Journal of Gorgan University of Medical Sciences
Year:2013 | Volume:15 | Issue:2 (46)|Papers Count:22

Background and Objective: Femoral shaft traumatic fracture is one of the major causes of mortality and morbidity. Nowadays, the standard treatment method in adult is reduction with femoral interlocking intramedullary nailing. This study was performed to compare the open and closed methods femoral interlocking intramedullary nailingin femoral shaft fractures treatment.Materials and Methods: This clinical trial study was done on 40 18-50 year old patients (33 men and 7 women with mean age of 26.3 years) with femoral shaft closed fracture who were referred to the Shahid Kamyab hospital of Mashhad, Iran during 2007-08. Patients were divided into two 20 membered groups of open and close femoral interlocking intramedullary nailing treatment. Subjects were followed for one year and the union time, infection and non-union level were measured. Clinical and radiological findings were analyzed using SPSS-13, Student’s t-test and Fisher's exact test.Results: 97.5% of union was obtained within six months in both groups. Full weight bearing was determined 6-12 weeks (mean of 9.3 weeks) in close and 12-16 weeks (mean of 13.25 weeks) in open reduction. Complications included non-union in open (one patient, 5%), infection in open (one patient, 5%), shortening in both (one patientin, 5%), limited range of movement in both (one patient, 5%) and malrotation in close (one patient, 5%) groups. Close reduction group showed higher rate of radiologic callus formation and earlier full weight bearing than open reduction group (P<0.005), but union rate was not significant.Conclusion: This study showed that there is no difference between final union rate of open and close reduction by interlocking intramedullary nailing in femoral shaft fractures.

Background and Objective: Viral upper respiratory tract infection and cold drugs consumption is prevalent among children. These drugs have no effect on disease improvement, but it may also have accompanied with many side effects. This study was conducted to compare the effect of honey and diphehydramine on the alleviation of cough in 2-5-year-old children with viral upper respiratory tract infection.Materials and Methods: This double-blind clinical trial study was carried out on 170 children (60 boys and 66 girls) aged 2-5 years old with viral upper respiratory tract infection who were taken to the pediatric clinic of Shariatee hospital in Bandar Abbas, Iran during 2010. Children demographic characteristics were including age, gender, period of illness, vaccination history, weight, growth, overall health, and cardiopulmonary examinations. Patients were randomly divided into two groups of 63 children receiving honey (three times a day and the last dose an hour before bed) and diphehydramine syrup (5mg/kg/BW). Two days later, subjects were examined again for the severity and frequency of coughs during day and night. Data were analyzed using SPSS-19, independent t-test and chi-square test.Results: Mean±SD of the age of children was 45.21±11.39 and 43.98±11.95 months in honey and diphenhydramine groups, respectively. The frequency and severity of night coughs was lower in the honey group (97.4%) as compared to the diphenhydramine group (58.7%) (P<0.02). The frequency and severity of daily coughs was lower in the honey group (84.1%) while it was lower in 58.7% of the diphenhydramine group (P<0.01).Conclusion: This study showed that honey is more effective than diphenhydramine in the alleviation of cough caused by viral URTI in 2-5-year-old children.

Background and Objective: Post-operative nausea vomiting (PONV) and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration.Materials and Methods: This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation (CV) group and anesthesia continued with mechanical ventilation. For the patients of the second group (spontaneous respiration/SR), after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N2O/O2. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student’s t-test, chi-square and Fisher’s exact tests.Results: Post-operative nausea was non significantly higher in CV group (8%) than SR (6.52%). The rate of vomiting was higher in CV (16%) as compared to SR group (2.17%). (P<0.001, RR=8.57, CI: 1.91-38.41). The rate of laryngospasm at the end of the surgery was higher in CV group (15.21%) as compared to SR group (26%) (P<0.02, RR=0.94, CI: 0.05-1.77). The rate of excessive discharge at the end of the surgery was significantly higher in CV group (52%) in comparison with SR group (11.95%) (P<0.001, RR=0.94, CI: 0.05-1.77).Conclusion: This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants.

Background and Objective: Menopausal symptoms influence mental, physical and emotional health, as well as social performance and family relationships. Due to the undesirable side effects of alternated hormone-therapy, tendency toward alternative treatments in relieving these symptoms have been increased, and the use of herbs like phytoestrogens seem preferable. This study was conducted to determine the effect of red clover Isoflavones extract on menopausal symptoms.Materials and Methods: This clinical randomized, triple-blind trial was conducted on 72 menopausal women who referred to Navab Safavi health care center, Isfahan, Iran during Oct-Apr 2011. After two weeks of monitoring and determination of the baseline symptoms score including hot flushes and sweating, paresthesia, insomnia, nervousness, depression, vertigo, weakness and fatigue, arthralgia and myalgia, headache, palpitation and formication, the women were randomly divided into two groups of 36 subjects: placebo and intervention (taking 45 mg of red clover Isoflavones extract capsules). The subjects were given one capsule daily for eight weeks and menopausal symptoms were recorded weekly. Data were analyzed using SPSS-18, independent t-test, ANOVA, chi-square and Mann–Whitney tests.Results: 55 women completed the study: 27 subjects in the placebo and 28 in the intervention group. The mean age of subjects in placebo and intervention group was 53.92±3.21 and 52.96±3.07 years, respectively. The mean age of menopause in the placebo and intervention groups was 51.38±2.63 and 50.05±1.17 years, respectively. The mean elapsed time since menopause was determined as 2.69±1.47 years in placebo and 2.66±1.65 years in intervention group. The average score of menopausal symptoms at the end of the 10th week was 13.87±7.22 and 16.44±11.59 in intervention and placebo groups, this reduction was significant (P<0.05).Conclusion: This study showed that consumption of capsules containing red clover Isoflavones extract for 8 weeks, reduces menopausal symptoms in postmenopausal women.

Background and Objective: Immobilization stress has a variety of effects on the enzymes activity. This study was conducted to determine the protective effect ofAloe vera extract on the serum level of creatine kinase enzyme in male rates exposed to acute and chronic immobilization stress.Materials and Methods: This experimental study was conducted on 45 male Wistar rats weighing approximately 200±30g. Animals were randomly allocated into 9 groups of 5 rats: control, normal saline, chronically immobilized, acutely immobilized, chronically immobilized normal saline, acutely immobilized normal saline, Aloe vera extract (600mg/kg/daily), acutely immobilized Aloe vera (600g/kg/daily) and chronically immobilizedAloe vera groups (600g/kg/daily). Aloe vera extract with a dose of 600mg/kg/BW was administered by gavage feeding before applying stress. For chronic immobilization, animals were put under immobilization stress for 2 hrs a day for 3 weeks and for acute immobilization animals were put under immobilization for 8hrs a day for one week. At the end of the experiments, blood samples were collected using cardiac puncture method and serum level of creatine kinase enzyme (units/L) was measured by spectrophotometery. Data were analyzed using SPSS-19, one-way ANOVA and Tukey post-hoc tests.Results: Serum level of creatine kinase enzyme represented a statistical significant increase in rats exposed to acute (2368.20±104.96 units/L) and chronic immobilization (2177.80±234.75 units/L) compared with control group (1240.40±706.40 units/L) (P<0.001). The enzyme alteration level was not significant inAloe vera (1619.80±171.41 units/L), acutely immobilized Aloe vera extract (1619.00±206.03 units/L) and chronically immobilized Aloe vera extract (1448.00±106.07 units/L).Conclusion: This study showed that gavage of Aloe vera extract (600mg/kg/daily) in rats can prevent the elevation of creatine kinase enzyme activity resulted by immobilization stress.

Background and Objective: Diabetes mellitus cause learning, memory and cognitive skills disorders in the long term. This study was conducted to determine the protective effect of silymarin on the learning and memory deficiency in streptozotocin-diabetic rats.Materials and Methods: This experimental study was conducted on 40 male Wistar rats weighing 240-300 grams. The rats were randomly allocated into 5 groups: control, silymarin -treated control (100 mg/kg), diabetic, and two silymarin -treated diabetic groups (50 and 100 mg/kg). Silymarin was daily administered (i.p. and daily) ten days after streptozotocin injection for 4 weeks. Finally, initial (acquisition index) and step-through latencies (retention and recall index) were measured using passive avoidance test and alternation behavior percentage as an index of spatial memory was determined using Y maze. The level of malondialdehyde in the homogenate hippocampal tissue of the animals brains was measured. Data were analyzed using Sigma Stat-3.5, one-way and two-way ANOVA, Tukey, and Kruskall-Wallis tests.Results: A significant reduction of STL was observed in diabetic (P<0.01) and silymarin-treated (50mg/kg) diabetic (P<0.05) groups and this parameter was significantly higher in diabetic group receiving a high dose of silymarin compared to diabetic group (P<0.05). Meanwhile, alternation percentage in diabetic animals was significantly lower than control group (P<0.05) and this index did not show a significant difference in silymarin-treated diabetic groups in comparison with diabetic group. In diabetic rats, there was a significant increase in the tissue level of malondialdehyde (P<0.05) and silymarin treatment with dosage of (100 mg/kg) significantly reduced the level of MDA (P<0.05).Conclusion: This study showed that although long-term administration of silymarin at a high dose (100 mg/kg) affects the ability to store data in memory and to recall it in diabetic animals in passive avoidance test, it does not improve short-term spatial memory in diabetic animals. The beneficial effects of silymarin may be via attenuation of lipid peroxidation in hippocampus tissue.

Background and Objective: The first effect of stress on the immune system is usually a rapid increase in function which manifests itself by an increase in the number of inflammatory cytokines in blood. It is however, followed by a decrease of function in immunological response. During inflammation, the expression of hepcidin gene is increased in order to keep iron away from pathogens. This study was conducted to determine the effect of chronic mild stress on the expression of hepcidin gene in the hippocampus of the male adult rats.Materials and Methods: This experimental study was carried out on 30 adult male Wistar rats, weighing approximately 200-250 grams. They were randomly allocated into two groups of 15 rats: control and chronic mild stress group. Animals in intervention group were exposed to chronic mild stress for 3 weeks.At the end of the stress protocol, 2 ml blood sample was collected to measure the serum concentration of IL-6. Real time PCR method was used to investigate hepcidin expression in hippocampus. Data were analyzed using SPSS-16 and independent t-test.Results: The mean level of IL-6 was significantly higher in the CMS exposure group (27.98±0.84 pg/ml) than control group (18.29±1.18 pg/ml) (P<0.05). Hepcidin expression in the hippocampus of intervention group was significantly higher (2.69±0.226%) in compared to control group (1±0.105) (P<0.001).Conclusion: This study showed that chronic mild stress increases the expression of hepcidingene and the serum level of IL-6 in adult rats.

Background and Objective: Toll-like receptors (TLRs) have been discovered as the most important receptors in innate immunity. One of the most important TLRs is TLR4, the key receptor for the LPS component of gram-negative bacteria. Two polymorphisms, D299G (rs4986790) and T399I (rs4986791), inTLR4 gene are associated with a decreased response to LPS. This study was done to estimate the expression of different polymorphisms of TLR4 gene in colorectal cancer cell line by flowcytometery.Materials and Methods: In this laboratory study, the HCT116 cells were transfected with plasmids containing different variants ofTLR4 gene including; Flag-tagged- TLR4 wild type, flag-tagged D299G and T399I Using TurboFect transfection reagent. Transfection efficiency was evaluated by GFP plasmid.Expression of different variants ofTLR4 was assessed in transfected cells by flowcytometery. Data were analyzed using SPSS-11.5 and chi-square test.Results: TLR4 was detected on HT29 and CaCo2 cell lines at low levels. HCT116 cells did not express detectable amounts of TLR4 by flowcytometery prior to transfection. Gene transfer efficiency for GFP plasmid was about 80% in HCT116 cells by flowcytometery and microscopic analysis.TLR4 expression and LPS responsiveness significantly was higher in HCT116 cells which were transfected with wild type TLR4gene compared to non-transfected and mutant transfected cells (P<0.05).Conclusion: Lower expression of TLR4 on cells with mutant TLR4 showed that these polymorphisms affect on expression patterns of TLR4 on colon cancer cells.

Background and Objective: The relation between stress and gastrointestinal diseases, particularly irritable bowel syndrome (IBS), has received consideration for years. This research was conducted to compare the attachment styles and coping strategies in IBS and healthy female students.Materials and Methods: This case – control study was conducted on 50 female students with irritable bowel syndrome and 50 healthy students in Gorgan, Iran druring 2011. Age, grade and major were similar in both cases and controls. ROME III criteria questionnaire, together with a physician report confirmation were used to diagnose IBS. All attendants in the study filled in Rass adult attachment scale questionnaire and Lazarus coping strategies questionnaire. Data were analyzed using SPSS-17 and student t-test.Results: In the IBS group the level of ambivalent (9.78±2.72) and avoidance (7.68±1.76) attachments were higher than the control group (8.1±2.65 and 6.56±1.82 respectively) (P<0.05). The most prevalent attachment style in control group was the secure style (11±3.89). There was a significant statistical difference between female of IBS group and control group regarding the mean±SD of coping strategies including: isolation (7.04±2.44, 5.9±1.95), self-control (9.62±2.39, 8.32±1.6), demanding social support (5.54±1.6, 6.92±2.42), evasion – avoidance (9.64±2.81, 6.8±1.37), solving the problem (8.2±1.85, 6.66±1.7), re-evaluation (16.2±1.81, 14.3±1.61) and taking responsibility (5.67±1.41, 4.5±1.58) (P<0.05).the direct coping strategy in IBS and control groups was 63.76±9.76 and 67.58±10.78. This difference was not significant.Conclusion: This study showed that in comparison to healthy female students, subjects with IBS use more ambivalent and avoidant attachment styles.

Background and Objective: Nanosilver particles are one of the functional nanotechnology filed. These nanoparticles have antibacterial characteritics. Combination therapy is one of new and specific therapeutic regiment in medicine. Eucalyptus plant is useful in growth inhibition of bacteria. This study was done to evaluate the inhibitory effect of alcoholic eucalyptus extract with nanosilver on E.coli growth.Materials and Methods: In this laboratory study, E.coli was cultured in nutrient agar medium. Primarily 50ml of bacteria was inocolulated in each plate, antibiograms disc contiminated with 3.1, 6.25, 12.5, 25 and 50 ppm concentration of nanosilver accompanied with 100% of etanolic extract of eucalyptus were placed in each plate subsequently. Diameter of inhibitory zone were evaluated following 24, 48, 72 hrs in 6th and 8th days. Data were analyzed using SPSS-15, ANOVA and Tukey tests.Results: After six days, inhibitory growth zone diameter of E.coli was 0.5 mm. This diameter in experimental group with 3.1, 6.25, 12.5, 25 and 50 ppm of nanosilver in combination with etanolic extract of eucalyptus were 0.55, 0.58, 0.82, 0.83 and 1.02 mm. Inhibitory growth zone in group of 12.5, 25 and 50 ppm of nanosilver was significant in compared to the control (P<0.05).Conclusion: The most proper time of inhibitory effect on E.coli growth is six day after treatment in combination of 50 ppm nanosilver particles with extract of eucalyptus.

Background and Objective: Hemoglobinopathies are among the most prevalent genetic disorders worldwide, and occur as a result of mutations in the gene involved in synthesizing hemoglobin chains. By now more than 1000 defects in hemoglobin chains are discovered. Hemoglobin D (Hb D) is one of these disorders, identified by a single nucleotide mutation on codon 121 of beta globin chain. This study was carried out to evaluate Hb D mutations through molecular methods in Mazandaran province of Iran.Materials and Methods: This descriptive laboratory study was done on 70 patients with an electrophoresis band in hemoglobin-S zone in Mazandaran province of Iran during 2010-11. Capillary zone electrophoresis was done to find out Hb D in 51 patients. Subsequently, PCR-RFLP was performed to evaluate the samples at molecular level.Results: Molecular investigation revealed all cases are carriers of hemoglobin D-Punjab. Two patients were shown to be homozygote carriers of the abnormal gene.Conclusion: This study showed all Hb D affected patients were carriers of Hb D Punjab.

Background and Objective: Improvement in self-care and self-efficacy behaviors has proved to be a vital factor in a successful management of asthma. This study was carried out to determine the relationship of patients self-efficacy with control of asthma symptoms.Materials and Methods: This correlation study was carried out on 257 asthmatic patients (133 men and 124 women) aged 18-35, who referred to Sheykholrayis clinic of Tabriz, Iran, during 2011. Data collection tools included a questionnaire of social-personal specifications, asthma self-efficacy scale questionnaire and asthma control questionnaire as well as patients’ spirometer parameters. Data were analyzed using SPSS-17 and Pearson Correlation Coefficient test.Results: Among aspects of self efficacy, the regular use of medicine and patient relation with physician were demonstrated to be 4±0.6 and 2.7±0.7, respectively. Among aspects of asthma control, the level of activity restriction resulted by the disease during the past week and the number of spray puffs used during past week were 3±1.1 and 1.5±1.2, respectively. There was a significant relation between self-efficacy and asthma control (P<0.001, r=-0.378).Conclusion: This study showed that in asthmatic patients, self confidence is an effective factor in the control of asthmatic symptoms.

Background and Objective: Impacted molars teeth, especially third molar, are important in most branches of medical sciences. The angular position of molar teeth is in side effects and therapeutic regiment. This study was conducted to determine the angle of the impacted mandibular third molars.Materials and Methods: This descriptive study was carried out on 429 patients (269 men and 160 women) selected for surgery on impacted mandibular third molar in the oral and maxillofacial surgery clinic in Gorgan, Iran during 2010-11. Pre-operative diagnosis was done by physical examination and OPG radiography. Demographic characterstics including age, gender, ethnicity, impaction angle were recorded for each subject. Data were analyzed using SPSS-16, independent t-test and chi-square test.Results: Totally, 480 impacted third molars were studied. Mean age of patients was 26.06±6.21 years.Impaction of the third molar was more prevalent among men (62.7%) than women (38.30%). Impacted mandibular third molar of 189 people (44.1%) were in left side in 200 people (46.6%) were in right side and in 40 people (9.3%) were bilateral. According to impaction angle, mesioangular (41.7%) and distoangular (3.5%) types had the highest and the lowest frequency, respectively. In bilateral cases, the mesioangular-mesioangular type (48.8%) was the most prevalent. The mesioangular type was the most prevalent in all ethnic groups. The most prevalent angular position of the impacted third molar was the mesioangular type in both sexes.Conclusion: This study showed that the most prevalent angular position of impacted mandibular third molar is the mesioangular type.

Background and Objective: The incidence of neural tube defects (NTDs) is varied according to race, geographical situation and other predisposing factors. This study was carried out to determine the incidence rate of NTDs and its risk factors in Yasuj, Iran.Materials and Methods: This case - control study was done on live newborns in Imam Sajad hospital, Yasuj, Iran during 2000-10.78 neonates with NTDs out of 36755 live newborns were considered as cases. The control group was also consisting of the same number of healthy neonates who born at the same period and in the same hospital. Data were collected by a check-list and analyzed using SPSS-19, Chi-Square, Logistic regression and odd’s ratio.Results: The incidence rate of NTDs was 2.12 per 1000 live births. Anencephaly and Spina Bifida was detected in 59 (75.6%) and 19 (24.3%) of affected newborns, respectively. The ratio of females to males was 1.5 times.53.85% of mothers with affected newborns were grouped in 27-36 years age range. The mean number of pregnancies and abortion between two groups of mothers had no statistical significant differences. There is no significant relation between the mothers occupation and the incidence of NTDs.10 (12.8%) of mothers from case group and 7 (8.97%) of mothers from control group have used tobacco.52 (66.7%) of mothers of case group and 30 (38.5%) of controls did not consumed folic acid. The relation between non-user folic acid during pregnancy with NTDs was significant (95% CI: 1.4-6.15, OR=2.93, P<0.001).Conclusion: This study showed relatively high incidence of NTDs in Yasuj. Non-consuming folic acid increased the risk of NTD by 2.93 times.

Background and Objective: There is not a general protocol strategy about the necessity of routine microscopic examination of tonsillar samples in children. This study was conducted to determine the histopathological characteristic of tonsillar tissue in 1250 children, Tabriz-Iran.Materials and Methods: This descriptive study was conducted on 1250 children (724 male and 526 female) aged 2-14 years old who underwent tonsillectomy in Tabriz, Iran during 2008-11. Variables including age, sex, clinical diagnosis and surgical indications were recorded. Paraffin blocks were prepared from samples of tonsillectomy and stained with haematoxylin and eosin. Histopathologocal results were categorized in four groups: Follicular hyperplasia, follicular hyperplasia with infection, malignancy and normal.Results: None of the children had initial clinical suspicion of tonsil tumor. Patients’ primary complaints were as follows: 92.5% mouth breathing, 93% nocturnal snoring, 74.3% recurrent and chronic cold and infections, 56.4% sore throat, 48.2% halitosis, 26% nocturnal apnea, 22.2% dysphasia, and 18.2% anorexia. Children with tonsillar hypertrophy and obstructive symptoms (57%), and tonsillar hypertrophy and recurrent infections (42.2%) underwent tonsillectomy. In the histopathlogical examination of all patients being hyperplasia together with lymphoid hypertrophy were observed and there was no evidence of malignancy in any of the patients.Conclusion: No instance of malignancy was found in the histopathological examination of children’s tonsil-removed tissues and all of the tonsils had benign hyperplasia with lymphoid hypertrophy.

The latest reported incidence of subarachnoid hemorrhage due to aneurysms and arterio-venous malformations (AVMs) is around 15 per 100, 000 pregnancies. It is also the third leading cause of maternal death from non obstetric causes accounting for 12% of total mortality. A pregnant woman with 42 years old G5P4Lch4 had vaginal delivery in 12 Aug 2009. One week after delivery she was visited by General Physician due to headache. She was admitted with signs of dizinous, vomiting projectile and painful stimuli, hospital consciousness level 5 and coma. CT scan was demonstrated a massive bleeding inside the brain. Massive hemorrhage into the ventricle was detected following neurosurgery. She was dead due to cardiac arrest after 10 days. Based on this case report, woman with headache following delivery should be recommended for cerebral aneurysm.