Scientific Journal of Kurdistan University of Medical Sciences
Year:2006 | Volume:11 | Issue:2 (Serial number 40)|Papers Count:15

Background and Aim: Postoperative hemorrhage is one of the most common serious complications after adenotonsillectomy requiring proper management during and after surgery. This study was conducted to compare effects of electrocoagulation versus suture ligation on control of bleeding after tonsillectomy. Materials and Methods: This was a blind randomized control trial study including children schedueled for tonsillectomy in Tohid hospital in Sanandaj from April 2004 to May 2006. 110 patient were entered into the study. Surgical indications were tonsillar hypertrophy with obstructive symptoms and recurrent tonsillitis. Method of anesthesia was the same for all the patients and method of surgery was dissection by use of snare. All operations were performed by the same surgon. To control bleeding, suture ligation was used for the left and electrocoagulation for the right side of the operation site in the same patient. The sites of electrocoagulation and suture ligation were alternately changed in the next patients. The time spans required for suture ligation or electrocoagulation, primary and secondary postoperative bleeding, local and recurrent pain, formation of whitish memberane along with its sloughing and cicatrization of tonsillar fossa were recorded. The collected data were analyzed by use of SPSS win and x² and t- student tests. Results: 46 female and 64 male patients, with mean age of 9 ± 2.7 years were entered into this study. The overall primary and secondary postoperative bleeding rate was 1.8% and 2.7% respectively. Primary bleeding in electrocoagulation site included 0.9% and in suture ligation site 0.9% (p<0.05). All the cases of the secondary bleeding occurred in suture ligation site (p<0.05), massive bleeding was detected in 0.9% of the patients, all of them in the electocoagulation sites. There were no significant correlation between pain after tonsillectomy, recurrent pain, duration of cicatrisation and method of haemostasis (p>0.05). Conclusion: Results of the study showed no significant difference between electrocoagulation and suture ligation in controlling post tonsillectomy bleeding, but secondary bleeding in electrocoagulation was less common than that in suture ligation. In order to control bleeding from vessels, suture ligation is more suitable than electrocoagulation.

Background and Aim: Cold injury has been used as a useful model for studies of traumatic brain injury. This model is used to induce brain edema. Brain edema is a pathophysiological condition of increased brain water content due to a variety of coexisting brain injuries, including ischemia, trauma, tumor and infection. The purpose of this study was to evaluate the effects of cold injury on sensorimotor cortex of mouse.Materials and Methods: 15 male NMRI mice, 6- 8 weeks old every one of them with the weight of 30- 35 gr (5 mice per group) were studied. To produce cold injury a metal probe cooled with liquid nitrogen and was applied to the surface of the intact skull above the parietal lobe by force of 100 gr for 30 sec. Brains were removed 72 h after cold injury, 10 µm serial sections were obtained following fixation, processing and blocking of the brain. The sections were stained using creysl fast violet. Sensorimotor cortex was recognized and 35 fields were chosen randomly to be studied. To do morphometrical study on cortex of frontal and parietal lobes, the cells with a nucleus diameter of 10µm were determined. The data were analyzed by means of ANOVA and TUKEY'S HSD test.Results: The results indicated that the number of alive neurons in the model group was significantly (p<0.05) lower than that of control groups.Conclusion: Cold injury decreases the number of normal cells of sensory motor cortex and leads to cell death.

Background and Aim: Pityriasis versicolor (tinea versicolor) is a common fungal disease and many topical and systemic drugs have been used for its treatment. But more or less the treatment results had been similar with high recurrence rates. The aim of this study was to compare the therapeutic effects of Artemisia sieberi 5% lotion with clotrimazole 1% lotion in the treatment of tinea versicolor. Materials and Methods: This was a double blind RCT study. 100 patients were divided into group 1 and group 2 by block randomization. Group 1 and group 2 comprised 51 and 49 patients respectively. Artemisia sieberi and clotrimazole lotions started for group 1 and group 2 accordingly and continued for 2 weeks. The patients were evaluated from clinical and laboratory points of view. The data collected were registered in check lists, introduced into SPSS win, and analyzed by means of independent T, x2 and fisher’s tests.Results: in our study the cure rates at the end of the second week, from clinical point of view were 86.3% and 65.3% in group 1 and group 2 respectively (p=0.013), but from laboratory point of view the cure rates were 92.2% and 73.5% with a significant relationship (p<0.010). Also 4 weeks after treatment (2 weeks after discontinuing the drugs) clinical improvement reached 86.3% an 59.2% in group 1 and group 2 respectively (p<0.01) which reveals an important relationship. In microscopic study, after 4 weeks the smears were negative in 96.1% and 65.3% of the patients of the group 1 and group 2 accordingly which disclosed a significant relationship (P<0.01).Conclusion: The results of this study indicates that Artemisia sieberi lotion was more effective and had less recurrence rate than clotrimozole lotion in the treatment of pityriasis versicolor.

Background and Aim: Type 2 diabetic patients are at increased risk for the development of complications including cardiovascular, nephropathy and neuropathy. The increased risk is not fully explainable by factors such as dyslipidemia and hypertension. Therefore, oxidative stress has proposed as an alternative explanation although the underlying mechanism(s) is not clearly understood. The objective of the present study was to evaluate plasma prooxidant/ antioxidant status in uncomplicated type 2 diabetic patients. An aged- matched group of non -diabetics was used as control group.Materials and Methods: In this case-control study, 20 type 2 diabetic patients 7 males and 13 females (44.2±0.7 years) and 20 non- diabetic patients 12 males and 8 females (43.2±0.9 years) were entered into this study. Plasma malonedialdehyde, total glutathione, catalase and superoxide dismutase were dertermined spectrophotometrically and level of vitamin E was measured by HPLC. Statistical analyses were carried out by means of the SPSS-Win version 10 soft-ware package. Results: The glutathione levels and vitamin E/triglyceride ratios in diabetic patients were lower than those of non diabetics (148.8±15.5 nmol/L vs 192.9±54.4 nmol/L; p<0.05 and 14.4±1.6 mmol/mmol vs 17.0±1.1 mmol/mmol; p<0.05; repsectively). Compared to control group, diabetic patients exhibited slightly higher levels of malonedialdehyde (196.1±10.7 nmol/L vs 175.2±20.4 nmol/L). Catalase content and superoxide dismutase revealed different activities in diabetic and control groups but the differences failed to show any statistical significance (571.9±65.3 mg/L vs 541.1±67.4 mg/L and 0.29±0.06 OD vs 0.26±0.01 OD, respectively). Conclusion: This study revealed that plasma markers of oxidative stress, when compared with control group, were slightly altered in uncomplicated type 2 diabetic patients. These data provide additional support for the hypothesis that oxidative stress precedes the development of diabetic complications.

Background and Aim: Hepatitis-B virus (HBV) is one of the most common chronic pathogens in the world. More than 2 billion people in the world have been exposed to this virus and 350 million of them (5% of world population) are chronic carriers of HBV. One of the most common ways of transmission of this virus is transfusion of blood and its products. For this reason blood transfusion organization controls all blood products for HBsAg. In HBV chronic carriers viral replication should be detected by use of suitable antigenic markers such as HBeAg. Therefore HBeAg positive patients with elevated liver enzymes can be recognized and treated for chronic hepatitis. The aim of this study was to detect prevalence rates of HBeAg positivity, elevated liver transaminases in HBsAg positive individuals, and recognition of chronic hepatitis patients in Sanandaj from 1383 to 1384. Materials and Methods: This study was a descriptive-analytic cross sectional study. The sampling method was census. 139 HBsAg positive people between 18-65 years of age were entered into the study.Results: According to the results of this study 20 subjects (14/4%) were HBeAg positive with no significant correlation between the male and female ratio. Measurement of liver transaminases at the same time showed that 7 HBeAg positive patients (35%) had higher than normal serum AST levels (≥47 IU/L) (p=0.001) and 8 other (40%) had higher serum ALT levels (≥47 IU/L) (p=0.000). In general in 7 (35%) HBeAg positive patients both AST and ALT were elevated but only 7 HBeAg negative persons (5.9%) had elevation of both enzymes. Conclusion: This study revealed HBeAg positivity may be considered a risk factor for elevated aminotransferases levels and chronic hepatitis was prevalent in a significant number of HBsAg positive blood donors, but severe liver disease was absent.

Background and Aim: Prophylactic anti-biotherapy in acute appendicitis is necessary to prevent peritonitis and gangrene of appendix. But anti-biotherapy in the first 24 hours after appendectomy in acute supurative cases requires further investigations. The aim of this study was to evaluate the effect of anti-biotherapy on prevention of the complications of the surgery and duration of hospitalization. Materials and Methods: This is a prospective blind clinical trial study from 1379 to 1382 in 3 university's hospitals in AHWAZ including all the cases of supurative appendicitis. In this study 200 patients were divided into two equal groups. In one group cefazolin and metronidazole were prescribed for the purpose of prophylaxis before surgery and in the other group, in addition to prophylactic anti-biotherapy, cefazolin and metronidazol continued for another 24 h after surgery. Then the patients were followed up for 2 months to be examined for wound infection, abdominal and pelvic abscesses, wound dehiscence and duration of hospitalization. Results: In this study, 200 patients 56% male and 44% female were divided into two equal groups. Mean age of the patients was 18.5 years (15-40). The first group received antibiotics for 24 h after operation. But wound infection and post operative fever were detected in 4% and 6% of these patients respectively and mean days of hospitalization was 2.6 days (2-7 days). In the second group without post operative anti-biotherapy incidence rate of wound infection and post operative fever were 4% and 8% respectively and the mean days of hospitalization was 2.8 days (2-7 days). There were no abdominal or pelvic abscess and wound dehiscence in both groups. In this study incidence of wound infection (p=1.00) and post operative fever (p=0.58) and mean days of hospitalization (p=0.68) were similar in both groups and there were no significant statistical differences.Conclusion: It seems that post operative anti-biotherapy in supurative appendicitis is of no value in reducing the incidence of wound infection, post operative fever and mean number of days of hospitalization.

Background and Aim: Needle stick injuries can cause transmission of 3 important blood viruses (HCV-HBV-HIV) to health care personnel. Generally these injuries inflict loss of life and property on the health care personnel, so that the medical associations of different industrial countries have scheduled important plans in order to take care of patients, provide personnel education and guarantee the health of physicians and medical staff. Considering the prevalence rate of blood-borne diseases in African and Asian countries, as well as our country, it is important to scrutinize the reasons and prevalence rate of these injuries to take proper preventive measures. This study was conducted with the aim of determination of the prevalence rate of needle stick injuries in the personnel of health care centers of Kurdistan’s medical university.Materials and Methods: This descriptive-Analytic study was conducted in the university’s hospitals. A questionnaire including necessary information was designed and sent to the personnel of the hospitals. The sampling method was census. 847 individuals filled out the questionnaires. The collected data were analyzed by means of SPSS statistical software.Results: The findings of this study showed that the majority (73.7%) of the subjects were female. The mean age was (36.1±7.07) years old. Most of the subjects had the bachelor degree (47.9%); (74.5%) of them were nurses, %5.5 midwives, 3.3% anesthetists, 7.7% personnels of the laboratory and 9% were the radiology staff. About 57.5% of the subjects had experienced splashing of blood or secretions into their mouth or eyes. In most cases, needles and angiocatheters were responsible for injuries in 43.77% and 35.3% of the cases respectively. According to the staff's opinion the most important predisposing factors included haste and being inundated with work. There was a significant difference between professions and needle stick injuries (p<0.05).Conclusion: Prevention of needle stick injuries should be regarded a priority. Providing safe medical equipments regardless of their costs, in addition to necessary education for health care staff, should be taken into consideration. Special centers for treatment and follow up of the injured personnel should be allocated.

Background and Aim: Parasites infect man by way of water, soil, edible things and direct contact. Numerous factors such as the economical, social and cultural conditions as well as lack of personal health care are involved in the dissemination of the parasites. Eating of raw vegetables is common among Iranians and provides a rich source of vitamins and essential nutrients but may lead to human contamination if not washed properly. Materials and Methods: In this study 30 plant farms were selected in Isfahan in order to assess the rate of contamination of the plants. Afterwards 480 samples of the vegetables were collected and examined for cysts, eggs and larvae in Isfahan Research Center. Floatation method was used for detection of the parasite eggs. Finally the results were recorded and analyzed by means of SPSS (Version 11.5).Results: We found giardia cyst in 7, dicrosoelium egg in 8, hymenolepis egg in 14, ascaris egg in 16, trichostrongylus egg in 10, teania egg in 5 and trichosephalus egg in 6 cases. In fact, egg of ascaris was the most and teania was the least common parasites and fortunately we did not detect any dangerous agent like Entamoeba histolytica. Conclusion: In the recent years, in spite of improvement of health care, economical, social and agricultural conditions in Isfahan, parasitic infections are still prevalent. Using new methods for garbage collection, repair of ego system, preventing domestic and wild animals (like carnivorous animals) from entering into the plant farms and education of people of different social classes will be effective in reducing parasitic and infectious diseases.

Background and Aim: Osteoporosis is the most common metabolic bone disease. This study deals with prevalence of osteoporosis, osteopenia and their related factors in post-menopausal women who had referred to Kurdistan densitometry center in Sanandaj.Materials and Methods: This descriptive-analytic study included 305 post-menopausal women without previous history of osteoporosis who had referred for densitometry to Kurdistan densitometry center from 1382 to 1383. Sampling method was census. Patients with secondary osteoporosis were excluded. Data were extracted from a questionnaires filled out by the subjects. Bone mineral densities of femoral neck and second to fourth lumbar vertebrae were measured by DXA method. The results were expressed on the basis of T-score. Osteoporosis and osteopenia were defined as T<-2.5 and -2.5<T<-1, respectively, according to who criteria. Data were introduced into SPSS software and analyzed by descriptive and analytic methods. Results: The mean values for age, weight and menopausal time period in the post- menopausal women were 57.7±7.6 years, 65.4±10.4 Kg and 10±8.3 years, respectively. The mean values for T-scores in the femoral neck and lumber spine were –1.83±1.18 and -1.57±1.01 and the global prevalence of osteoporosis and osteopenia were 34.4% and 69.8%, accordingly. Only 14.8% of the post-menopausal women had normal bone mineral density. Osteoporosis had statistically significant relationship with age, menopausal time period, weight and exercise (p<0.001). History of previous fracture had an important relationship with osteoporosis of the neck of femur (P<0.001).Conclusion: This study revealed that osteoporosis and osteopenia were common among the post-menopausal women and prevalence of osteoporosis was almost similar to the profiles of other developing countries, was higher than those of developed countries.

Background and Aim: Trace elements have been considered to play critical roles in bone metabolism. The aim of this study was to determine serum zinc profile and its association with bone mineral density (BMD) abnormalities in thalassemic patients.Materials and Methods: Serum zinc levels of 131 transfusion-dependent β-thalassemic patients, between 10-20 years of age, were measured by flame-atomic absorption spectrophotometry (F-AAS). BMD values at lumbar (L1-L4) and femoral neck were determined by dual x-ray absorptiometry (DXA). Daily dietary zinc and calcium intake were evaluated by food frequency questionnaires. Patients’ history of treatment and demographic data were obtained.Results: Low serum zinc was present in 84.8% of the patients and severely low levels detected in 44.7%. In 68.7% and 17.6% of the patients BMD z-scores less than (-2) were observed at lumbar and femoral regions. Female patients with severe zinc deficiency had lower lumbar BMD z-scores (-3.26) in comparison to other females (-2.54). Serum zinc levels of female patients with femoral BMD z-scores less than (-2), were significantly lower than those of other females. Conclusion: Considering low serum zinc level and decreased daily zinc intake, proper nutrition of thalassemic patients showld be regarded important.

Background and Aim: In spite of new medications, there is no effective treatment for OCD patients. At the present time strong association between OCD and the range of bipolar disorders is more evident. In these patients, the change of mood and the appearance of the fast mood cycles during medical therapy with antidepressants is a real hazard. In this view, medical therapy with anti OCD which is not accompanied by antidepressants, is of considerable theoretical and clinical value. This research deals with the assessment of the effect of naltrexone on OCD.Materials and Methods: This study included 23 patients with OCD who had received clomipramine, fluextine or a combination of both for at least 3 months. Continuing these drugs with the same doses, naltrexone 25-100 mg/day was also started for the patients. Lack of response and unbearable drug side effects occurred in 3 and 4 patients respectively, leading to deletion of these patients from the study. Ultimately 16 patients (9 women and 7 men) took part in this study actively. All the patients were assessed by means of YBOCS before and after treatment. The data were analyzed by Wilcoxon, Kolomogrov-Smirnov and T tests.Results: The grades of minor criteria for obsession, compulsion and total of YBOCS were decreased significantly after treatment and also the severity of OCD reduced. 2 patients remained free of symptoms of OCD for more than 6 months after stopping Naltrexone and the other medications. In this study, OCD was most commonly associated with bipolar disorders.Conclusion: Regarding the small sample size and the openness of the question, the validity of these results is limited, but it appears that Naltrexone is at least effective on some subgroups of OCD especially those associated with bipolar disorders. The study of long term effects of Naltrexone after the termination of treatment is recommended in the future.