Hormozgan Medical Journal
Year:2006 | Volume:10 | Issue:2|Papers Count:18

Introduction: Malaria is a public health problem for approximately 2.4 billion people, 40% of the world’s population, particularly in the tropical and subtropical countries. Countries in Asia, and Latin America, the islands of the South, West, and central Pacific Ocean are all affected. Drug resistance is the greatest challenge in combating against malaria. Drug resistance in malaria is now widespread and increasingly has sophisticated the treatment in many parts of the world. This review study was conducted to determine the present situation of malaria drug resistance.Chloriquine, the most valuable antimalaria, has been the drug of choice for treatment of malaria all over the country almost for half a century. It is well absorbed, well tolerated, and inexpensive. However, the first report of chloroquine-resistant flaciparum malaria was published by Edrissian two decades ago. Consequently, mosquitoes of the Anopheles species spread the drug resistant parasite strians throughout the malarious areas of Iran. As a result, both prevalence and intensification of resistance has increased. Recent study has located several mutated genes responsible for plasmodium falciparum resistance to chloroquine and sulfadoxine/pyrimethamine combination. Application of genetic information for early detection of resistance foci and further monitoring of drug resistant malaria is a useful epidemiological tool in comparison with traditional methods. There is much to be done in the research of malaria and its treatment.Conclusion: Education on the prevention of malaria is greatly needed. Treatment of malaria with a single drug should no longer be regarded as ethical. Combination of two antimalarial with independednt mode of action should replace the conventional treatment. Although, recently combination of chloroquine and fansidar has been introduced as the first line treatment in falciparum malaria, nevertheless experiences in other countries reveal that such a combination is not suitable. It is highly suggested that the present first line drug should switch to the newly formulated antimalarials, i.e. artesunate, a derivative of artemisinine, not only is able to diminish the problem, but also due to its brilliant therapeutic efficacy, resolves the patient’s symptoms rapidly and prevents treatment failures as well. Furthermore, gametocyte rate will decrease too.

Introduction: Malaria has continued to be a public health problem in Bandar Abbas with a morbidity of 1093-5672 cases during last decades. Several years study on malaria cases showed differences in the disease epidemic curve in different parts of Bandar Abbas district. Therefore, this study was conducted to determine the malaria situation during 1998-2002, to find the probable effective factors on the disease and to obtain the last data to use in malaria control program.Methods: In this descriptive cross-sectional survey, ecological, geographical and demographic aspects of malaria disease were studied. Malaria data and is probable effective factors such as epidemiological indices, monitoring, treatment, amount of insecticides used in the malaria control program, living in urban or rural area, using electricity power, changes in the weather conditions, etc were obtained from Bandar Abbas public health center and its related urban and rural stations during 1998-2002. For data analysis, SPSS and EPI-info statistical software's were used.Results: Bandar Abbas district with Annual Parasite Incidence (API) of 1.7-4.2 per 1000 population had a specific condition and involved 4.1-7.9% of total positive malaria cases in Iran during 1998-2002. The most and least cases occurred during 1998 and 2001, respectively. While during the period of this study 6905 positive malaria cases were reported. The number of villages with positive cases dropped from 102 in 1998 to 55 in 2001.Conclusion: The disease situation indicates a hypoendemic and unstable area. Considering new wave of immigrants from different countries and chance of disease outbreak after heavy precipitation, it should be concered as a suitable biological condition for anopheles mosquito's maturation. As the district has emigrants from different countries, it must always be kept in mind the danger of malaria epidemies.

Introduction: Overweight and obesity are risk factors for developing many diseases such as hypertension. Furthermore, obesity indicators such as abdominal height, waist circumference and hip circumference can independently and sometimes more severely lead to blood pressure changes. The objective of this study was to evaluate the association between blood pressure changes and anthropometric indices in over-18 residents of Bandar Abbas.Methods: The survey is a population- based cross sectional study in which one percent (2087 subjects were) population of Bandar Abbas residents were included by multi-phase random sampling. Anotrophometric, demographic and blood pressure data was gathered by door-to-door visit in 2 morning and afternoon shifts via interviewing and measurement. Data were analyzed by S-plus and SPSS software's and statistical methods including cumulative distribution, one-way analysis of variance, t distribution and Pearson correlation tests.Results: 67% of total sample size was women and 32.7% were men. The frequency of women and men with normal body mass index (BMI) were 599 (42.8%) and 358 (52.5%) respectively. The starting point of meaningful and crescendo changes in blood pressure was in higher levels of overweight (BMI>29.9).Conclusion: Age-controlled anthropometric indices have positive and meaningful correlation with blood pressure changes in both sexes. Men were more vulnerable than women considering BMI changes and its relationship with blood pressure. It is generally recommended to consider weight control and body fitness for hypertension prevention in both sexes.

Introduction: QT dispersion (QT Max – QT min) reflects inhomogeneous ventricular depolarization that may provide a substrate for serious arrythmias and is associated with adverse clinical outcomes in patients with coronary artery disease. Some studies have shown reduction in QT dispersion after successful angioplasty due to coronary reperfusion, but effect of coronary artery bypass grafting on QTd is less known. This study evaluated the effects of coronary artery bypass grafting (CABG) on QT dispersion in first days after surgery.Methods: In this descriptive cross-sectional study, QTd of 50 patients who underwent coronary artery bypass grafting were calculated pre-and post-surgery This measurement was performed after surgery on three occasions (first day, third day and predischarge) in patients without serious or malignant arrythmias.Results: QTd & QTcd (mean SD) decreased in third postoperative day compared to preoperation values. QTd and QTcd decreased from 62.9 (26.9), and 64.8 (28.08) to 43.1 (22.8) and 59.4 (29.9) respectively (P<0.005 and P<0.03) in the third day after surgery comparing to presurgery. The decrements were more significant between predischarge and preoperation: QTd decreased from 62.2(26.9) to 41.6(24.16) and QTcd decreased from 71.7(32.47) to 51.5(27.69) (P<0.001).Conclusion: CABG, the most comprehensive method of revascularization in patients with coronary artery disease, is an important factor in reducing QT dispersion and eventually reducing malignat ventricular arrhythmia after surgery.

Introduction: Invagination is the most common cause of acute abdomen and the second common cause of intestinal obstruction in the children under the age of two years, and the delay in diagnosis and treatment can be dangerous and even fatal. The aim of this study is to estimate the exact value of the diagnostic clinical and radiological findings in order to speed up the diagnosis of this emergency issue.Methods: This cross-sectional study was performed on 160 patients diagnosed with invagination. After collecting the data, sensitivity, specificity and the positive and negative predictive values of clinical and radiological findings were calculated using SPSS software.Results: 63.1% of the patients were boys and most of cases were 10-50 months old. In 21.9% of the patients, three major clinical findings (triad) existed simultaneously: colicky abdominal pain, abdominal mass, currant-jelly stool. Ultrasonography and barium enema had the diagnostic sensitivity of: 69.3, 87.9, 91.4, 83.3 and 94.4 percent, specificity of 20, 39.2, 45.6, 27.7 and 88.9 percent, positive predictive value of 85.8, 45.1, 56.6, 87.6, and 97.1 percent, and also negative predictive value of 8.5, 85.1, 87.2, 65.3 and 80 percent, respectively.Conclusion: Our study showed that in contrast to other world centers, the usage of barium enema was more frequent and of less curative value. Furthermore, in this study ultrasonography has not been used for all patients and its diagnostic value has been less than barium enema. Considering the important role of ultrasonography in diagnosing and treating the disease in recent years, training residents and specialists of radiology and even other specialties of medicine (such as pediatrics and surgery) is a necessity.

Introduction: Considering the higher incidence of atherosclerosis and cardiovascular disorders in diabetes mellitus and the role of vasorelaxation disturbance in the development of these complications, this study was conducted to evaluate the effect of two-month oral administration of Marrubium vulgare (MV) on the vasorelaxation response of isolated aorta in experimental model of diabetes mellitus in rats.Methods: In this experimental study, 32 male Wistar rats were randomly divided into four groups: control, MV-treated control, diabetic, and MV-treated diabetic groups. For induction of diabetes, streptozotcin (STZ) was intraperitoneally administered (60mg/kg). MV-treated groups received MV mixed with standard pelleted food at a weight ratio of 1/15. After 2 months, relaxation response of KCI-and noradrenaline-precontracted aortic rings was determined after addition of acetylcholine using isolated tissue setup.Results: Comparing to one week before test serum glucose level showed a significant increase in diabetic group at 4th and 8th weeks (P<0.001), while this increase was not observed in MV-treated diabetic group. In addition, the latter group showed a higher vasorelaxation in KCI-and noradrenaline-precontracted rings (P<0.05) as compared to diabetic group. Meanwhile, there was no significant difference between control and MV-treated control groups regarding relaxation response.Conclusion: It can be concluded that oral administration of MV for 2 months could improve the vasorelaxation response of the vascular system and this may prevent the development of hypertension in diabetic rats.

Introduction: peganum harmala L. (Zygophyllaceae) and varthemia persica DC (Compositeae) were used for co-culture studies. P.harmala was found to be one of the richest natural sources of b-carboline alkaloids. b-carboline alkaloids posses different neuropharmacologic activities including BDZ antagonism, MAOinhibitor and aminoreuptake inhibitor.The production of b-carboline alkaloids in cell suspension culture of these two plants may be increased by various factors including co-culture.Methods: In this experimental study, P.harmala seeds surface were sterilized and transferred under aseptic condition to the Petri dishes to produce seedlings. Callus cultures were established from seedling and cell suspension cultures were obtained from callus. The cultures were established in Murashige and Skoog media supplemented with sucrose and growth regulators.Co-culture of two plants was established by using different ratio of each culture. Methanol extract of cultured cells was prepared. The harmin harmalol and harmol were extracted and identified by TLC. The quantity of alkaloids was determined using U.V sepectorphotometer.Results: Harmin, harmalol and harmol were produced in all samples. The highest concentration of alkaloids was found in the termination phase of growth cycle. The co-culture of P.harmala and V.persica cell suspension at the ratio of 1:1 produced more alkaloids comparing to P.harmala cell suspension.Conclusion: V. Persica cell suspension seems to influence b-carboline alkaloid production in P.harmala cultures. Total b-carboline alkaloid production increase parallel to growth cycle.

Introduction: Besides from dermal route, recently vertical transmission of hepatitis C has been a matter of investigation and the risk of transmission is evaluated. The aim of this study was to determine the risk of mother-to-infant vertical transmission of hepatitis C.Methods: In this descriptive study, over a period of 2 years, between Aug. 1998 and Jun. 2000, two thousands pregnant women were examined in the obstetric department of Shiraz University of Medical Sciences. The patients underwent serologic study to screen the presence of antibody to hepatitic C, hepatitis B and HIV infection.Clinicolabaratory tests were also scheduled for offsprings of HCV-Ab positive mothers at birth, 6 and 12 months later. Results were presented using descriptive methods.Results: Twelve (0.6%) of the 2000 women were found to be positive for HCV antibody. In two (16%) of them, positive history of jaundice was recognized, 3 (25%) patients had positive history of hepatitis in their families, 2 (16%) patients had blood transfusion, 4 (33%) patients had dental procedures and 2 (16%) patients had history of major operation in the previous years. Serologic screening tests for antibodies to HIV and hepatitis B surface antigen were negative. All of 12 women had normal liver function test during pregnancy and after delivery, the offsprings of these anti-HCV positive mothers were screened for HCV infection at birth and 6 and 12 months after birth. All of babies were positive for HCV antibody at birth but became negative at 6 and 12 months of age. Liver function tests were within normal range during this period.Conclusion: Vertical transmission of hepatitis C is uncommon and anti-HCV antibody is most likely to be acquired passively in uterus and is eliminated by the age 6 months. No endogenous anti-HCV antibody production was detected at 12 months of age.

Introduction: Epstein – Barr virus (EBV) is a herpesvirus which establishes a persistent life-long infection in over 95% of adults world wide. Infection is usually asymptomatic but the virus is associated with a variety of disease, including nasopharyngeal carcinoma (NPC), Burkitt’s lymphoma (BL), Multiple sclerosis MS, EBV-associated B-cell lymphoproliferative disease (BLPD), Hodgkin and non-Hodgkin lymphoma in the immunocompromised host, particularly organ transplant recipients.Our study focuses on seroepidemiology of EBV infection in asymptomatic healthy students of Islamic Azad University of Kazeroon.Methods: In our descriptive study, the study group comprised 90 asymptomatic volunteer students. All of them were at the age of 20-25 and selected randomly. At the beginning, demographic data were recorded. For serological studies, 5ml of blood sample was collected and the sera were isolated by centrifugation. For heterophile antibody detection, monospot test was performed on the sera by hemagglutination. Linkewise, ELISA was used to detect IgM and IgG antibodies titer to EBV capsid antigen (VCA) and IgG titer to the EB unclear antigen (EBNA) and early antigen (EA) ELISA results were recorded at 450mm optical density (OD). Finally the results were analysed by statistical methods.Results: Overall, EBV antibody was positive in 80 person (88.9%) out of 90 subjects and they had a previous infection. VCA, EBNA and EA IgG antibodies were detected in 79 (87.8%), 80(88.9%) and in 2(2.2%) samples out of 90 subjects respectively. VCA IgG antibody was determind only in one (1.1%) sample and monospot test was positive in 4(4.4%) samples out of 90 sera. EBV antibody was not identified in 10 (11.1%) subjects. Also we didn’t find any significant relationship between students with different sex, field of study, place of residence and viral infection rate.Conclusion: The overall incidence of EBV infection in this study was 88.9% which is close to the observations in other studies on healthy individuals specially in underdeveloped countries.

Introduction: Application of insecticidal baits is one of the most common and effective strategies for controlling German cockroach, (Blattella germanica L.) The current study was designed to investigate the susceptibility level of German cockroach to fipronil and imidacloprid gel baits in laboratory situation and to recommend its usage in Iran.Methods: This experimental study was conducted on eight German cockroach strains. Tests were conducted on newly emerged adult males (Ultimately 3 weeks old). Adult male German cockroachs starved for 12 hours, and then ingested fipronil and imidacloprid gel baits for 2 hours. After given time was over, we removed the bait and replaced it with mice foods. Mortality was recorded at 12 intervals for 6 days. Data were pooled and assessed by probit regression analysis.Results: Feeding assays revealed that in all strains mortality rate after 2 hours ingestion of fipronil and imidacloprid gel baits for 144 hours (6 days) was 100%. In all strains more than 60% mortality in imidacloprid ingested gel bait after 24 hours and 100% mortality (except Shahmorady and Zanjan dormitory strains) after 48 hours was observed. Whereas, in some strains 10-30% mortality in fipronil ingested gel bait was seen and in some strains no mortality after 24 hours while most of them had a rate of 60% mortality after 48 hours. These observations indicate that the imidacloprid gel bait operates faster than the fipronil gel bait as is expected. The susceptible strain showed LT50 of 47.13 and 11.31 h for fipronil and imidacloprid gel baits, respectively. The result of this investigation indicated that all feral strains are susceptible to fipronil and imidacloprid gel baits.Conclusion: Considerins the ever-increasing infestation of human habitations with German cockroach, and its resistance to conventional insecticides (esp. pyrethroides), its intensity in the future. is increasingly growing Toxic fipronil bait can be an appropriate substitute for controlling this hygiene pest in Iran.

Introduction: The accreditation information management (IM) standards by affecting various aspects of the EHR have a strong impact on the adoption of the EHR systems. Regarding this importance, conducting a comparative study related to IM standards in pioneer countries can facilitate a standardization movement for developing IM standards and reviewing medical records standards in our country.Methods: This is a comparative-descriptive study in which the IM standards for the national accreditation agencies of Canada (CCHSA), USA (JCAHO) and New Zealand (QHNZ) were collected and investigated through the internet, and e-mail.Results: The finding of the study revealed that adopted IM standards in these countries focus on the timely entry, defining the time frame within which record must be completed, standardized methods of defining, coding, classifying, gathering data from various sources, linking and combining different types of information from outside and inside the organization and confidentiality. Conclusion: Generally, all agencies relying upon IM standards, not only improve information management processes, medical records and ensuring health care quality, but also provide a basis for reinforcement of health information systems and EHR. Because information management processes and medical records in our country have many shortcomings and deficiencies, a standardization movement in order to develop IM standards and reviewing medical records standards regarding to EHR is a necessity.

Introduction: Based on a legislation which was decreed by Islamic republic of Iran parlement (Majles) in 1990, ministry of health and medical education was obliged to promote medical education of all who are responsible in medical and health services. So all general practitioners require continuing medical education (CME) for recertification or additional qualification of their office.Methods: This descriptive study was conducted in Bandar Abbas city to provide insight of general practioners about CME programmes. Study population was selected among general practioners that had private office. They compeleted a predesigned questionnaire and the result were analyzed using minitab statistical software.Results: Based on the results, 68.5% of general had enough knowledge of CME, 94.5% had participated in CME programme, 67% belived that CME increases quality of their clinical skills and internal medicine topics were considered most important among other topics of medicine such as surgery, ophthalmology, etc.Conclusion: General practitioners in Bandar Abbas have enough knowledge about the aim of the programme and most of them support the authorities for making it mandatory. A majority of general practitioners consider CME a programme which increase their motivation and improve standards.

Introduction: Breaking bad news to patients is one of the physician’s most difficult duties. Yet medical education typically offers little formal preparation for this difficult task. Previous studies showed patients generally desire frank and empathetic disclosure of serious illnesses and bad news. In this study we study how physicians of Kerman University of medical sciences break bad news to their patients.Methods: In this descriptive study, a questionnaire including demographic data, questions regarding information about how physicians give bad news and the emotional support that they provide to patients and questions addressing the environmental aspects of giving bad news in the office was sent to 75 randomly selected physicians. After assessing the validity and reliability of questions, questionnaire was given to physicians and the results were analyzed using descriptive statistics. Results: Of 75 questionnaires, 44 were returned. The responding physicians were 29 men and 15 women with mean age of 39.08±8.61 and 8.21±6.59 year's duration of practice respectively. They are more concerned about emotional support than environmental support when they gave bad news to their patients. There were no statistical relationships between physician's scores of emotional and environmental support during breaking bad news and their sex, marital status and duration of their practice.Conclusion: Without proper training the discomfort and uncertainty associated with breaking bad news may lead physicians to emotionally disengage from patients. Providing undergraduate and postgraduate education could help physicians to do better in hard situations of breaking bad news.

Introduction: Clinical skill education is a principal part of medical education which is not usually organized and systematized. Providing information is helpful in future programming and decision-making. This survey was conducted on medical students to study the evaluation methods used for clinical courses of Hormozgan University of Medical Science (HUMS).Methods: This cross-sectional study was based on the opinion poll of 102 medical students of HUMS in 2003. The survey consisted of 10-item questionnaire designed to evaluate preliminary information, general, assessment method, type of exams and the effect of other person’s viewpoints on clinical skill evaluation which was distributed among students at the beginning of a clinical course and collected at its end. The results are presented by Epi-info 2000 software in a descriptive format.Results: Being punctual and answering oral questions was almost gradually evaluated according to student’s opinion (49% and 39.2%, respectively). Most students (81%) believe that scientific exam allocates less than 25% of evaluation grades, and some (70%) think that other people’s opinion (excluding the faculty) is completely ineffective in evaluation. Most of the students believed their evaluation best represented their clinical reasoning skill, while other skills such as communication with patient or physical examination and emergency procedures were least reflected in their evaluation.Conclusion: The greater role of subjective assessments including teacher’s opinion on student evaluation and fewer objective methods applied for evaluation of clinical skills has let to the suggestion that a curriculum revision and introduction of more objective methods such as OSCE, logbooks or portfolios is necessary.

Introduction: The childhood histiocytoses are a grouped of rare disorders in which they have in common a prominent accumulation of cells of the monocytemacrophage system of bone marrow origin.Three classes of disease are recognized. Some of them have benign and others malignant courses. They have variable presentations rangin from a solitary lesion of bone to a multisystem disorder. Skeleton is the most common system involved. Tissue biopsy is diagnostic and after that a thorough clinical and laboratory evaluation should be undertaken. In single system disease, treatment is generally curettage or local radiation while chemotherapy is used for multisystem involvement.Case report: We present a 2-years-old boy from Qeshm Island with chief complaint of skin lesions. The parents had noticed a bony defect in right frontal 10 months prior to admission, but as they thought it is due to blunt trauma, they didn’t seek medical care.Conclusion: The diagnosis is based on tissue biopsy and then completes clinical and laboratory investigations. Young age and multisystem involvement have poor prognosis.