ARAK MEDICAL UNIVERSITY JOURNAL (AMUJ)
Year:2008 | Volume:10 | Issue:4 (41)|Papers Count:17

Introduction: The third leading cause of mortality in developed countries is trauma which 50% of these are because of head injuries. Since the injury to the brain is not limited to the time of accident and it can be developed or exacerbated some times after the accident, therefore care and treatment of these patients especially during the emergency phase can prevent secondary injuries. So it is important to investigate the quality of these patients’ care in emergency phase at hospitals.Materials and Methods: This is a descriptive study which is done during a 6 months period. It is done using a quality of care checklist which was developed for three groups of patients with mild, moderate and sever head injury .The checklist is developed based an standards of care. The quality of 693 patients’ care by health care team (physicians and nurses) was evaluated during the first 24 hours of hospitalization. Four domains of care including general, neurologic, respiratory and homodynamic care were assessed by the checklist. The highest score in each domain was 10. 9 and more was considered excellent care, less than 9 to 7 good, less than 7 to 5 moderate and less than 5 poor. Data was introduced using descriptive statistics.Results: Results showed that the health care team in the domain of general care had 7.39(good care), in the domain of respiratory care 5.08 (moderate care) and in the domain of hemodynamic care had 7.48 (good care), scores.Conclusion: Findings showed that although care of head injury patients was not poor but it was not excellent also, which shows some deficits in the management of these patients.It is necessary to improve the quality of care by educating health care professionals and providing enough equipment for care.

Introduction: Urolithiasis as the most common disorder of urinary tract could be treated and prevented by different methods .In this study according to the traditional medicine recommendations, the powder prepared from inner layer of hen's crop, in the form of oral capsules (druge) were used for elimination of urinary stones.Materials and Methods: This is a clinical trial study. In this study 60 urolithiasis patients, were diagnosed by urologist were studied in two equal case and control groups. All the patients were treated classically for urolithiasis whereas the case group was also treated by drug and control group used placebo. In both groups, the effectiveness of treatment was assessed by clinical indexes, and radiology and sonography evaluations. Data was analyzed using Man Whitney U and Kruskal Wallis tests.Results: The results of this study showed that, there were no significant differences between case and control groups for rate and duration time of stone elimination.Conclusion: In spite of traditional medicine comments, the usage of inner layer of hen's crop was not effective on solubility, elimination and treatment of urolithiasis.

Introduction: Due to absence of frozen section in the majority of hospitals, malignant breast masses are being operated in two admissions first for biopsy and second for mastectomy. With simple and rapid technique of touch imprint (intraoperative cytology) we can do both operations in one time, if it be accurate.Materials and Methods: During 2003 to 2006 reports of touch imprints of 70 patients with breast masses compared with reports of permanent section. We had tow pathology teams in separate hospitals for cytology and permanent section.Results: In 70 patients, 39 cases had malignant and 31 cases had benign masses. In 39 patients with malignant masses, 36 patients had malignant and 3 patients had benign cytologic reports. In 31 patients with benign masses 2 patients had malignant reports in cytology.Therefore sensitivity, specificity and accuracy of touch imprint in diagnosis of malignant breast masses are 92.3%, 93.5% and 92.9% respectively.Conclusion: Because of high specificity of touch imprint it seems this test can be done in centers that do not have frozen section for intraoperative diagnosis of malignant breast masses.

Introduction: Diabetes is the most important metabolic disease in human. The prevalence of both types of diabetes is rapidly increasing over the world. Diabetes causes many complications including ESRD. Diabetes is responsible for 30% of ESRD. The prevalence of diabetic nephropathy in Iran is also high. Many of these patients are becoming dialysis dependent. Many studies have shown the changes of trace metals’ levels in diabetic patients including cupper, zinc, Manganese and Chromium. This study evaluates the correlation between urinary cupper and diabetic nephropathy.Materials and Methods: This is a case-control study. Samples were selected among type 2 diabetic patients attending to diabetes clinic in Vali-e-Asr hospital in Arak. Diabetic patients were divided in two groups based on microalbuminuria, 42 patients in case and 40 patients in control group. Then the patients were classified based on duration of diabetes into 4 groups and based on the HbA1c into two groups. Then urinary cupper was determined with atomic absorption spectophotometry and compared. Independent T test was used to analyze data.Results: The patients were 28.1% male and 69.9% female in case group and 37.5% male and 62.5% female in control group. The mean cupper level was 36.14mg /L (14.54-57.74) in case group and 14.77% mg /L (10.17-19.37) in control group. There was a statistically significant difference between two groups (p=0.003).Conclusion: The results show a positive relation between urinary cupper and diabetic nephropathy and confirmed the results of other studies that reported the elevation of cupper in microalbuminuria. This study also showed that age, gender, duration of diabetes and HbA1c level have no effect on urinary cupper.

Introduction: Peptic ulcer is a condition in which there is an ulcer in stomach or duodenum. The incidence of peptic ulcer is 5 to 10% and is more prevalent in men. Infection with helicobacter pylori, NSAIDS, smoking and alcoholism are of the most important risk factors. Another risk factor is the O blood group. Since most researches in this field are done abroad this study is done with the aim of determining the relation between ABO blood group and Rh with peptic ulcer.Materials and Methods: In this case-control study, 325 persons with dyspepsia were investigated. These individuals were referred for endoscopy. The case group was 110 persons in whom endoscopy had revealed a peptic ulcer and control group was 215 persons in whom endoscopy had showed no sign of ulcer. Blood grouping was performed by slide and tube methods. Chi 2 tests were used for data analysis.Results: Based on the results patients’ age was between 18-75 years. 68.6% of samples were women because they had more referrals. There was a significant relation between age and sex with peptic ulcer. 25.5% of patients were single and 72.5% married.Among all samples; 32.9% had A blood group, 18.5% B, 11.1% AB and 37.5% O; and 88% were Rh positive and 12% Rh negative. There was no significant relation between ABO blood group and Rh with peptic ulcer. The gathered data was analyzed using odds ratio, relative risk and Chi 2 test.Conclusion: Although some investigations have showed correlations between ABO blood group and ulcer peptic, our data showed no correlation. This may be due to the prevalence of helicobacter pylori infection among patients with peptic ulcer which needs more investigations. Other effective factors may be life style and nutrition.

Introduction: Endocrinopathy is a known consequence of external beam radiotherapy to the brain tumors. The aim of this study was to find out the incidence of hyperprolactinemia in brain tumor patients treated with radiotherapy, when radiation portals included whole of the hypothalamus and pituitary glands.Materials and Methods: This descriptive study was conducted from December 2004 to February 2006 on about 42 patients with brain tumors, who were referred to radiation oncology center of Hamadan to be treated with external beam radiotherapy, whose radiation portals included whole hypothalamus and pituitary glands. Serum prolactin levels were measured at the beginning of treatment, and at one month, three months, six months and one year after completion of radiotherapy. Data was introduced using descriptive statistics.Results: Of 42 patients 6 were excluded which one was because pf previous hypothalamus and pituitary radiotherapy, three because of nonadherence to follow up program and two because of previous endocrinopathy Of the patients attending the follow up clinic, 11% were found to have hyperprolactinemia at six months and 22 at one year. This condition in women and men was 37% and 15% respectively.Conclusion: Abnormality in prolactine secretion is a late complication of brain radiotherapy and a significant number of patients develop hyperprolactinoma following radiotherapy to the brain (hypothalamus and pituitary region). It seems this complication increases by increasing the radiation dose and is more prevalent in women.

Introduction: Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder (DBD). In this study the effect of family training on basal salivary cortisol in children with DBD was investigated.Materials and Methods: This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after treatment (family training). The disruptive behavior of the child was assessed with child behavior checklist (CBCL). Before and after treatment cortisol levels and score of behavior were compared. Data was analyzed using descriptive statistics, paired T test and pearson correlation.Results: Salivary cortisol before family training was 7.9±4.6 nmol/L and after that was 10.46±3.84 nmol/L which was significantly different (p<0.001). Behavior score before treatment was 72.05±10.10 and after that was 49.361±1.89 that was also significantly different (p<0.0001). Children with lower basal salivary cortisol had a better response to intervention.Conclusion: Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also the response to parent training in children with DBD.

Introduction: Homocysteinemia is currently regarded as an independent risk factor in venous thrombosis and vascular diseases. So noticing its causes and risk factors in high risk populations, such as elderly and chronically ill patients is of much importance. This research is designed, considering the important role of homocysteinemia and the lack of statistics and adequate information about the prevalence of this disease among hospitalized patients in ICU.Materials and Methods: The is a descriptive, cross-sectional study, done by census sampling method on patients admitted in ICU of Rasoul-Akram hospital, during a 6 months period. Epidemiologic data was collected from the patients' files. A blood sample was taken from the patient to measure homocysteine level. Data was introduced using descriptive statistics.Results: 52 patients with the mean age of 58.42 were included in this study. Among these, 12 (23.1%) had a high homocysteine level and the other 40 patients (76.9%) had a normal range of homocysteine. The mean homocysteine level in patients with normal levels was 9.28(3.08-15.48) micromol/dl and the mean in patients with homocysteinemia was 21.05(11.05-31.05). Among patients with homocysteinemia, 25% had renal failure and 25% were presented with cerebrovascular accident (CVA). There was no significant difference between homocystein level in patients with renal failure and those with CVA.Conclusion: According to the 23.1% frequency of hyperhomocysteinemia in hospitalized patients of our study, also considering the Folate and vitamin B6 and B12 role in homocysteinemia, and also due to previous epidemiologic studies, it seems that evaluating Folate, vitamin B6 and B12, creatinine clearance and plasma albumin level may clarify the role of these factors as the probable predictive factor in patients with homocysteinemia.

Introduction: Sodium arsenite is an environmental pollutant which its amounts in industrial cities are more than other places because of its use in chemical industry. Human populations are exposed to this chemical compound through food, soil, air and water which has toxic and histopathological effects on different body organs including kidney. The aim of this investigation is to study the quantitative histopathological effects of sodium arsenite on the kidney structure of rats.Materials and Methods: 12 male Wistar rats with mean body weight of 200±20 g were randomly divided into 2 groups (n=6). One treated with sodium arsenite (8 mg/kg/day in drinking water) and the other one (the control group) received drinking water only. 2 months after treatment the rats were weighed, anesthetized with ether and dissected. The left kidney was taken out, cleaned, weighed and then fixed in 10% formaldehyde solution. After obtaining 1mm thick slices, tissue processing was carried out, then 5μm thick sections were prepared and stained using H&E method. Slides were finally studied stereologically and data was statistically analyzed using paired samples t-test and the means were considered significantly different at p<0.05.Results: The results of this investigation indicated significant reduction in the total mean volume of kidney (p<0.001) and cortex (p<0.001) and medulla (p<0.003) in sodium arsenite treated group compared to the control rats. The mean volume of tubules and interstitial tissue as components of cortex reduced significantly compared to the control group (p<0.003).The mean volume of glomeruli and Bowman's capsule significantly reduced in treated group (p<0.001). While the other components did not show a significant reduction in volume. A significant reduction was also found in the kidney (p<0.002) and the body weight (p<0. 01) in the treated group compared to the control ones at the end of the experiment.Conclusion: We concluded that exposure to sodium arsenite leads to histopathological changes in kidney structure however more studies are needed to determine the effects of these structural changes on the kidney function.

Introduction: Impressive researches demonstrate the importance of essential fatty acids for many physiological and behavioral mechanisms in both humans and animals.Essential fatty acids must be supplied via the diet. In this study we assessed the dietary effects of cis and trans fatty acids on seizures induced by Pentylenetetrazol (PTZ) in rats.Materials and Methods: In this experimental study animals were divided into four groups. In the three case groups; cis, trans or cis+trans fatty acids were added to the standard food of rats and in control group only standard food was dietary administrated. After one month, kindling was established in rats with PTZ in subconvulsive dose (45mg/kg i.p.).Convulsing activities were monitored for 20 min. Five stages of convulsing activities were observed. If after three consecutive sessions the animal was in the fifth stage, it was considered as a kindled animal. Data was analyzed using K-S, T, Tukey tests and analysis of variance.Results: Results showed that the convulsion stage in trans group was significantly more than others. Also it was found that duration of the fifth stage in trans group was significantly more than control and cis groups.Conclusion: Results suggest that, administering sis and trans fatty acids have some effects on PTZ induced kindling in second generation of the rats who were kindled before.More severe seizure and longer duration of seizure was seen in trans group comparing to cis group.

Introduction: In resent years, neuronal type Na+ channel is one of the important currents for action potential depolarization phase in heart cells. In this study neuronal type Na+ channel is blocked by low concentration of TTX to compare the effect of TTX blocker on pacemaker activity of sinoatrial node (SAN) and atrioventricular node (AVN) of mouse heart.Materials and Methods: In this experimental study the pacemaker activity of distinct intact SAN and AVN, was recorded before and during consuming 100 nM TTX and cycle length (CL) was measured. Data was analyzed using T test.Results: 100 nM TTX increased CL on SAN preparations by 22.2±6% and on AVN preparations by 52.5±13.5%. These changes were significant in the two nodes.Conclusion: It is possible to conclude that; the neuronal type Na+ channel was present in the two nodes, and the effect of TTX on CL of the two nodes was different.

Introduction: Previous investigations and available data demonstrate that there are different patterns of diseases distribution in developed and developing countries. While in developed countries the major cause of death is cancers, in developing countries the main cause of death is infectious diseases. Various factors may be responsible for different causes of death in two those groups of countries. However there are raising scientific evidences that some infectious and parasitic organisms when enter the body may effect the tumor growth. In order to explore this presumption, in this work the effect of Leishmania major infection on fibrosarcoma tumor growth in mouse model has been investigated.Materials and Methods: In this experimental study a group of inbred mice (n=6) were infected with Leishmania major as case group. After one month both these mice and some more mice as control group (n=6) were challenged with fibrosarcoma cells. The size of growing solid tumors was measured in individual mouse every two days up to two weeks.This measurement was performed 5 times on days 5, 7, 11, 13 and 16. Tumor area was also calculated for every single mouse. T test was used to analyze data.Results: Results of this work showed that the mean size of tumor in case group was smaller than that of control group only in the first week following challenge with fibrosarcoma cells but the tumor mass was bigger in days 13 and 16 in case group.However the difference between the tumor mass in case and control groups was not statistically significant.Conclusion: Results of this investigation revealed that there was no significant difference between the tumor mass in case and control mice. However to explore more about the hypothesis of this study, it is recommended that the research work be carried out using different tissue parasites and also different cell lines.

Introduction: Oculogyric crisis which is a dystonic reaction is commonly caused by neuroleptics and rarely occurs with atypical antipsychotics specially Clozapine. In this article a case of Clozapine induced oculogyric crisis is reported.Case: The patient was a 25-years-old woman with auditory hallucination, loosening of association and persecutory delusion that was admitted and treated. Because of poor response to typical antipsychotics, she was prescribed Clozapine. Then she experienced multiple episodes of oculogyric crisis and was treated successfully with anticholinergic medication (Artane).Conclusion: In this special case, Clozapine caused oculogyric crisis. This side effect is rare but should be considered as a possible adverse effect of Clozapine. On the basis of this report, Clozapine induced oculogyric crisis may be treated successfully with Artane.

Introduction: Sneddon syndrome is a combinaison of skin lesions (livedoreticularis) and acute cerebrovascular accident. The syndrome involves many organs such as kidney, heart, skin and brain. Some patients have a good prognosis when taking Aspirin and Diprydamol. In this article a case of this syndrome is reported.Case: The patient is a 40 years old woman with a history of 8 times intrauterine fetal deaths. She was now admitted to the neurology ward with signs of weakness in left side of the body (hemiparesis), dysarthria, 7th central nerve paralysis, and skin lesions (livedoreticularis).All laboratory data such as serology and microbiology were normal. After skin biopsy from the lower limbs and rule out possible secondary etiologies, this patient was recognized with Sneddon syndrome and recieved anti- platelet treatment.Conclusion: Despite the fact that this syndrome is rare, it seems considering the probability of appearing this syndrome, especially in young patients who are suffering from acute cerebrovascular signs and skin lesions in the same time, early treatment can prevent the desease from developing to other organs.

Introduction: Wilson disease is a hereditary disorder of copper metabolism which can present with hepatic, neurologic or psychiatric symptoms and in rare cases as a hemolytic disturbance. Free copper can result in red blood cell damage and hemolysis which is a rare - feature of the disease affecting less than 10% of patients. In this condition the liver is usually involved and liver transplantation can be life saving. This article is a case report of acute hemolytic crisis as the initialmanifestation of Wilsondisease. Case: An 8 years old girl was admitted in pediatric ward of Golestan hospital because of abdominal pain, icterus, anemia and tea color urine. Hepatitis or Glucose 6 Phosphate Dehydrogenase deficiency was the first diagnosis. Because of unresponsiveness to transfusion, Wilson disease was considered and the diagnosis was established with the presence of Kayser Fleischer ring. Conclusion: Chronic or acute hemolytic anemiais a rare or unusually presentation of Wilson disease. In any child especially older than 5 years with liver disease or hemolytic anemia, Wilson disease should be considered and appropriate diagnostic tests performed.