Journal of Arak University Medical Sciences
Year:2006 | Volume:9 | Issue:3 (36)|Papers Count:16

Introduction: Bone mineral density (BMD) measured by dual energy x-ray absorbtiometry (DEXA) is widely used in management of patients with osteoporosis. Factors which are specific to machine or operator, can influence the accuracy and precision of BMD estimations. In this study we investigated the effect of leg rotation and femoral neck on densitometry of femur. Materials and Methods: In a before and after, interventional study on 200 women between 30-70 years old, without metabolic bone diseases, densitometry was done first in standard position and then in 15° rotation of leg from standard position and then after changing femoral neck angle from 90° to 80° in relation to central femoral neck axis. Density of femoral neck, ward triangle, greater trochanter, shaft of femur and total hip was measured and data was analyzedby means comparison test. Results: External rotation of leg by 15° from the customary position, increased the average BMD in femoral neck, wards area, trochanter and shaft (p<0.001, p<0.04, p<0.001, p<0.008 respectively). While no significant change was observed in average BMD of total hip. Change of femoral neck area angle from 90' to 80' in relation to central femoral axis decreased BMD in femoral neck (p<0.001), and significantly increased BMD in wards triangle, trochanter, shaft and total hip (p<0.001, p<0.001, p<0.001, p<0.04 respectively). Conclusion: Malrotation of hip can be an important confounding factor when interpreting serial BMD values. Regarding the less effect of malpositioning on BMD of total hip, this area may be preferred for assessment of densitometry result.

Introduction: Spinal anesthesia is a conventional way of anesthesia for cesarean section (CS), which nausea and vomiting is a common complication of it. Metoclopramide is the standard medication used for preventing intraoperative nausea and vomiting (IONV). Because of extrapyromidal side effects of Metoclopramide and known antiemetic effects of low-dose Propofol and Dexamethasone, this study was performed to compare the effectiveness of these drugs for preventing IONV.Materials and Methods: This study, is a randomized clinical trial which is done on 144 parturients who were admitted for emergency CS. Patients were divided randomly into four groups and received: Metoclopramide 0.1 mg/kg IV, Dexamethasone 150 μg/kg IV, Propofol 0.1mg/kg every 5 minutes from clamping umbilical cord till the end of operation and the fourth group received 2 ml distilled water. During the operation parturients were monitored for IONV. Data was analyzed using Kruskal-Wallis and one way ANOVA. Results: The Number of patients having nausea was lowest in Propofol and highest in Dexamethasone group. There was no statistical significant difference between Dexamethasone and placebo groups. The lowest rate of vomiting was in Metoclopramide and Propofol groups and there was no significant difference between them. Also the lowest level of retching was in the Prepofol group.Conclusion: According to results, the antiemetic effects of Propofol and Metoclopramide are similar. Amount of retching in Propofol was slightly lower than Metoclopramide and administration of Propofol was simple, cheap and without serious complications, so we recommend it for emergency CS.

Introduction: An association between depression and altered immunity has been suggested by a number of studies but has not been consistently demonstrated .The effect of maternal depression response on fetal immune system have not been investigated. Thus in this study we evaluated the effects of depression on some parameters of innate and humoral immune system of pregnant women and their infants.Materials and Methods: 62 pregnant women (including 32 depressed and 30 healthy) and their infants in Taleghani hospital of Arak in 2004 were included in this study. All depressed mothers had a diagnosis of depression by Beck Depression Inventory (BDI) and clinical interview based on DSM-IV system. The level of immunoglobulin and components were evaluated by single radial immunosdiffusion (SRID) method of Mancini. Leukocyte and lymphocyte counts were determined by Hycel (an automated cell counter) and for more accurancy were also evaluated by manual method. Statistical analysis was performed using K-S, Mann-Whitney, One way ANOVA, Kruskal-Wallis and Pearson tests. P<0/05 was considered significant.Results: Serum IgM level and serum C4 level of infants of mothers with depression were significantly lower than infants of healthy mothers. Lymphocyte number and percentage in infants of depressed mothers was also significantly higher than infants of healthy mothers. The mean cord/maternal blood ratio of IgG in infants of depressed mothers was also significantly lower than infants of healthy mothers. Serum IgG level of depressed mother was significantly higher than other mothers.Conclusion: Fetal impact of stress and depression during pregnancy is just beginning to be understood and research in this area is developing. Our results indicated that maternal depression adversely affects the development and function of fetal immune system. These results are in agreement with the immunological findings of preterm and LBW infants.

Introduction: Sensory stimulation of comatose patients is an important nursing intervention for increasing their LOC and tactile stimulation especially massage is one of the most important stimulations. The nurse as a person, who is responsible for this, must know the effects of this intervention on patients. But there are some conflicts about this intervention's effects especially on vital signs (pulse, blood pressure and respiration). This study was done to determine the effect of massage on comatose patient's vital signs who were hospitalized in intensive care unit.Materials and Methods: This study is a clinical trial. Samples were consisted of 100 comatose patients, divided into two equal groups randomly. The two groups were matched in age, geneder and glascow coma scale. Samples in experimental group received 20 minutes massage on their back, feet and hands in three continuous days. Vital signs in experimental group were measured before and immediately after intervention and vital signs in control group were measured at the same time with experimental group. A check list used was used for collecting data. Data was analyzed using descriptive and analytic statistics (T, paired T and Chi-square tests).Results: Findings showed that massage decreased vital signs significantly as followed: pulse rate and diastolic blood pressure in each three days (p<0.05), systolic blood pressure in first and third days (p<0.05), respiration rate in second day (p<0.05). Conclusion: This study showed that massage can decrease comatose patients' vital signs which can be the indicator of their relaxation and decreasing stress.

Introduction: Considering the increasing incidence of atherosclerosis and cardiovascular disorders in diabetes mellitus, this study was conducted to evaluate the beneficial effect of two-month administration of Plantago Psyllium (PP) seed on the contractile reactivity of isolated aorta in diabetic rats.Materials and Methods: In this experimental study, 32 male Wistar rats were randomly divided into four; control, PP-treated control, diabetic and PP-treated diabetic groups. To induce diabetes, Streptozotcin (STZ) was intraperitoneally administered (60mg/Kg). PP-treated groups received PP mixed with standard pelleted food at a weight ratio of 6.25%. After 2 months, contractile reactivity of thoracic aortic rings to KCl and Noradrenalin were determined using isolated tissue setup. Data was analyzed using ANOVA and Tukey tests.Results: Serum glucose level showed a significant increase in diabetic group after one and two months (p<0.001), but it, s decrease in PP-treated diabetic group was not significant in comparison to diabetic group. Also PP-treated diabetic group showed a lower contraction to KCl (p<0.05) and noradrenalin (p<0.01) as compared to diabetic group. Meanwhile, there was no significant difference between control and PP-treated control groups regarding contractile reactivity.Conclusion: It can be concluded that oral administration of PP for 2 months can decrease the contractile responsiveness of vascular system and this may prevent the development of hypertension in diabetic rats.

Introduction: There is little information about essence and combination of ductuli efferentes secretions. Glycoconjugates importance in sperm production and maturation has been confirmed in previous studies; therefore this study is done in order to recognitize Glycoconjugates in ductuli efferentes epithelium and determination of their distribution pattern by means of lectin histochemistry.Materials and Methods: In this descriptive study tissue species were obtained from 30 adult male BALB/c mice. After fixation and routine laboratory processes, 5 µm sections were prepared from paraffin blocks. These slides were exposed to different lectins by means of lectin histochemistry. Reaction intensity in different cells was investigated by light microscope and graded according to the previous related studies. Then results were compared with each other by Kruskal-Wallis and Dunn statistical tests. Results: The mean of reaction intensity in ductuli efferentes epithelium in reply to different lectins, showed significant statistical difference (p<0.005). The most intense reaction was seen in response to WGA (Wheat Germ Agglutinin) lectin and after that to SBA (Soybean Agglutinin), VVA (Vicia Villosa Agglutinin) and PNA (Peanut Agglutinin) respectively. But the staining was negative with GSA-I (Griffonia Simplicifolia Agglutinin-I) lectin.Conclusion: Results indicate that the cells of ductuli efferentes epithelium in mouse are involved in synthesis and secretion of sperm maturation related glycoconjugates and produce a variety of these components in various amounts. There is a large amount of components, containing terminal sugars such as Sialic acid, Galactose-N- Acetylgalactosamine and N-Acetylgalactosamine in ductuli efferentes cells. The lack of Galactose in this epithelium shows that, it hasn’t a role in sperm maturation.

Introduction: Hypertension is a common asymptomatic and usually easy to treat disease. Regarding the fact that genetic, social and nutritional factors responsible for inducing hypertension are not the same in different societies, it is necessary to performer a study to introduce a model of hypertension which includes laboratory measures as risk factors of hypertension at Arak city in 2004. Materials and Methods: This is a case-control study. Study samples were 1000 persons (263 patients with hypertension and 737 healthy people). Samples were selected using multi-stage method in which the population ratio in city and village in both groups was considered. Laboratory findings and ECG results were documented. Data was analyzed using descriptive statistics and logistic regression.Results: In this study hypertensive patients were compared to healthy people. Some risk factors in this study were LVH (p<0.0001), high triglyceride, hypercholesterolemia and hyperglycemia. Also a model was made based on ECG results and laboratory findings to predict the probability of hypertension.Conclusion: By educating physicians about the determined risk factors in this study, they can control them better and decrease hypertension complications in heart, brain, kidney and eye. On the other hand the obtained model can be used in determination of the probable hypertension in people with positive family history.

Introduction: Plantar fasciitis is one of the common complications in adults. It can be treated by surgical and nonsurgical interventions. Nonsurgical treatments (functional foot orthosis, heel pad, night splint and wedge) are emphasized as the main option in management of plantar fasciitis. Wedge can be used effectively because of its low weight, low price, easy making and availability to the patient. In this study the effect of medial heel wedge on managing pain in patients suffering from plantar fasciitis was examined. Materials and Methods: In this before and after clinical trial, 15 patients with plantar fasciitis including 6 male and 9 female with 18 involved extremities were selected by non probability sampling. Variables including pain, ADL, sport and recreational activity, quality of life, stride length and step length were measured in three stages: once before intervention and then two and four weeks after intervention. For evaluating the variables, FAOS questionnaire was used. Data was analyzed using ANOVA. Results: The improvement of variables such as pain, ADL, quality of life, sport and recreational activity, step length and stride length was significant (p=0.05). Conclusion: Medial heel wedge reduced pain by shifting the center of force into lateral border of heel in addition to reduce the tension of plantar fascia.

Introduction: Regarding the fact that dissanitation in swimming pools can cause a lot of diseases such as Dermatophytosis in swimmers, this study is done with the aim of determination of Dermatophytic infections in covered public swimming pools of Qom city during 2004.Materials and Methods: In this descriptive study 480 samples were taken from six public swimming pools. Samples were carried to the laboratory where they were passed through milipore filters. Filters then were trasfered to mycosel agar medium and incubated for three weeks at 25 C°. Data was analyzed using fisher test. Results: Among 480 samples, eleven Dermatophytes (8/8 percent) were isolated and indentified as follow: Trichophyton Mentagrophytes (2/4%), Trichophyton Tonsuranse (1/6%), Trichophyton Equinum (1/6%), Trichophyton Verrucosum (0/8%) Trichophyton Rubrum (0/8%), Trichophyton Schoenlinii (0/8%) and Epidermophyton Floccosum (0/8%). There was a significant relationship between prevalence of Dermatophytes and disregarding of personal hygiene standards (p=0/0001) and no significant relationship between residual Chlorine of swimming pools and prevalence of Dermatophytes.Conclusion: Because the majority of isolated Dermatophytes were anthropophilic and had been transferred from swimmers to the swimming pools it is necessary to care personal hygiene standards and provide good sanitation conditions in water and environment of the swimming pools.

Introduction: The reported 12 months prevalence of low back pain in nurses ranges from 43% to 76%. In most researches physical factors were only a part of high prevalence of low back pain in nurses. This study was conducted to determine the association between occupational stress and low back pain in nurses.Materials and Methods: In this case-control study, 80 nurses as case group and 80 nurses as control group were selected via convenience sampling. Case group were defined as those subjects who had experienced low back pain in the last 12 months. Control group were defined as those subjects who had not experienced low back pain in the last 12 months. A questionnaire was used for data collection which consisted of 3 sections: demographic information, history of low back pain and occupational stress. Data was analyzed using paired T, Mann-Whitney, and Chi-square tests, correlation coefficient and one way ANOVA.Results: Results indicated that, there was an association between low back pain and occupational stress (p<0/01).Also an association existed between low back pain and working hours per month (p<0/05). Statistical tests showed no significant difference between the two groups in terms of age, gender, marital status, number of childbirth, number of pregnancy, smoking, sport, work shift, number of years spent in the hospital (nursing experience).Conclusion: Results indicated that occupational stress in case group was more than control group. Since there was not any significant difference between other factors and low back pain, it can be concluded that there is an association between low back pain and occupational stress.

Introduction: There is difference between susceptibility or resistance to infectious diseases such as cystic and alveolar Eclinococcosis in human and animals, that is due to the difference between individual host factors and immunologic responses. This study is done to investigate the resistance and susceptibility markers (HLA) in Hydatid patients and healthy persons.Materials and Methods: This analytical (case-control) study is carried out on 60 patients with confirmed cystic echinococcosis and 30 healthy individuals living in Arak. Blood samples were gathered and tested by microlymphocytotoxicity method. At first diagnostic kits with specific antiserums for each antigen (28 antigens) were provided and then lymphocytes were separated. After dye and stabling with formalin and based on cells morphology, results were seen by invert microscope. Data was analyzed using Odds Ratio, Relative Risk, Preventive Fraction, Aetiologic Fraction and Chi square test.Results: Results showed that HLA-A1 was significantly higher in patients (p<0.05), and people having this antigen are more susceptible for the infection. In spite, HLA-A10 was higher is healthy individuals (p<0.05) and have a preventive effect in disease involvement. Other investigated antigens had no significant difference in the two groups. For more accurate results molecular investigation is needed. Conclusion: In individuals having HLA-A1 there is more chance for cyst growth in confronting hydatosis and this individuals are more susceptible to the disease. But in individuals having HLA- A10 there is less chance for cyst growth in confronting hydatosis and this antigen have a preventive effect against hydatid cyst.

Introduction: One of the severe forms of affective disorders, defined in DSM-IVTR, is bipolar disorder type1. This is a psychotic disease that coexists with structural and biochemical changes of CNS. It is probably under influence of environmental and/or genetic factors. Finger and hand prints are formed during the late first and second trimester of fetal development, and then remain unchanged. There are some suggestions that disturbance in dermatoglyphic patterns probably are in relation with appearance of bipolar disorder. It seems that this disturbance is appeared at the first and second trimester of fetal development, which is a critical period for CNS growth. This study is done to investigate the dermatoglyphic patterns in bipolar disorder.Materials and Methods: This is a case-control study in which we have studied the dermatoglyphic changes in 30 bipolar disorder patients and compared to those of 72 healthy controls. The x2 test was used for quantitative and T-test for qualitative data analysis. Results: Results showed that TABRC in patients was decreased in comparison to healthy people but this decrease was not significant. Regarding the type of patients, fingerprints, Loop and Whorls forms were heterogeneous and were significantly different in comparison to control group (p=0.001, p=0.003). Conclusion: It seems that dermatoglyphic patterns can be an interesting and probably suitable procedure in determining the prognosis of bipolar disorder type 1 and other psychiatric disorders.

Introduction: Using one subcutaneous infiltration of Bopivacaine can cause a good pain relief in pediatric surgery, so the child may no longer need rectal Acetaminophen after surgery. In this study, we compared the efficacy of the two drugs.Materials and Methods: This was a clinical trial, performed on 141 pediatric patients between 6 months to 3 years old with unilateral or bilateral inguinal hernia or undescending testis. Patients were divided randomly into two groups. The first group received infiltration of Bopivacaine preoperatively and the second received the routine rectal Acetaminophen after surgery. In both groups pain score was measured with FPRS score 3,6,12 and 24 hours after surgery. After collecting data they were analyzed with T-student and Friedman tests. P<0/05 was considered significant. Results: Global FPRS pain score was lower in the group treated with Bupivacaine infiltration on 3 and 6 hours after surgery (p<0/05), but in 12 and 24 hours after surgery no significant difference was seen in the two groups.Conclusion: This study showed that, infiltration of Bupivacaine reduces pain better than Acetaminophen, especially during the first 6 hours after surgery. So because of better pain control and also single administration, we suggest using infiltralition of Bupivacaine preoperatively.

Introduction: Adenosarcoma is a rare uterine tumor composed of benign epithelial and malignant stromal elements. In 20% of cases stroma contains heterogonous elements (usually from stratified muscle type). Association between Tamoxifen usage (exogenous strogen) or ovarian the coma (endogenous strogen) and occurrence of this tumor has been reported. This is a case report of a uterine Adenosarcoma.Case: The patient was a 45 years old woman with history of 16 years OCP use who was admitted with a uterine mass and undergone total hysterectomy. Microscopic assessment of slides, stained by H&A, was indicator of Adenosarcoma with cartilage heterogonous elements.Conclusion: Uterine Adenosarcoma is a rare tumor. Although there is a few reports of cartilage heterogonous elements in uterine Adenosarcoma, this case had multiple cartilage points in stroma. Also in this case, the coexistence of this tumor with long- term OCP use was considerable.