JOURNAL OF GORGAN UNIVERSITY OF MEDICAL SCIENCES
Year:2010 | Volume:12 | Issue:2 (34)|Papers Count:19

Background and Objective: Change in the cell surface and extracellular matrix glycoconjugates has been reported in many cancers. Moreover, diagnostic and prognostic importance of these substances and also their roles in therapeutic modalities for cancerous patients has been emphasized. This study was designed to explore the histochemical study of cellular mucopolysaccharides in esophageal and gastric carcinoma and its relation to tumor differentiation.Materials and Methods: In this laboratory study tissue samples of 40 patients with esophageal squamous cell carcinoma and 40 patients with stomach adenocarcinoma in different grades of tumor were selected from pathology department of Emam Reza hospital in Mashhad, Iran. Tissue samples were stained with Alcian Blue (PH 1 and PH 2.5) for Sulfated and Carboxylated mucosubstances respectively, along with positive and negative controls.Results: Normal esophageal epithelium and carcinoma cells of different grades showed negative reactivity but normal and tumoral stromal cells depicted positive staining in both PHs. In PH 1, normal glandular and carcinoma cells of the stomach were negative but in PH 2 glandular cells were positive though carcinoma cells showed weakly staining. Normal and tumoral gastric stromal cells showed positive staining in PH 1 and PH 2.5.Conclusion: It is highly probable that in the process of cancerization of normal esophageal squamous cells, functional changes, from the perspective of producing Carboxylated and Sulfated mucosubstances, do not occur, whereas some changes in glandular cells of stomach which result in diminishing the production of Carboxylated mucosubstances during cancerization process are observable.

Background and Objective: Until now there is no drug formulated to prevent Neuronal Loss following Brain Stroke. In this study, we compared the effects of the mitoKATP opener, diazoxide, on ultra-structural morphology changes following in cortical neurons following in-vivo ischemic injury.Materials and Methods: In this experimental study, Rats randomly allocated in eight experimental groups including sheme, positive control, 1, 5 and 25 mg/kg/body weight of Glybanclamid groups and 2, 6 and 18 mg/kg body weight of Diazoxide experimental groups, respectively. In animals in each experimental group, only 2 hours following adminstration of Diazoxide or Glybanclamid ischemia was induced for 15 min by the 4-vessel occlusions surgery followed by 24 hours reperfusion. After tissue prosseccing, ultra-structural changes in neuronal mitochondria and nuclei were studied by electromicroscope.Results: Ultrastructural morphological changes including nuclear pyknosis, swollen mitocondria and cristae damage after iscemia were observed in control and sheme groups. These changes were severe in Glybanclamid experimental groups. Also these changes were depending on dosage of Glybanclamid. Ultrastructural changes were decreased in Diazoxide treatment group (18mg/kg body weight), but in 2 and 6mg/kg/body weight of Diazoxide groups these decreasing of Ultrastructural changes was not observed.Conclusion: This study showed that Diazoxide with dosge of 18mg/kg/body weight has neuro-protective effects on diminishing ischemia-induced structural deterioration of neuronal mitochondria and morphological apoptotic changes in nucleus.

Background and Objective: Patent ductus arteriosus (PDA) is a common problem in preterm infants which can result in serious hemodynamic changes causing respiratory and cardiac morbidities if not treated in the first week of life. The treatment options available are pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The cyclo-oxygenase inhibitors approved for use are indomethacin and ibuprofen which have been used with different routes of administration and dosages. This study was conducted to evalute the lower and standard dose of oral ibuprofen in patent ductus arteriosus closure in preterm infants.Materials and Methods: In this clinical trial study, 44 preterm infants (<35 weeks gestational age) were randomly assigned to receive either a low dose (0.2mg/kg/dose for 3 doses, 24 hours apart) ibuprofen or a standard dose (10mg/kg/dose for the first dose, followed if needed, at 24hours interval by one or two additional doses of 5mg/kg each). These premature neonates either had clinical signs of patent ductus arteriosus or were diagnosed by echocardiography before stabilization of clinical signs. Patent ductus arteriosus closure was confirmed by echocardiography. They were under observe for drug's side effects (oliguria/anuria, GI bleeding, serum creatinin, intraventricular hemorrhage) and their clinical course was recorded.Results: The patent ductus arteriosus closure rates were the same with both doses (74% in case group vs.76% in control), 5 infants in the case group (22%) and 3 infants in the control group (14%) did not respond to the first course of therapy and needed a new course. There was a significant more rate of reducing renal output with the standard dose 33% vs. 4% (P<0.05), but the serum creatinin level was not different between two groups. One infant (4%) in the case group and 3 infants (14%) in the control group had GI bleeding. There was not any difference in intraventricular hemorrhage grading between two groups.Conclusion: This study showed that inspit of lower renal side effect, the low dose oral ibuprofen in comparison to standard dosage did not have any meaningful difference in closure of PDA in preterm infant.

Background and Objective: Using of laryngeal mask air way (LMA) was recommended for air way management in short duration elective surgeries. One of its side effects is the increasing of secretion of air way and subsequently laryngospasm. Anticholinergic drugs (hyoscine NBB and atropine) have been administrated to reduce of these side effects. This study was carried out to compare the atropin and hyoscine n-butylbromide (NBB) on hemodynamic and nausea and vomiting in anesthesia with laryngeal mask air way.Materials and Methods: In this randomized double- blind control trials, 100 patients (20-50 years) with class 1 and class 2 of Anesthesia, have been operated less than one hour under general anesthesia with LMA during 2007-08 in Beheshti hospital. These patients were divided to 2 groups every other one randomly with equal persons. After controlling the base of heart rate (HR) and mean arterial pressure (MAP), both groups was administrated to premed according weight. Then 0.5mg/5ml atropine to the first group and 10mg/5ml hyoscine NBB (Buscopan) to the second group was injected and hemodynamic was controlled after two minutes. Anesthesia with thiopental sodium was induced and LMA was inserted. Then hemodynamic was controlled during the time. The amount of secretions of air way was investigated according to the numbers of suction at the end of surgery and after removing of LMA. The severity of postoperative nausea and vomiting was assessed with attention to need of patients to antiemetic until 6 hours. Data was analyzed statistically.Results: Antiemetic effect of atropin and hyoscine n-butylbromide (NBB) was similar. With mild secretions, moderate and sever antisialague effect of hyoscine NBB was 80%, 18% and 2% and in atropine group was 72%, 22% and 6% retrospectively. Heart rate increase (less of 20%) without rising MAP was obsered in two groups.Conclusion: This study showed that the effects of hyoscine and atropine in decreasing airway secretions, nausea and vomiting are similar.

Background and Objective: Several studies have demonstrated the importance of a coordinated, synchronized action of a scapular and glenohumeral muscles. Minimal alteration in performance and coordination of these muscles has the potential to lead to joint dysfunction. The impingement syndrome is the most common diagnosis of shoulder pain. The purpose of this study was to determine whether strength deficits could be detected in patients with shoulder impingement.Materials and Methods: This case – control study was done on 15 patients with impingement syndrome and 15 healthy matched persons by nonprobability sampling in Tehran, Iran during 2008. Strength of glenohumeral and scapulothoracic muscles was tested with a hand held dynamometer. Independent and paired t-test was used to statistically analyze between and within groups differences.Results: Compared to non impaired subjects, those with impingement syndrome demonstrated a significantly lower strength of shoulder muscles (P<0.05). The strength deficit between involved and noninvolved sides of patients was determined (P<0.05). In impingement syndrome patients, the external-to-internal rotator muscles strength ratio was significantly lower than on the control group (P<0.05).Conclusion: The result of this study suggests that strength deficit of shoulder muscles may be an important aspect of the impingement syndrome. Muscular strength assessment should be considered in evaluation and effective treatment of a patient. Physical therapy treatment should be emphasizing strengthening of weak muscles.

Background and Objective: Visceral Leishmaniasis or Kala-azar is an important infectious disease in northwestern Iran. Members of the Leishmania donovani complex, L. donovani and L.infantum, are the two main parasites causing the disease in the world. In this study immunophenotype characters such as N-glycosylation, and T-cell and B-Cell epitopes of CPB gene was evaluated in the Leishmania parasites isolated from sandflies of the region.Materials and Methods: Partial of the CPB (702-741 bp) of Leishmania parasites was amplified and sequenced and used for bioinformatics analysis such as test three dimensional (3D) protein structure, N-glycosylation, and T-cell and B-Cell epitopes.Results: In 7 out of 3477 sand flies there was a positive PCR test for systeine protease B, gene. Also according to findings of this study, both agents of kala-azar L. donovani and L. infantum were bing transfered by sand flies of Phlbtomus perfiliewi transcaucasicus in North West Iran. DNA analysis of the CPB gene showed a cytosine insertion at 5’ end of the proofreading frame of the gene resulted in a stop codon (TGA) seven AA further down and hence translation is halted. This caused a short amino acid chain with only 76 AA much shorter than normal CPB peptide with 234-247 AA. This mutation has not been found in the L.infantum strain resulted in a normal CPB peptide. AA analysis showed no N-glycosylation site, T-cell and B-Cell epitopes on the short peptide of the L. donovani strain.Conclusion: This is the shortest CPB peptide chain reported for the L. donovani complex in the literature. This short peptide could have an effect on host-parasite and vector-parasite interactions. Since the CPBs genes have important implication on host–parasite and play key roles in infection and expression of the disease, further studies on the L. donovani parasite and its diminutive peptide necessitate to improve our understanding about the epidemiology of visceral leishmaniasis in Iran.

Background and Objective: Destructive effects of thyroid diseases in pregnancy and fetal frowth are well established subclinical autoimmune thyroid diseases can double the rate of preterm labor, abortion and postpartum thyroiditis. This study was done to compare thyroid function and autoimmunity derangment in goiterous and non-goiterous pregnant women.Materials and Methods: This case - control study was done on 100 healthy and 100 goiterous pregnant women in Dezyani hospital located in Gorgan, Northern Iran during 2005. Five mililiter of blood sample was obtained from each subject to measure thyroid hormones concentration including T3/ T4/ TSH/ T3 RUP and thyroid autoantibodies (Anti Tg/Anti TPO). Thyroid hormone and auto antibodies were measured using IRMA and ELISA techniques.Results: Thyroid volume was enlargel twice and tripl of its orginal size in 34% and 66% goitrious pregnant women respectively. Mean serum TSH in cases and controls were 1.81±1.33 microU/ml and 1.84±1.4 microU/ml respectively. The mean of Anti TPO and Anti Tg in cases were 373.91±197.36 U/ml and 248.80±70.59 U/ml respectively. The same indecs for controls were 79.52±63.99 U/ml and 248.80±70.59 U/ml respectively. In pregnant women with goiter 36% had high Anti TPO and 9% had high Anti Tg, but in control group 16% and 4% of controls had elevated Anti TPO and Anti Tg, respectively.Conclusion: According to thyroid function tests there were elevation of antibody in 20% of the healthy subjects and 45% of the goiterous subjects, therefore it is advisable to measure thyriod function tests accompanied with thyriod antibodies in all pergnant women either with or without goiter in order to prevent feto-maternal disorders.

Background and Objective: Computerized tomographic angiography (CTA) is a minimally invasive modality to image the vasculature without the morbidity of direct large vessel vasculature access and its major indications in urology are assessment of the renal vasculature in preparation for donor nephrectomy, identification of extravessel in evaluation of ureteropelvic junction obstruction and for diagnosis of renal artery stenosion. This study was done to evaluate vescels of kidney donors using CTA and formal angiography and comparison with intraoperative findings.Materials and Methods: In this descriptive study, kidney vessels of 70 and 30 living kidney donors were assessed with computerized tomographic angiography and formal angiography respectively. The patterns of vessels of kidney during operation were examined. Two observers assessed the findings of preoperative CTA and formal angiography with intra operation observations.Results: In CTA group there were two patients each with two main renal veins which were observed during operation was not recorded on computerized tomographic angiography. In formal angiography group there was one patient with unrevealed two main renal veins prior to surgery. In both groups, the accuracy of anatomical diagnosis of the main kidney artery was 100%.Conclusion: This study showed that kidney vascular assessment by either the computed tomography angiography or formal angiographies have similar clinical diagnostic accuracy.

Background and Objective: Lower ureter is the most common site of stone traped causing renal colic and hydroureteronephrosis. If medical therapy is not effective, the treatment consists of extracorporeal shock wave lithotripsy (ESWL), transurethral lithotripsy (TUL) or on rare cases, open surgery. This study was done to compare the ESWL with TUL in sixty patients with lower ureteral stones which did not responed to thraputic regiment.Materials and Methods: This prospective cohort study was done on sixty patients with obstructive lower ureteral stones for more than 3 weeks that have not been responded to the thraputic regiment in Imam Reza hospital, Mashhad, Iran during 2004-06. According to treatment indications sixty patients divided in two equal ESWL and TUL groups. Success of procedure was evaluated by ultrasonography and KUB radiography. The success rate of two different technique and the side effects in each patients was recorded.Results: In ESWL group in 14 patients (46.66%) the stone was broken and its particles were removed but in 13 patients (43.33%) the stone was not broken and they became candidates for TUL. In 3 patients (10%) the stone was broken but the particles did not pass. The only complication of ESWL was renal colic which was in 15 patients (50%) and cured by medical treatment. In TUL group, in 93.5% of patients, the stone was broken and particles were removed, but in 6.5% the procedure was not successful and the patients underwented ESWL or open surgery. 10% of patients experienced fever and colic pain, who underwented medical treatment.Conclusion: This study showed that TUL technique has higher successful rate than ESWL technique in lower uretaral stones.

Background and Objective: Cardiac arrest is responsible for half of the death cases, which is preventable in rapid and effective cardiopulmonary resuscitation (CPR). During the last years, a great amount of progress has occurred in this field, but there is still a lack of enough data for CPR. The aim of this study was to assess and compare the survival rate of patients undergoing CPR in two university hospitals in Tehran, Iran.Materials and Methods: In this retrospective analytical study, the survival rate of 178 patients undergoing CPR in the emergency department of two university hospitals (Taleghani and Shaheed Modarres) were assessed and compared during 2005. The related variables including the time delay for CPR, the time length for CPR and the outcome of CPR were analyzed.Results: 24 hours after the cardiac arrest, 7 cases of 54 (13%) survived in Taleghani hospital and 33 of 124 (26.6%) survived in Shaheed Modarres hospital (P<0.05).Conclusion: This study showed that the rate of short term survival of patients after CPR is similar to other parts of country but lower than the other parts of the world.

Background and Objective: Acquired immunodeficiency syndrome (AIDS) is a definition of dysfunction of immune system in human that is induced by infection with a virus named; human immunodeficiency virus (HIV). The most high risk group in HIV infected people is intravenous drug users (IDUs) with unsafe sex. This study was conducted to evaluate knowledge and attitude of IDUs with unsafe sex about AIDS and relation with socioeconomic levels in Golestan province in North of Iran.Materials and Methods: This Cross-Sectional study was conducted on 134 IDUs in Golestan province during 2007. Samples were chosen by a random systematic method. Data was collected with interview by standard questionnaire. Data was analyzed by SPSS-16 and One-way ANOVA, T-test student, Kruskal-wallis, Mann-Whitney U and Kendall tests.Results: This study showed that 36.6% of samples had moderate knowledge about AIDS and 49.3% of them had negative attitude about AIDS. 67% of subjects had education between 6-12 years, 44.8% were married and 53% were jobless and without income. Level of knowledge had a significant relation with age (P<0.05) and education level (P<0.05). Older subjects had better knowledge. Level of knowledge in 25-34 years group was higher than other age. Well educated people had higher knowledge compared with low educated and illitrate subjects. Level of knowledge had a significant relation with attitude (P<0.05).Conclusion: The findings of this study showed that 65% of subjects with high risk behavior on HIV/AIDS had a appropriate knowledge about transmission of HIV, but half of these population have a poor HIV/AIDS attitude.

Background and Objective: Diagnosis of latent tuberculosis infection (LTBI) by tuberculin skin test (TST) is accompaind with limitations. A few documented data exist regarding the performance of serology tests for LTBI diagnosis in HIV infection. The aim of this study was to determine LTBI prevalency and compare TST results and IgM antibodies against M.tuberculosis antigens (IAMA) for the diagnosis of LTBI in HIV infected individuals.Materials and Methods: In this descriptive study, sixty two HIV infected subjects were chosen randomly from an addict treatment center in Ahvaz southwest Iran during 2008. The patients underwent TST, using 5 TU of purified protein derivative, and IAMA was measured. Data were analyzed using SPSS-15 software and Chi-Square test.Results: From 62 studied cases, 34 (54.8%) had positive result for TST, whereas 6 (9.7%) had positive IAMA. LTBI was diagnosed in 37 (59.7%) by either TST or IAMA. Overall concordance between TST and IAMA was 45.2%. In subjects with positive test by either TST or IAMA, only 4.8% had positive test by either diagnostic procedure. Discordant results were found in 54.8% of subjects. Positive results for both diagnostic methods in subjects with above and below 200 CD4-cell/mm3 did not show any significant differences.Conclusion: This study showed that LTBI prevalence among HIV infected individuals among addict patients, in this region is higher than other parts of the world. Also TST is a useful test for LTBI diagnosis is preferable to IAMA method.

Background and Objective: Quality of medical articles is effective at improvement of medical science. This study was done for determining of published medical articles quality in approved Medical Journals.Materials and Methods: This cross- sectional study was done on 690 medial articles, which published between 1983-2005 in scientific journals, approved by special Medical Journal committee of Ministry of health and medical Education (MOHME) in Iran, during 2007. Source of data was indexed medical journal in the Iranmedex database.Results: Type of study in 52% of articles was descriptive, 21.2% was interventional and 5.8% of them were analytical. In recent years the number of analytic and interventional articles have been increased significantly in comparison to other types (P<0.05). There was no qualitative type article in published papers. The percentages of original, case report and review articles were 44.9%, 36.9% and 14.1%, respectively. In recent years the rate of original articles has increased in comparison to case report and review articles (P<0.05). In 80% of articles, at least one statistical test was applied. 60% of articles were clinical and 82% of them have been written in Persian language.Conclusion: Findings showed an increasing trend in quality indexes of published articles. It seems in recent years, the changes of MOHME policies in evaluation of  the research deputy of medical science universities; implementation of research and scientific writing workshops; ratting protocol of approved medical journals; and academic members promotion guidelines, resulted in improvement qualitative index of articles.

Vulvar melanoma is a very rare tumor with the rate of 0.1-0.19.100000. It mostly occurs during post menopausal period. In this case report, our patient was a 43 years old woman, her symptom was a small pruritic lesion noticed two months earlier when she was referred to the clinic. This lesion was a 5mm diameter dark brown and flat on her left labialis minor. Malignant melanoma with 3-5mm thickness was diagnosted following biopsy. Wide local excision with more than 2cm free margin and inguino femoral lymphadenectomy at the site of the lesion was done. The recurrence of tumor was not abserved during four months follow-up.

Buschke-Lowenstein Tumor (BLT) or Giant Condyloma Acuminatum (GCA) is a slow-growing, locally aggressive, cauliflower-like tumor of great size that usually arises in the perineal region. Buschke-Lowenstein Tumor is triggered by human papilloma virus (HPV), usually either genotype 6 or 11. Buschke-Lowenstein Tumor is usually preceded by condyloma acuminatum and occurs at any age after puberty, usually between the 4th and 6th decades. Invasive overgrowth and recurrence after treatment are its characteristics and malignant transformation is also possible. Here, we have reported a case of a 33 year-old man with penile Buschke-Lowenstein Tumor arising from common genital warts.