Internal Medicine Today
Year:2010 | Volume:16 | Issue:1 (47)|Papers Count:11

Background and Aim: Electroconvulsive Therapy (ECT) is one of the less dangerous treatments for psychological disorders and the best one which receives much consideration in psychiatry today; and it is also performed under general anesthesia. Because sodium thiopental and propofol are the most common drugs used for this purpose, in this study we compared sodium thiopental and propofol for convulsion time and recovery duration in ECT.Materials and Methods: In this semi-experimental study, 26 subjects were divided into two groups randomly. In one group propofol was used and in the other one sodium thiopental for induction, but muscle relaxation and premedication were the same for both groups. The subjects were monitored for blood pressure and cardiovascular response, and after ECT the time of convulsion and recovery was recorded. Blood pressure and heart rate of patients were checked and recorded before anesthesia, one and five minutes after ECT. The data were analyzed through SPSS software, version 11.5, applying independent t-test (p<0.1).Results: The mean of convulsion duration was 34.4±6.3 minutes in propofol group and 41.7±9.7 in thiopental group which showed that there was a significant difference between the groups (p=0.003).The mean of recovery duration in propofol group was less than that of thiopental group which indicated that there was a significant difference (p=0.09). Also, the mean of blood pressure in propofol group was less than that of thiopental group, a difference which was statistically significant (p<0.1).Conclusion: The results of this study showed that ECT with propofol causes a faster recovery and reduces the occurrence of homodynamic changes. Therefore, it is suitable to use propofol instead of sodium thiopental for ECT especially in patients with high blood pressure.

Background and Aim: Previous studies have demonstrated that lead exposure has destructive effects on some body systems. Lead, as a heavy metal, may produce variety of toxicity effects on endothelial cells lining luminal surface of the vascular system. Any changes or damages to endothelial cells may lead to cardiovascular diseases especially formation of atherosclerotic plaques. The aim of this study was to determine the effect of lead exposure on endothelium in the aorta and left coronary vessels in male rabbits.Materials and Methods: Twenty white male rabbits (weighing 1.8-2 kg, and 4 months old) were obtained and divided randomly into a control group of nine and an experimental group of eleven. Both experimental and control groups were fed with a normal diet. The experimental group was given leaded water (547 ppm) and the control group was given unleaded water for 40 days. After treatment, all the rabbits were sacrificed and their thoracic aorta and left coronary artery were removed and processed according to routine histological methods. Formalin fixed paraffin embedded and 5mm thickness sections were deparaffinized, rehydrated and stained with heamatoxilin-eosin and were then photographed.Results: The results showed that lead can create pathological changes in endothelium of aorta and left coronary artery including disruption of endothelial cells, blood cells adhesion and aggregation on inner surface of mentioned vessels.Conclusion: According to our findings, lead can cause morphological changes in endothelium. Thus, lead exposure may result in endothelial dysfunction, atherogenesis and cardiovascular pathogenesis.

Background and Aim: Knee osteoarthritis is one of the most common disabilities and has caused a lot of limitations in human. There are many methods proposed for its treatment. The aim of this study was to assess the effect of grade one mobilization of patellofemoral joint on reducing the pain and joint stiffness and improving the physical function in knee osteoarthritis patients.Materials and Methods: This study was one side blind clinical trial which was carried out in physical therapy department of Sarcheshmeh copper town polyclinic. The patients were selected randomly. Outcome instrument was WOMAC index (sum of data resulted from WOMAC questionnaire form) and measurements were done before and after treatment nearly one week after final treatment session. 30 patients with diagnosis of knee osteoarthritis, grade two or three, were divided into 3 groups randomly: Group 1: Mobilization+Exercise therapy, Group 2: Exercise therapy and Group 3: Mobilization. The ultrasound with the intensity below 0.2 w/cm2 in three minutes was used for all groups as placebo. The duration of treatment was 10 sessions for 3 weeks. To analyze the data, nonparametric tests were used at the significance level of 0.05.Results: In group one, WOMAC index decreased from 61.5+9.69 before treatment to 49.7+11.88 after treatment (P=0.005). In group two, WOMAC index decreased from 56.7+17.24 before treatment to 45.2+19.90 after treatment (p=0.022), and in group three, WOMAC index decreased from 59.6+16.51 before treatment to 47.7+19.72 after treatment (p=0.059). The difference of WOMAC index at the follow-up session, in comparison with the one before treatment, was significant only in group one which decreased to 50.1+11.73 (p=0.005).Conclusion: This study showed that grade 1 mobilization of patellofemoral joint can cause the effect of exercise therapy on reducing the pain and joint stiffness and improving the physical function in patients with grade 2 or 3 knee osteoarthritis continue at least for about one week.

Background and Aim: The epidemic of HIV/AIDS is a well-recognized global phenomenon and the most serious of infectious disease challenges to public health. The number of people living with HIV (PLWH) has increased in all Asian regions, including Iran. It can damage all physical, social, spiritual, psychological and financial aspects of human function. The present research was designed and conducted to better understand the interactions of people living with HIV/AIDS.Materials and Methods: This qualitative study was conducted using an interpretative phenomenological approach. In-depth, audio-taped and semi-structured interviews with 19 participants were used to collect data. Questions were open-ended and largely discovery-oriented. Interviews were audio-taped and transcriptions were analyzed to highlight the participants’ life experiences. Observations were also recorded in comprehensive field notes. A hermeneutic approach was used to analyze the data.Results: According to the findings, 19 participants were between 21 and 56 years of age; 24.1% single, 47.4% had CD4 counts under 200 cells/mm3 and others with earlier phase of HIV infection. Four main themes emerged: (a) beliefs (b) supportive tent, (c) different behaviors and (d) mutual reactions, including some sub-themes.Conclusions: Other people's behaviors are understood differently for PLWH in such a way that some behaviors are threatening. Other negative behaviors in some aspects have been accepted and most of them have had negative impacts on their reactions. Therefore, people with HIV/AIDS diagnosis face many challenges. Improving the level of awareness and others' attitudes and strengthening appropriate interaction are suggested.

Background and Aim: Growth charts are widely used to assess children’s growth status and can provide a trajectory of growth during early important months of life. The objectives of this study were to construct centile reference charts for height-for-age for children aged 25 to 60 months and compare the results with the WHO reference.Materials and Methods: A total of 23644 apparently healthy boys and girls aged 25 to 60 months were recruited in July 2004 for 20 days from those attending community clinics for routine health checks. Anthropometric measurements were done by trained health staff using WHO methodology.The LMSP method with maximum penalized likelihood, the Generalized Additive Models, the BCPE distribution, the AIC and GAIC (3) criterion, and Worm plot and Q-tests as goodness of fit tests were used to construct the centile reference charts.Results: The height-for-age percentile curves for boys and girls aged from 25 to 60 months were derived utilizing a population of children living in the northeast of Iran. Among all age groups from 25 to 60 months, the median values of children living in the northeast of Iran were lower than the corresponding values in WHO reference data. The height curves of boys were higher than those of girls in all age groups.Conclusion: Significant differences between growth patterns of children living in the northeast of Iran versus international ones necessitate using local and regional standards and growth charts. International norms may not properly recognize the populations at risk for growth problems in Iranian children; therefore, they may be misleading for our healthcare system.

Background and Aim: With attention to the high prevalence of binocular vision anomalies, specially, convergence anomalies among university students which cause symptoms such as eye-strain, binocular vision symptoms, headache and problems in near daily activity, this study aims to assess the relationship between binocular vision symptoms and near point of convergence and jump convergence anomalies in students of Zahedan university of medical sciences.Materials and Methods: In this cross-sectional study, 181 students were selected randomly, and divided into symptomatic and asymptomatic groups. At first, refractive errors of individuals were determined by retinoscopy and corrected, if necessary. The convergence status was evaluated by near point of convergence and jump convergence. NPC, as the nearest point that subjects report diplopia, was determined using small isolated letter of approximately 20.30 (6.9) size from snellen reduced chart and jump convergence by two targets in different distances 15 and 50 cm along the median plane. The data were analyzed through SPSS software version15 using descriptive and analytical statistics of t-test, c2 and ROC curve.Results: From 181 students, 56 students (30.9%) were symptomatic and 125 (69.1%) asymptomatic. The means of near point of convergence in all subjects, symptomatic and asymptomatic ones, were 10.95, 15.20 and 9.05 cm, respectively. The normal patterns of jump convergence in all persons, persons with and without symptoms, were 72.4, 37.5 and 88 percent, respectively. In this study, a significant difference was found between NPC and symptoms (p<0.001) and symptoms and jump convergence (p=0.01).Conclusions: Abnormal near points of convergence and jump convergence can produce binocular vision symptoms; hence, the use of these two tests for evaluation of convergence status is necessary and if there is any functional abnormality, appropriate treatment options are selected. Often this problem can be easily managed by orthoptics.

Background and Aims: As the most common mental disorder, depression has a major role in the determination of an individual's mental health. In this respect, bereavement and losing spouse is one of the most important causes in developing depression. Thus, this research intends to study, first, the level of the depression among the martyrs’ widows in Tehran with the use of special depression scale for war martyr's widows whose psychometric dimensions have been studied by the authors and, then, to find out its relation with some other demographic variables.Materials and Methods: This is a descriptive study performed on 660 widows in Tehran. Participants completed a Special Depression Scale for War Martyr's Widows. The psychometric characteristics of the questionnaire were approved for using in Iranian Martyr's Widows population. Then, the collected data were analyzed with descriptive statistics and ANOVA.Results: The results showed that about 50% of participants got a score higher than mean in the scale which indicated that depression thought and feelings for Iranian martyrs’ widows were in a higher status. Depression scores had a significant relation with their income, education, residential status and their occupation. Marital status didn't have any significant effect on the level of depression in martyr's widows.Conclusion: The results showed a high level of depression in Tehran Martyr's Widows and that they were concerned about war related experiences and feelings. Having high income, higher education, a private house and occupation were associated with lower scores on Special Depression Scale for War Martyr's Widows. The results obtained have been discussed in this regard as well.

Background and Aims: Breastfeeding has the main role in the health of mothers and infants, and the instruction of mothers is essential in this context. This project aimed at comparing the effectiveness of instructional environment (Hospital versus Home) and other related factors to breastfeeding of mothers in hospital with home in Gonabad city.Material and Methods: In this quasi-experimental study, the research sample included 162 mothers who were admitted to 22 Bahman hospital of Gonabad, they were residents of Gonabad and were divided into two groups randomly. One group was instructed with instructional package of film in hospital and another group was instructed by the same package at home. The data were analyzed through SPSS software version 11.5 applying descriptive statistics, independent t-test and ANOVA at the 0.05 level of significance.Results: The results of this research showed that the highest percentage of research units constitute mothers who were 30-45 years of age (40.7%), were residents of the city (74.7%), had a personal house (75.9%) and had more than one child (55.6%). After instruction, there were significant statistical differences between the averages of total grades of breastfeeding function of mothers on the basis of location of residence (p<0.001), location of instruction (p=0.04), education (p=0.006) and age (p=0.01) so that breastfeeding function was better in mothers who were residents of the city, were instructed at home, had higher education and were older.Conclusion: The results showed that instructional package of WHO film at home had more effects on breastfeeding function of mothers in comparison to hospital setting. Mothers were more relaxed at home, complications after delivery decreased and the condition of learning was better.

Background and Aim: The results of laboratory tests have little practical utility unless clinical studies have ascribed various states of health and disease to intervals of values. Some factors affect hematologic values, including race, environment, time and test method, blood collection location, gestational age and maternal factors. Since these factors vary in various populations, they can cause differences in reference hematologic values.Material and Methods: In this study in 1387, 447 healthy neonates with more than 2500 gr, born in different hospitals of Mashhad, were selected and cord blood specimens were taken using EDTA anticoagulant. Complete blood count, hemoglobin, hematocrit, and RBC indices were measured by using sysmex cell counter. Differential leukocyte counts were determined in peripheral blood smear. The data were analyzed by SPSS software, version 11.50 for which p value£0.05 was significant.Results: Mean and hematologic reference ranges were determined as follows: WBC (×103ml)=11.62 (5.16-18.2), RBC (×106 ml)=4.45 (3.61-5.29), Hb (g/dl)=15.9 (13-18.8), Hct (%)=48.3 (39.6-56.9), MCV (fl)=108.7 (97.5-119.8), MCH (pg)=35.8 (31.7-40), MCHC (g/dl)=33 (30.1-35.2), RDW (%)=17.1 (14.1-20.3).Conclusion: We observed some differences in hematologic values in cord blood of neonates in comparison with other references which should be considered in clinical evaluations. Especially RBCs and hemoglobin were higher and MCV, WBC and absolute neutrophil count were lower.