Journal of Babol University of Medical Sciences
Year:2014 | Volume:16 | Issue:6|Papers Count:11

BACKGROUND AND OBJECTIVE: Access to the intravascular system for administration of fluids, medications, blood products and hemodynamic monitoring is the most common invasive method. These therapies are not without defect and have numerous side effects that most common side effect is phlebitis; the goal of this study was the comparison of 2% Nitroglycerin ointment and 2% Chlorhexidine solution effect in preventing catheter-related phlebitis.METHODS: This study is a randomized controlled trial. One hundred patients selected from the cardiology department and CCU. The subjects were divided randomly into two groups (50 in each group). Location of the catheter was disinfected by Chlorhexidine solution and in another group by alcohol and Nitroglycerin ointment. Then two groups were assessed for signs of phlebitis every 12 hours up to 72 hours. In the distal portion of the catheter in alcohol and 2% Nitroglycerin ointment group after disinfecting, 1.5 cm of ointment was applied. The dressing was replaced and the catheter site every 12 hours was assessed. (IRCT: 201304077494N5)FINDINGS: There was no significant difference between the incidence of phlebitis in 2% Chlorhexidine and 2% Nitroglycerin group in 72 hours, but there was a significant difference between the incidence of phlebitis in two groups in 48 hours (p=0.014). Twenty two percent in the Nitroglycerin group had phlebitis. The grade percentage of phlebitis among patients was 18% (9 patients) grade 2, and 4% (2 patients) grade 3. Thirty two percent in the chlorhexidine group (16 patients) had phlebitis and the grade percentage of phlebitis among patients was 2% (1 case) one grade, 14% (7 cases) 2 grade, 16% (8 patients) 3 grade.CONCLUSION: Based on these results, the use of topical 2% nitroglycerin ointment and 2% chlorhexidine solution to reduce venous catheter-related phlebitis is recommended. However using 2% nitroglycerin ointment is more effective.

BACKGROUND AND OBJECTIVE: Premature birth is a special experience for mothers. Separation of mothers from their neonates before the determined time due to preterm labor and hospitalization in NICU associated with many physical and mental consequences for them and makes major changes in their life. This study was carried out in order to more comprehensive understanding of this phenomenon and aimed to describe the mother’s experience of premature birth.METHODS: The present study was a qualitative study with the content analysis approach. The data collection was conducted with 15 unstructured and in-depth interviews with the mothers having premature birth during 2012-2013 in medical educational centers in the North and Northwest of Iran. A purposive sampling method was used in this study. All interviews were recorded and transcribed verbatim and finally analyzed using a qualitative content analysis with a conventional method.FINDINGS: Data analysis led to extraction of continuum of separation in mothers of premature birth. This theme revealed in mothers by three categories of separation include: infant- mother, family-mother and social-mother. Analysis of the participant’s experiences showed that the extension of mother's aloneness is greater and longer in the first days of birth and gradually overtime, it is decreased and separation from the infant would be changed to separation from family, wife, relative and friends, respectively.CONCLUSION: Based on the results of this study, mother's separation during the process of infant care, is not limited to hospitalization of premature infant, therefore it should be paid attention to continuum and progression of separation. Also, according to the needs of these mothers, appropriate interventions should be designed.

BACKGROUND AND OBJECTIVE: Decreasing muscle strength and the quality of life (QOL) are some major problems for hemophilic patients. The purpose of this study was to compare two treatment protocols, including land-based and water-based exercise therapy on muscle strength and QOL in patients with hemophilia for 8 weeks.METHODS: In this experimental study, thirty-eight patients with hemophilia (type A) were randomly assigned into land-based exercise therapy, hydrotherapy and control groups. The participants in hydrotherapy group performed hamstring stretching and quadriceps strengthening exercises in water while the patients in land-based exercise therapy group followed the same exercises outside the water three days in a week for 8 weeks and the subjects in control group have their everyday life. The muscle strength and QOL were evaluated using hand held dynamometer and WOMAC questionnaire at base line and after interventions, respectively.FINDINGS: The patients who completed the interventions had significant increase in hamstring (Mean±SD: hydrotherapy: post-test 17.7±4.8; exercise therapy: post-test 17.3±8.1; control: post-test 12.3±6.6) strength and quadriceps (Mean±SD: hydrotherapy: post-test 20.9±5.5; exercise therapy: post-test20.2±7.7; control: post-test (15.2±6.8) and improvement in QOL compared to subjects in control group (p<0.001). More significant (p<0.01) improvement in QOL (hydrotherapy: post-test 26.4±9.1; exercise therapy: post-test 26.4±9.1; control: post-test 43.4±6.4) was found in participants of WET group in comparison to those in LET group, although no significant (p>0.05) difference was detected between the WET and LET therapeutic programs in changes of quadriceps and hamstring muscle strength at baseline and after finishing the treatment protocols.CONCLUSION: Both interventions can improve quality of life and muscle strength of knee joint in patients with knee joint arthropathy due to hemophilia, although the influence of water-based exercise therapy program in improving QOL protocol is more than land-based exercise therapy method.

BACKGROUND AND OBJECTIVE: Berberine, an isoquinoline alkaloid is reported to exhibit an anti-diabetic and antioxidant effect. Thus, this research study was conducted, for the first time, to evaluate the effect of berberine on synaptic plasticity at dentate gyrus (DG) of streptozotocin- induced diabetic rats.METHODS: In this study, the male Wistar rats (n=40) were randomly allocated into five groups: control, control berberine-treated (100 mg/kg), diabetic, berberine-treated diabetic (50, 100 mg/kg) groups. Diabetes was induced intraperinoneally administration at the dose of 55 mg/kg. Berberine was orally administered at doses of 50 and 100 mg/kg/day one week after STZ injection for a period of 7 weeks. Blood samples were taken from the tail vein 1, 3, 5, 7 weeks after STZ injection to measure blood glucose levels and Y maze task and passive avoidance test were used for assessment of learning and memory deficiency. Moreover electrophysiological evaluation including: field excitatory post-synaptic potentials (fEPSP) and Long-term potentiation (LTP) in perforate path-DG synapses was assessed in order to investigate the effect of berberine on synaptic plasticity. Field excitatory post-synaptic potential (fEPSP) slope and population spike (PS) amplitude were also measured.FINDINGS: Increased blood glucose, reduced weight and short-term spatial memory in diabetic rats treated with berberine were improved (p<0.01). With respect to the control group (192±14), PS amplitude was significantly decreased in the diabetes group (112±12). In comparison to control group (112±12), chronic treatment with berberine (100 mg/kg) (192±10) improved PS amplitude (p<0.05). In addition fEPSP amplitude was significantly decreased in the diabetes group (121±6) in comparison to control group (167±11). In comparison to control group (152±6), chronic treatment with berberine (100 mg/kg) (147±3) improved fEPSP amplitude (p<0.05).CONCLUSION: This study showed that berberine treatment in dose dependent manner ameliorates memory impairment and improves synaptic plasticity in STZ diabetic rats.

BACKGROUND AND OBJECTIVE: Stroke is a major cause of mortality and long term disability in adults. It has been reported that the mechanical flow control (MFC) of brain reduces reperfusion injury. Therefore, in the present study the effect of MFC on embolic stroke model after delayed tissue Plasminogen Activator (tPA) therapy in ovariectomized-female rat was investigated.METHODS: In this experimental study thirty-two female rats (200 to 250 g) were divided into four groups as following: Control (ovariectomized and stroke induction), MFC (ovariectomized, stroke induction and occluded and released common carotid arteries), tPA (ovariectomized, stroke induction and tPA injection) and tPA+MFC (ovariectomized, stroke induction, tPA injection and occluded and released common carotid arteries). All animals were ovariectomized and one month later, stroke was induced by a natural clot injection into the right middle cerebral artery. tPA (0.9 mg/kg i.v) was administered at 6 h and MFC was induced at 6.5 h after the stroke by 5 cycles of occluding (30 sec) and releasing (30 sec) common carotid arteries. Infarct volume and neurological deficits were measured two days later and then compared.FINDINGS: Compared to the control group (32±1.6%), tPA (43±5.2%) increased the infarct volume (p<0.05) while combination of tPA+MFC (17±5%) significantly reduced it (p<0.001). Although tPA increased blood brain flow (p<0.001) and neurological deficits (p<0.05), application of MFC at 30 min after tPA administration, reduced both of them (p<0.001 and p<0.05, respectively).CONCLUSION: Based on our findings, late tPA therapy followed by application of MFC shows neuroprotective effects.

BACKGROUND AND OBJECTIVE: Reperfusion following brain ischemia is associated with releasing of different substances influencing the cerebrovascular diameter, which can alter cerebrovascular autoregulation as a homeostasis mechanism of brain blood flow. The present study was considered to evaluate the effect of transient focal cerebral ischemia on the brain blood flow autoregulation during early phase of reperfusion.METHODS: The experiment was performed on 12 rats that divided into two groups; sham and ischemic groups, n=6 for each group. In ischemic group, transient focal cerebral ischemia was induced with 60 min middle cerebral artery occlusion (MCAO) followed by 12 hr reperfusion. Regional cerebral blood flow (rCBF) was continuously recorded during experiment and lesion volume of right hemisphere was determined by tri-phenyl tetrazolium chloride (TTC) staining method 12 hr after termination of MCAO. Autoregulation of ischemic region was measured 30 min after beginning of reperfusion by transient increasing of blood pressure (intravenous injection of phenylephrine 0.01 g in10 mL saline with increasing 0.1 mg/min) and simultaneous recording of rCBF in ischemic region.FINDINGS: The means of cerebral blood flow in the ischemic regions was reduced by 80% in ischemic group compared with sham. Also ischemia/reperfusion induced infarction in a large area of right hemisphere in ischemic group (326±5 mm3). Increasing of arterial pressure from 90 mmHg to 170 mmHg did not change the focal cerebral blood flow of sham. But in ischemic group enhancing of arterial pressure up to 90 mmHg increased the blood flow of the ischemic regions.CONCLUSION: The findings of this study indicated that cerebrovascular autoregulation of ischemic region severely damage at the early phase of reperfusion following brain ischemia, which results in intensification of brain ischemia injury.

BACKGROUND AND OBJECTIVE: Irregular sexual cycle due of improper hormone secretion is most common cause of infertility. Considering fact that women experience twice the rate of depression as men and electroconvulsive therapy (ECT) is one of used treatment methods, therefore this study was conducted to investigate the effect of electric shock on secretion of sex hormones.METHODS: In this experimental study 60 albino mice (weighting 28±1.5 g and 9-12 weeks) with normal sex cycle were divided into 12 groups of 5 mice in each group after determining estrous cycle stages with vaginal smear: four control groups in our estrous cycle stages, four groups receiving one shock in each of four stages and four groups receiving two-shocks (with interval of 4 hours) in each stage of sex cycle. Shock operation was conducted with laboratory shock device and tolerable shock for mice. Blood samples were collected from mice in the same stage of receiving shock to measure sex hormones and assayed by ELISA method and compared.FINDINGS: Mean serum level of estrogen hormone showed significant difference only in the group receiving two shocks in metestrus stage (3.92±0.074) in comparison to control group of this stage (4.36±0.118) (p<0.05). Only in diestrus stage, mean serum level of progesterone of one-shock group (5.264±0.243) and two shock group (5.24±0.029) showed no statistically significant difference in comparison to control group (5.466±0.102).CONCLUSION: The result of study indicated that electroshock operation had no effect on serum level of both hormones just in diestrus stage of estrous cycle.

BACKGROUND AND OBJECTIVE: Neonatal sepsis is a major cause of death in neonates in developing countries. In empiric treatment, antibiotic therapy is usually started before pathogen identification. The purpose of this study was to determine the frequency and antibiotic resistance of common bacteria in late onset sepsis at the neonatal ward in Booali-Sina hospital of Sari, Iran.METHODS: In this cross-sectional and descriptive study, a total of 100 neonates with clinical diagnosis of late onset septicemia were admitted. Two blood samples were taken before antibiotic therapy and transferred to the bacterial medium. After 72 hour incubation, the samples were analyzed to determine bacteria isolates and antibiotic susceptibility test was performed by disk diffusion technique.FINDINGS: Among 100 neonates with suspected to late onset sepsis, 20 neonates had positive blood culture. Staphylococcus aureus (35%), klebseilla pneumonia (20%) and Escherichia coli (20%) were the major etiological agents. The percentage of the antibiotic resistance of the gram negative bacteria to ceftazidime, ceftizoxime, cefotaxime and ceftriaxone were 72.7%, 54.5%, 54.5% and 60%, respectively. The gram positive bacteria (100%) were resistant to oxacillin, and 77.7% were resistant to cefalotin and clindamycin. Vancomycin and imipenem were considered as the most potent antibiotic against gram positive and negative bacteria (sensitivity 100%).CONCLUSION: Gram negative bacteria developing resistance to cephalosporins was observed in this study. In conclusions, the empiric use of this drug should be associated with more attention.

BACKGROUND AND OBJECTIVE: Regarding increasing traffic accidents and major surgery in this region the number of patients who need intensive cares is increasing too. Determinants of outcome in patients admitted to the Intensive care unit are varied. The aim of this study was to evaluate the determinants of outcome in patients admitted to the surgical intensive care unit of Shahid Beheshti hospital (Babol, Iran).METHODS: This cross sectional study was carried on patients who were admitted to the surgical intensive care unit of Shahid Behishti hospital during 2009-2010. Information including gender, age and cause of admission, treatment process and length of stay extracted from files.FINDINGS: Out of 334 patients, 170 (50.8%) patients recovered completely, 102 (30.5%) with partial recovery discharged or transferred to other wards, 5 (1.5%) referred to other hospitals for further evaluation and treatment and 57 (17.2%) were died. There were meaningful correlation between outcome of patients and age (p=0.049), cause of admission (OR=0.52, 95%CI: 0.28-0.97) and length of stay (p<0.001). There was no meaningful correlation between outcome of patients and level of consciousness and intubation, mean arterial pressure and level of consciousness.CONCLUSION: Knowledge of determinants of outcome in patients of intensive care units may help to recognize high risk patients, optimum care planning and decreasing the mortality rate.

BACKGROUND AND OBJECTIVE: Chondroid syringoma is a relatively rare cutaneous mixed tumor arising from sweat gland and pleomorphic adenoma or benign mixed tumor is the most common salivary neoplasm. Because of morphologic and histopathologic similarities between chondroid syringoma and pleomorphic adenoma, these two lesions were previously considered together, however these tumors should not be mistaken with each other and must be differentiated from each other. The aim of this case report was to present a challenging lesion in buccal area of uncertain origin along with discussing about contributing features for defining the origin of lesion and accordingly its diagnosis.CASE: The lesion belongs to a 45 year old female with complaint of a mass in right buccal area that was surgically excised and submitted for histopathologic assessment. Histopathologic features were compatible with a mixed tumor and differentiation between a salivary gland pleomorphic adenoma and sweat gland chondroid syringoma was very difficult that along with discussing about their differences and similarities, we present our reasons for attributing this lesion to each of the above-mentioned diagnoses. After two years of patient's follow-up, recurrence of the lesion was not observed.CONCLUSION: Some features such as age, gender, presence of follicular or sebaceous differentiation, amount of keratinization, presence of single-layered ductal structures, presence of hyalinized stroma, presence of fatty tissue, presence of hyaline cells, presence of tyrosine-rich crystalloid and to some extent immunohistochemical staining could help in differentiation of chondroid syringoma from pleomorphic adenoma.