates have declined in some countries during recent decades. Changes in mortality rates over time could be attributed to changes in disease incidence or case fatality rate. Very few studies have provided information regarding survival after stroke. We aimed to determine the case-fatality rate (28 days) among patients with first-ever stroke from a population-based study in Ardabil province, Northwest of Iran.Methods: This study was conducted between May 2005 and February 2006, all individuals with an acute stroke who were residents in Ardabil province and hospitalized at Alavi Hospital, were registered prospectively and assessed according to standardized diagnostic criteria. The data were analyzed through SPSS, Chi square and variance analysis.Results: A total of 352 patients with first-ever stroke were registered, and 346 (96%) were followed up. 288 (81.8%) ischemic stroke, 16.2% (57) ICH and 2% SAH. By 28 days, 70 patients (20.3%) had died. Hypertension, diabetes and cardiac disease history were reported in 61.6%, 16.8% and 26.1% respectively and 19.8% of patients were smokers. Mean age of survivors was different from patients who died at 28 days after index event (64.2±12.9 VS 69.1±10.9, p=0.03). The proportion surviving 28 days varied from 16.2% among patients with ischemic stroke to 43% among ICH and SAH. For ischemic stroke, Survival rates were similar for men and women, whereas men with ICH had lower survival than women.Conclusion: Case fatality rate after first-ever stroke is substantial. Rates of mortality differ according to patients diagnosis, age, sex, and heart disease. These data highlight the importance of long-term secondary prevention.

Background & Objective: With consideration the daily increased development of outpatient surgeries and high rate of these operations in elderly patients, rapid and safe recovery of patients for coming back to daily life is necessary. In this clinical trial study recovery time and nausea and vomiting after the use of two rapid-onset narcotic, alfentanil and remifentanil in elderly patients has been compared.Methods: In this double-blind clinical trial 40 elderly patients (age above 65) candidated to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group alfentanil was injected 10 mg/kg and for second group remifentanil 0.5 mg/kg during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia first group took infusion of alfentanil 1 mg/kg/min and second group remifentanil 0.1 mg/kg/min. At the end of surgery the time intervals between end of anesthesia drug adminstration and autonomic respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs especially nausea and vomiting were recorded. The data were analyzed in SPSS software using descriptive and analytical statistics as T-test, chi square and ANOVA.Results: The time of autonomic respiration in alfentanil group was 2 minutes and in remifentanil group 3.3 minutes, this time in alfentanil group 1.3 minutes shorter but the difference was not significant. The time of eyes opening with stimulation, verbal response and discharge of recovery room were not significantly different. During recovery incidence of nausea and vomiting in remifentanil group (30% of patients) was significantly more than alfentanil group (5% of patients) (P<0.05).Conclusion: The time of recovery between alfentanil and remifentanil group was not significantly different, but incidence of nausea and vomiting in remifentanil group was higher than alfentanil group significantly.

Background & Objective: Ultrasound waves are extensively used for therapeutic application in physiotherapy. The therapeutic effects of ultrasound often result from the increasing temperature in the exposed tissues, although the nonthermal effects, such as cavitation have an important therapeutic role, the amount of heating depends upon the intensity and frequency of ultrasound. This study was carried out to evaluate the effect of alterations in intensity and frequency of therapeutic ultrasound on chromosome aberrations in human peripheral blood lymphocytes.Methods: This study which was a longitudinal and semi experimental one, was carried out in vivo condition as pre and post treatment. Twenty individuals were selected nonrandomly out of the patients referring to the physiotherapy unit. The studied samples were provided into four stages of before the treatment, the end of the fifth session, the end of the tenth session and a week after the end of the treatment, respectively. The treatment was carried out using ultrasound waves in different intensities and frequencies and the results obtained before the treatment were compared with three stages after the treatment. The results were analyzed by Wilcoxon and Friedman statistical tests.Results: The mean of the total number of chromosome aberrations at the first stage before exposure was 0.45 percent that in comparison comparing with the second stage after exposure it reached 1.62 percent (p=0.02), at the third stage to 3.23 percent (p=0.008) and at the fourth stage to 1.59 percent. A significant increase was observed between increase of ultrasound intensity and chromosomal aberrations frequency (p=0.002).Conclusion: It seems that exposure to therapeutic ultrasound waves with high intensities leads to an increase in the frequency of chromosome aberrations in the individuals undergoing exposure. However, increasing the frequency of these waves did not have significant effects on chromosome aberrations of the studied specimens.

Background & Objective: Preeclampsia is an unknown disease. It was seen in 3.7% of live births and it is the cause of mothers' death in 18%. In addition to complications for mothers, fetal damage has also been seen. Also we sought to consider predictors of neonatal outcome in women with preeclampsia and normal women.Methods: It is a prospective and cross-sectional study that was performed on 127 preeclampsia pregnant women and 254 normal pregnancies. Statistical analysis was performed by software SPSS/Win and was used X2 test for analysis of the results.Results: Prevalence of preterm labor was 54.4% in women with preeclampsia and 25% in normal pregnancy. There was no statistical difference such as parity (P=0.157), age (P=0.256) and type of delivery (P=0.226). There was a significant difference between two groups in gestational age (P<0.0001), birth weight (P<0.0001), neonatal mortality (P=0.013), neonatal Apgar score (P=0.005) and NICU admission (P<0.0001).Conclusion: It is clear that the difference between two groups is mainly because of preterm labor in preeclampsia group. Attention to exact control of illness and avoidance of making rash decision for terminating pregnancy in mild preeclampsia can improve outcomes of Neonates.

Background & Objective: Diabetes is one of diseases in which the main part of treatment depends on the patient's responsibility. Therefore their knowledge of the various aspects of nutrition has great importance. The aim of this study was to evaluate the effect of diabetic diet education on nutritional behaviors. FBS and BMI of patients with type II Diabetes mellitus in Iranian Diabetic Association.Methods: 88 type II diabetic patients from Iranian Diabetes Association (Karaj Branch) participated in this study. The Patients were randomly divided into two groups as experimental (44) and control group (44). Data were collected with a valid and reliable questionnaire (58questions) and checklist in two stage of before and one month after intervention.Results: After the intervention in the experimental group regarding diabetes and nutritional behaviors, there was a significant increase in mean score of knowledge (from 57.50 to 80.18) and a significant decrease in the mean of BMI (from 28.3 to 27.9) and in the mean of fasting blood sugar (from 167.9 to 134.5) (p<0.001). However, there was no significant change in the control group.Conclusion: The finding of this study indicated the efficacy of education on FBS and BMI in patients with type II diabetes.

Background & Objective: Obsessive-compulsive disorder is a common disease in psychiatry which increases anxiety in approximately 2% of the world population. Recent reports suggest that OCD starts in menstruation, Pregnancy, post-partum periods which causes failure in women's quality of life. The aim of study was to determine the onset of (OCD) in fertile women.Methods: In a descriptive study in 2006, 53 women with DSM-IV were interviewed for obsessive disorder at psychiatry clinic of Fatemi hospital. A questionnaire including two parts on demographic information and 8 questions on the onset of obsessive disorder in menstruation, pregnancy, puerperium periods was completed. Data were analyzed through SPSS.Results: In 3.8%, the onset of obsessive disorder was with the first menstruation period. In 12.5% it was during pregnancy. In 57.1% (4) of obsessive samples onset of obsessive was in second pregnancy. In 16.24% onset of OCD was after delivery. In 28.8% it was after first delivery and 30% after first delivery had affective disorders.Conclusion: The menstruation, pregnancy, post partum may be a periods of risk for recurrence or onset of obsessive compulsive disorder and women should be taken care of more in order to avoid disorders like depression. Midwife clinicians caring for women need to be aware of the impact of these symptoms and attention for mental health in women.

Background & Objective: Yersinia spp is from Enterobacteriacea family. The members of this group are all gram negative bacilli or cocobacili and non-spore and negative hemeoxidase which casuses a vast spectrum of diseases in humans the commonest one of which is gastroenteritis. Other diseases and clinical syndromes are septicemia, mesenteric lymphadenitis, Appendicitis, pharyngitis and rarely Reiter's syndrome. Due to frequent reports of febrile gastro-enteritis from Health centers of Ardebil, the probability of gastroenteritis resulted from Yersinia in this cold province is predictable. Thus this study was done to determine the role of Yersinia spp in the diarrhea of children under 5 in the cold seasons of the year in Ardebil.Methods: Stool samples from 490 children under 5 with diarrhea in a 7-month period were collected, and transferred in carry-Blair to the laboratory. Stool samples were cultured on Mac-Conkey agar and Salmonella-Shigella agar and Yersinia selective agar, TCBS agar and selenate agar. After adequate incubation, the growing colonies were identified according to the standard biochemical methods.Results: of 490 samples, only 405 were suitable to be cultured of which 9.38% pathogenic bacteria were isolated. The frequency distribution of the separated bacteria were as follows Y.enterocolitica, 13 species; vibrio, 11 species; Enteropathogenic E.coli, 6 species; Salmonella, 5 species; Shigella, 2 species and plesiomonas, one species.Conclusion: The findings of this study are the indicator of the role of Yersinia spp in diarrhea in the cold seasons of the year in the cold and mountainous province of Ardebil. On the other hand, the frequency of isolated vibria was due to simultaneous cholera epidemy in this area.

Background & Objective: Electrocardiography is a useful method in predicting coronary artery occlusion site, left ventricular function and the prognosis of patients with acute myocardial infarction. Accurate localization of coronary artery occlusion and the extent of ischemic area are very important in decision making for invasive procedures to restore coronary perfusion.Methods: In this prospective study the abnormal findings of first recorded electrocardiogram in 100 patients with acute myocardial infarction were compared with coronary angiography findings and the value of ST-T changes in predicting coronary artery occlusion site was evaluated.Results: In acute anterior wall infarction, ST elevation in aVR (p=0.001), right bundle branch block (p=0.001) and ST depression in V5 strongly predicts LAD occlusion at its proximal part. Also ST depression, especially equal or more than 1 mm, in inferior leads indicates proximal LAD occlusion. The absence of such ST depression in these inferior leads correlates with distal LAD occlusion (p=0.01). ST depression of aVL also is a sign of distal LAD occlusion (p=0.01). In acute inferior wall infarction ³ 1 mm ST depression in leads I, aVL and greater ST elevation in lead III than lead II refers to RCA involvement.Conclusion: In acute anterior myocardial infarction electrocardiography can help to differentiate proximal LAD lesion from its distal involvement. Also it is useful in determining the culprit vessel in acute inferior wall infarction and helps to recognize high risk patients with major benefit from invasive reperfusion strategies.

Background & Objective: Limited information is available on adolescent’s substance abuse in Iran. The aim of this study is to estimate prevalence of substance abuse among the sample of sophomore male students in Tabriz city, and to evaluate the associated factors.Methods: Of all sophomore male students in Tabriz, 1785 (13.7%) were randomly sampled, and a self-administered questionnaire with 48 questions was distributed to students in February and March 2005. The questions aimed to obtain information on substance abuse, smoking, self-confidence, tendency toward smoking and risk-taking behaviors as well as demographic information. The influence of different factors on substance abuse was evaluated with a logistic regression model.Results: The mean age of the subjects was 16.3±0.87 (min. 15, max. 19) years. Among 1785 students 226 (12.7%) had the experience of taking alcohol and 36 (2.0%) had used substances.The results indicate that, older age (OR=1.55), having general risk taking behavior (OR=1.70), higher smoking stage (OR=3.70), having masochism (OR=1.22), high socioeconomic class (OR=1.62), and use of illicit substances (OR=5.72) were factors associated with prevalence of the use of alcohol. Also higher smoking stage (OR=3.26), high socioeconomic class (OR=1.52), and the use of alcohol (OR=7.81) were factors associated with prevalence of the use of substances.Conclusion: This study showed the low prevalence of substance abuse, and determined some of its risk factors among students. This study may be supportive of interventions that target multiple behaviors. The findings of this study are important for public health officials however, more studies are necessary to generalize the findings.

Background & Objective: Herbal medicine has an old history with a broad application all over the world. Many researches have focused on the curative as well as antinociceptive effects of herbal extracts. In the previous study the analgesic effect of Chamomile extract containing 2 mg/kg essence in Rats which revealed a significant analgesic effect were studied.In this study it is planned to compare the analgesic effect of chamomile extract and Morphine (as a standard analgesic) in mice.Methods: This experimental study was carried out in Shahid Sadughi Medical School on 48 Syrian mice (25-30 grams) which were randomly divided into 8 groups. In this study the analgesic effect of intraperitoneal administration of Chamomile extract containing 2 mg/kg essence and different doses of Morphine (0.5, 1.0 and 2.0 mg/kg) were assessed by using Formalin Test (for chronic pain during 1 hr. post Formalin injection) and Tail Flick Test (for acute pain during 2 hr. post drug administration in 15 min. time intervals).Results: The results of this study showed that 2nd phase of Formalin Test had more analgesic effect than that of 0.5 mg/kg morphine. In the case of Tail Flick Test its analgesic effect was prominent 30-90 min. after drug administration which was identical to the analgesic effect of 1.0 and 0.5 mg/kg Morphine Sulfate (P>0.05).Conclusion: Data from this study confirms the analgesic effect of chamomile essence which was indicated in our previous study and that this analgesic effect is comparable with 1 mg/kg of morphine sulfate in both the Formalin TEST & Tail Flick TEST. Chamomile as an analgesic should be studied more in different studies.

Background & Objective: Depot-medroxyprogesterone acetate (DMPA) is an injectable contraceptive method that is widely used by 68 million women in over 114 countries and was reported Different medical and non medical reasons were reported for discontinuation of DMPA use. Due to little information about continuation rate and reasons for discontinuations of DMPA in this region and because of the different result of the research in other countries this study was designed. to evaluate the use of DMPA including continuation rate and side effects.Methods: In this cross sectional retrospective study 396 DMPA user women referring to health care centers in Ardabil were selected through classified sampling. The data were collected by a questionnaire by interviewing the subjects and data were analyzed by SPSS software using analysis variance (ANOVA) and correlation and T-test.Results: The mean age of the study population was 32±7.8 years, 33.8% had primary education and the majority of the users were housewives (%95) and only20 (%5) were employed. 6, 9, 12 and 24 month cumulative continuation rate of DMPA were recorded as %44.5, %26.5, %18.2 and %2.3 respectively. The most common reason for discontinuation among all of groups was amenorrhea. The most common side effects were amenorrhea (%69.7), low back pain (%13.4), and weight gain (%13.4) and headache (%10.4). There was a significant corvelation between education level and spouse's education level, spouse's job, family income, grariding, number of off spring, type of previous delivery and continuity of DMPA (p<0.05).Conclusion: The result of this study could help health authorities and care givers in term of correct counseling and follow up. This factor could result in more satisfaction and improve continuation rate of DMPA.