ARAK MEDICAL UNIVERSITY JOURNAL (AMUJ)
Year:2007 | Volume:10 | Issue:2 (39)|Papers Count:17

Introduction: Clubfoot is one of the most common foot deformities in children. The initial treatment of clubfoot is nonsurgical. The success rate of this treatment is 5-80%. If clubfoot does not respond to this treatment, surgery is indicated. Surgical treatment of clubfoot has several complications. The preferred method of surgical release in textbooks is a modified Mc Kay procedure with Cincinnati incision but it may have various complications such necrosis, excessive scar, infection, dehiscence and recurrence. The purpose of this article is to investigate surgical treatment of clubfoot with two incision procedure instead of Cincinnati incision.Materials and Methods: In this descriptive study 50 children (81 feet) with clubfoot disease who did not respond to nonsurgical treatment, since 1999 until 2002, in Al-Zahra hospital was selected and underwent soft tissue release procedure by poster medial and lateral incisions. After operation they were followed for at least two years. Every six months patients were assessed for early postoperative complications, clinical and radiologic recurrence. Data was presented using descriptive statistics.Results: 74% of patients were male. Their mean age was 3.40.69. There was positive family history in 14% of patients. Clinical recurrence was seen in 6 patients, (9 feet) (5 male, one female) that all had bilateral involvement. The most common type of recurrence was metatarsus adducts. There was no skin necrosis or deep wound infection after surgery but 2 cases of superficial infection was seen which were treated by drugs.Conclusion: Regarding the excellent results of this procedure and obtained correction and the least skin complications in comparison to textbooks we suggest the two incision procedure instead of Cincinnati incision in treatment of most clubs foots.

Introduction: Candidiasis is the second common cause of vulvovaginitis. We evaluate the frequency of species of Candida in vaginal candidiasis.Materials and Methods: In this cross-sectional anaiythical study, 220 patients with ypic and nontypic signs and symptoms of vaginal Candidiasis were studied. Smear and culture were done. For positive culture, evaluation of germ tube, clamidospor production and carbohydrate assimilation and fermentation was done. Data was presented by descriptive statistics and analyzed using Chi square, Man-Whitney and Kolmogrov tests.Results: 40% of patients showed positive culture and smear. Frequancy of Candida Albicanse (42.03%), Dublininsis (29.5%), Glaberata (14.75%), Gilermondy (6.81%), Norvejensis (2.27%), Tropicalis (2.27%), and Kefayer (2.27%) were determined. There was no significant relationship between antibiotic and OCP consumption and type of identified Candida.Conclusion: Frequency of non Albicanse species is increasing. We suggest treatment based on culture and smear, because non Albicanse vaginitis usually is resistant to Azols.

Introduction: Nowadays drug abuse is an important problem in the world. Existing data show that using drugs especially pseudo-amphetamine compounds have increased and it seems necessary to determine the knowledge of high risk groups especially youths in this field .The aim of this study is to survey knowledge and attitude of students in Arak University of medical sciences based on Health Belief Model.Materials and Methods: This is a cross-sectional analythical study which was carried out on 100 students of medical, nursing- midway and pre-medical schools in 2006.This survey was done by completing a questionnaire including 53 questions base on health belief model. Data was analyzed using Chi square and Mann-Whitney U tests.Results: The mean age of samples was 22.3 (±3.18) years which 67 persons were female. The highest obtained score was related to perceived sensivity and had a meaningful relationship with action (p<0.05). Based on student's opinion of cues to action, TV was the most important resoure in education about Ecstasy.Conclusion: Biased on findings and regarding the meaningful relationship of perceived susceptibility (the danger of using Ecstasy) with action, it is better to provide educational program to prepare youngsters minds about perceived sensivity.

Introduction: Stress is a condition that causes tension, disturbance in body and mind, discomfort and dissatisfaction. There are differences between stresses in the form of great life events and small daily stressful events. Regarding extension and variation of stresses in different parts of country, this study aims to investigate the prevalence and severity of stresses in central areas of Iran.Materials and Methods: This is a cross-sectional analytical study carried out on 6000 people older than 19 years old, selected from urban and rural areas of Isfahan, Arak and Najaf Abad on 2002, as a part of evaluation of the Healthy Heart program. Sampling method was cluster random sampling. Data was collected using GHQ-12 and stressors' type and severity questionnaire. Statistical analysis was performed using Chi square.Results: Of the total subjects under study %50.6 were male, and %49.4 female, with a mean age of 40.47±15.68 and 40.25±15.15 years' respectively. The proportion of women with high GHQ score was higher than men, which was more pronounced in Arak than the two other cities. There were also higher stress levels in unmarried and urban people. (p £0.05)The most prevalent stressor included economical, social and job-related issues and the most severe were death, family related and economical events.Conclusion: This study on stress as an indicator of lifestyle reveals high stress levels in the population, which warrants appropriate planning and community-based interventions, to improve lifestyle and reduce stress.

Introduction: Use of medicinal plants for decreasing blood glucose and lipids to normal level is clinically important. In this respect, Silybum marianum (SM) is a plant that can lower lipid peroxidation and lipids in an experimental model of hyperlipidemia. Therefore, the effect of chronic oral administration of this plant on serum glucose, triglyceride, total cholesterol, and HDL and LDL cholesterol level of diabetic rats was investigated.Materials and Methods: In this experimental study, female rats (n=36) were randomly divided into 4 groups, including; control, SM-treated control, diabetic, and SM-treated diabetic groups. The treatment groups received oral administration of plant-mixed pelleted food (6.25%) for 4 weeks. Serum glucose, triglyceride, total cholesterol, LDL and HDL cholesterol levels were determined before the intervention, and at 2nd and 4th weeks after the intervention. Data was analyzed using repeated measure ANOVA, One way ANOVA, student and pairt T and Tukey tests.Results: Serum glucose level in diabetic group was increased in second and 4th weeks after the intervention as compared to one week before that (p<0.001) and SM treated diabetic rats only had a mild non-significant effect. In addition, triglyceride level in diabetic group increased 4 weeks after the intervention in comparison to related data one week before that (p<0.05) and there was a significant lower level of triglyceride in SM-treated diabetic rats (p<0.05). Furthermore, a similar significant reduction was obtained for treated-diabetic group as compared to diabetic group regarding serum cholesterol level (p<0.05). On the other hand, HDL- and LDL- cholesterol levels were significantly higher (p<0.05) and lower (p<0.05) in SM-treated diabetic group as compared to untreated diabetic group respectively.Conclusion: Oral chronic administration of SM had no significant hypoglycemic effect and led to appropriate changes in blood lipid profile.

Introduction: Decubitus ulcer is a pressure-induced tissue injury that may affect skin, muscle, connective tissue, cartilage and bone. The present study was designed to find out risk factors of decubitus ulcer in head and spinal cord injured patient admitted to intensive care units (ICU).Materials and Methods: In this cross - seetional analythical study all consecutive craniospinal trauma patients admitted to intensive care unit were included.Upon arrival at the hospital and every 48 hours, all patients were examined for existence of bed sore. Braden scale, age, kind of mattress, site of primary injury and level of consciousness were used to determine risk factors. Data was analyzed using T and Chi square tests and logistic regretion.Results: Among 198 patients (171 male, 27 female with mean age of 31.4=19.8), 166 patients (3.8%) had cranial and 32 (16.2%) patients had spinal trauma. Of samples, 45 (22.7%) patients had 67 sores in 13 different sites. Incidence of bed sore was 22.7% (in cranial and spinal injured patients was 4.54% and 18.18% respectively). The most common sites were intergluteal cleft (33.3%) and sacral regions (28.9%). Bed sores were observed more frequently in immobile patients and those with impaired sensation, the difference were statistically significant (p<0.005 and p<0.005 respectively) hence immobility and impaired sensation are known as risk factors. Patient’s sores were not influenced by age, moisture, activity, nutrition and type of mattress variables. Time of hospital stay in patients with bed sore was significantly more than those without bed sore (P<0.00001). Coma patients (GCS 8) had developed bed sore more frequently than conscious ones (OR=6.1, RR=4.4, P=0.00001).Conclusion: Results show that risk factors of deubitus ulcers in ICU admitted craniospinal trauma patients were; decreased sensation, activity and level of consciousness and length of hospital stay.

Introduction: Nowadays, the attention of researchers has been focused on natural medicine in order to avoid the detrimental side effects of chemical drugs. In this study we assessed the effect of root extract of Tagetes minuta against HSV-1 and HSV-2.Materials and Methods: This research is an experimental study. Root extract of Tagetes minuta was obtained with 70% ethanol by maceration. Vero cells were grown in DMEM containing 5% fetal bovine serum. Serial dilutions of extracted suspension (1/10, 1/20, 1/40, 1/80, 1/160) were incubated by the exact titer of viruses and monitored for antiviral activity of extract. Data was analyzed using Doncan test.Results: Root extract obtained from Tagetes minuta significantly has antiviral activity against HSV-1 and HSV-2. This extract has more effect on HSV-2 than HSV-1. This study indicates that antiviral activity of the extract varies between different concentrations and the optimum antiviral activity on both viruses was obtained using 1/10 concentration.Conclusion: The results of this investigation showed that root extract of Tagetes minuta have good antiviral potenoial against HSV-1 and HSV-2, a good source of drug for treatment of diseases due to HSV-1 and HSV-2.

Introduction: Type of anesthesia is important in the maternal and fetal well being. There are different information's about effect of general and spinal anesthesia on Apgar score, so in this study a comparison was made on Apgar scores of neonates following these two methods.Materials and Methods: This study is a clinical trial and 168 term pregnant women were selected from elective cesarean candidates and divided in to general and spinal anesthesia groups by randomized allocation method. Then Apgar scores in first, fifth and twentieth minutes were measured in infants. Also maternal age, cause of cesarean, sex and duration of cesarean section time were all documented. Data was analyzed using T and Chi square tests.Results: Mean Apgar scores were 8.66±0.68, 9.8±0.42 and 9.97± 0.15 at first, fifth and twentieth minutes in general anesthesia group, and 9±0.38, 9.88± 0.32 and 10 at first and fifth and twentieth minutes in spinal group. The group differed significantly for first minute Apgar score (p<0.001) but there were no significant differences in fifth and twentieth minutes Apgar scores.Conclusion: First minute Apgar score of newborns of mothers under spinal anesthesia was more than those of mothers under general anesthesia but there was no difference between their five minute Apgar score.

Introduction: Cataract is one of the most important and a major disease in human. The prevalence of cataract in age 65-74 get to 50%, and over 75 it arrives to 70%. Absolute cure for cataract is surgery that can be done by different techniques such as intracapsular, extracapsular, and phacoemulsification. Cataract surgery has different side effects such as hemorrhage, Glaucoma, posterior capsular opacification and astigmatism. This study decides to compare astigmatism after two techniques of cataract surgery; phaco and extracapsular.Materials and Methods: This study is a double blind randomized clinical trial, which has been experienced on 112 patients. Patients were divided in two groups (A and B). In group A surgery was done by phaco technique which has a small incision of 3.2 mm and does not need suture. But in group B, (extracapsular group) the incision is bigger about 10 mm and needs suture. Then keratometry was done for each patient before surgery, one week and 2 months after surgery for determining astigmatism. Data was analyzed by independent and paired sample T tests. p< 0.05 was considered meaningful.Results: From 112 patients that had been studied, 56 patients underwent phaco technique and 56 patients underwent extracapsular technique. Mean of astigmatism before surgery in group phaco was 0.79±0.71 D and in extracapsular was 0.9 0.55 D (p>0.05). Mean of astigmatism 1 week after surgery in phaco group was 1.11 0.72 D and in extracapsular group was 3.99 1.46 D (p<0.05) and mean of astigmatism two months after surgery in phaco group was 1.0 0.71 D and in extracapsular group was 3.28 1.29 D (p<0.05).Conclusion: Induced astigmatism in phaco group was 0.21 D and in extracapsular was 2.38 D that has meaningful difference. Other criteria such as age, lens number, sex and left or right eye do not have any effect on induced astigmatism.

Introduction: In order to determine the importance and power of physical examination diagnosis, we decided to compare the results of physical examination in patients with distal forearm penetrating wound and whatever is observed during surgery as golden standard.Materials and Methods: This cross-sectional analytical study was performed on 91 patients with distal forearm sharp injury. Findings of physical examination were compared to what was found during surgery (definitive diagnosis) as golden standard.Results: Based on findings, physical examination value of diagnosis for FDP and FDS was determined. In FDS clinical examination value had 88% sensitivity, 40% specificity, 94% positive predictive value, 22% negative predictive value and 1.46 positive likelihood ratio, and 0.3 negative likelihood ratio; and FDP clinical examination value had 97% sensitivity, 25% specificity, 93% positive predictive value, 50% negative predictive value, 1.29 positive likelihood ratio and 0.12 negative likelihood ratio.Conclusion: Physical examination view point of rule in of flexor tendon injury because of sharp and penetrating trauma is more valuable than rule out.

Introduction: As tonsillectomy operations are done in vicinity of airways, two important purposes in anesthesia are decreasing bleeding and recovery time. Because of common use of Halothane and its reported side effects, we managed a study for comparing these two factors in two methods of anesthesia with or without Halothane.Materials and Methods: In a single blinded clinical trial, 140 (4-12 years old) children undergoing tonsillectomy were randomly allocated in two equal groups. In the control group maintenance was done with Halothane-N2O 50% but in the case group without Halothane plus hyperventilation (Liverpool technique). Bleeding volume was estimated according to preoperative and 6 hour's postoperative hematocrit. Recovery time was recorded in minutes. Data was ahalyzed using Mann-Whitney U, T, Leven and K-S tests.Results: There was not any significant difference in sex, age, and weight; and operation duration in the two groups. Mean recovery time in the case group was 7.87 minutes and in the control group 15.59 minutes, which showed a significant difference (p=0.00001). Mean bleeding volume in the case group was 44.22 ml and in the control group 58.52 ml, which also showed a significant difference (p = 0.005).Conclusion: According to our study it seems that anesthesia with Halothane causes more bleeding and prolonged recovery time in comparison to Liverpool technique.

Introduction: Chronic and relapsing abdominal pain is one of the most common reasons that bring children to pediatric clinics. About 20% of these children are suffering from idiopathic hypercalciuria. Since Hydrochlorothiazide is effective in relieving hypercalciuria, we assessed its effects on reducing these relapsing pains in girls with idiopathic hypercalciuria.Materials and Methods: In this single blind clinical trial study, 100 girls, aged 5-12 years old, with chronic relapsing abdominal pain and hypercalciuria were divided to two groups by random block design. All children and their parents were trained about consuming plenty of liquids and decreasing salt in foods. In addition to these measures, Hydrochlorothiazide (1 mg/kg/day) was also administered to children in the case group. The control group was assessed for the number of abdominal pain episodes for 3 months following the commencement of the diet and the case group for 3 months after becoming normocaciuric. The results were analyzed by Ttest.Results: The mean number of pain episodes in Hydrochlorothiazide group in the first, second, and third months were 0.38, 0.4, and 0.26 respectively; much lower than the corresponding months in the control group which were 1.60,1.94, and 1.84 in that order (p<0.001).Conclusion: It seems that single dose daily Hydrochlorothiazide is a safe and effective drug in the treatment of chronic relapsing abdominal pain in children with idiopathic hypercalciuria.

Introduction: Hyperlipidemia is one of the major risk factors of cardiovascular diseases. This study was done to assess lipid profiles according to sex and place of residence in the urban and rural area of Arak for controlling cardiovascular diseases.Materials and Methods: This descriptive study is the first phase of healthy heart program which was done in Arak. Sampling was randomized cluster. A questionnaire was used to collect demographic data and paraclinical test results (total cholesterol, LDL-c, HDL-c, and Triglyceride). Data was analyzed using T-student, Kolmogorov-Smirnov, Mann-Whitney and Chi-square tests.Results: Of 4303 individuals over 30 years, 51.6% were female. Total cholesterol, LDL-c and HDL-c disturbances were more in female (p<0.05) but there was not a sigmifiant difference between male and female in triglyceride disturbance. The increase in serum lipids was signfiantly different in urban and rural areas, in which total cholesterol and LDL-c disturbances were more in rural and triglyceride disturbance was more in urban areas (p<0.0001).Conclusion: High prevalence of dyslipidemia in the studied region can be related to unhealthy life style, nutrition and inadequate physical activity, so dyslipidemia and cadiovascular diseases could be decreased by changing lifestyle.

Introduction: Abdominal pregnancy is 1 in 10000 live births and advanced abdominal pregnancy is rare. Abdominal pregnancy is associated with high morbidity and mortality with the risk for death 7 to 8 times greater than tubal ectopic pregnancy and 90 times greater than intrauterine pregnancy. In this article a case of advanced abdominal pregnancy is reported.Case: The patient was a 35 year’s old (G4P3) woman presented with undelivered pregnancy after two years. After diagnostic procedures laparatomy was done. During the operation, fetus adhesion to the omentum was released. A 9 kg calcified fetus was delivered. Then the placenta and left adnex was removed completely.Conclusion: Regarding the high mortality rate of abdominal pregnancy, in every pregnancy specially in the precence of it’s risk factors (such as PID, history of ectopic pregnancy, history of infertility and using drugs to induce ovulation, IVF, prior tubal surgery and …) and also suspicious symptoms, this probability and early intervention must be considered.