Zahedan Journal of Research in Medical Sciences
Year:2005 | Volume:6 | Issue:4|Papers Count:14

Background: All patients be experienced a feeling of pain after surgeries. We studied the sedative effect of rectal Indomethacin (R.I) after cesarean section (C/S) with general anesthesia and compared the severity of pain and frequency of narcotic use in case (use of R.I) and control group (UN use of R.I).Methods and Materials: In a clinical trial case - control study (2002-2003) 104 women with a C/S under general anesthesia in Zahedan Ghods hospital were studied. Patients randomly divided in two groups. 52 patients in case group received 100 mg Indomethacin rectaly every 12 hours. 52 patients in control group don't received Indomethacin. All patients visited carefully before C/S and preterm labor (<37 week of gestational age), history of previous C/S, asthma, peptic ulcer and kidney disease were excluded from this study. Induction of anesthesia was similar in all patients with 5 mg/iv morphine and 1-2mg/IV Fentanil general. Every 6 hours after C/S patients were fallowed and compared for frequency of sever pain and narcotic injection, the time of oral feeding and ambulation were recorded and analysis were done by SPSS.Results: According to this study there was significant difference between feeling of severe pain and the need for sedative narcotic drugs in case and control groups after C/S (P<0.01). In case group patient’s ambulation and regular diet is shorter than control group.Conclusions: It seems that rectal Indomethacin after C/S reduces the feeling of severs pain and narcotic use to six times, and reduces 6-12 time of the ambulation and eating regular diet. That can cause a short recovery period after C/S.  

 Background: Autoimmune hepatitis (AIH) is a self-perpetuating hepatocellular inflammation of unknown cause. It is characterized by the presence of interface hepatitis on histologic examination, hyper gammaglobulinemia, and autoantibodies in serum. This study was performed to determine clinical and laboratory profile of AIH in Iran.Methods and Materials: The medical records of patients with AIH from 4 gastroenterology clinics in Tehran were retrospectively reviewed from September 1988 to May 2003. Forty-six patients with AIH whose medical records were complete were selected for final review. Results: Of the 46 patients, 38 (82%) were female. The median age at presentation was 24 years. All patients fell into the category of AIH type-I. Seventeen percent had associated autoimmune diseases with diabetes type-I and autoimmune hemolytic disease being more common. The onset was acute in 5% and chronic in 87% with the remaining 8% being asymptomatic. The most common symptoms were icterus (59%) and fatigue (33%) and the most common signs were splenomegaly (33%) and hepatomegaly (30%). In all cases, HBV and HCV serum markers were negative and serum levels of ferritin and copper were within normal limits. High serum levels of AST, total billirubin and alkaline phosphatase were detected in 93%, 39% and 74%, respectively while hyper gammaglobulinemia was found in 67%. SMA, ANA, PANCA and AMA were positive in 50%, 37%, 4% and 13%, respectively.Conclusions: AIH type-I is more common in Iran than in the United States and Europe and other types are seen rarely. Younger age at presentation, less frequent acute onset disease and lower rate of autoantibody positivity and hyper gammaglobulinemia may merit attention.    

Background: Chronic renal failure is an irreversible disease and is a common cause of mortality and morbidity in the children throughout the world. The etiology is different according to genetic and environmental factors. Determining the cause of CRF can contribute to its appropriate management and prevention of its progress.Methods and Materials: A cross sectional study was performed on 76 patients with CRF in a 9 year period. The patients were either admitted to the nephrology ward or were under observation of the nephrology clinic or dialysis division. The required data were filled in special forms and then were analyzed.Results: The average age of the patients for the initiation of CRF was 9.22± 4.1 years. 4.8% of those admitted to the nephrology ward and 0.23% of total admissions in the hospital suffered CRF. The most common causes of CRF in decreasing of frequency were congenital anatomic disorders of the urinary tract (47.4%), acquired nephritis (15.8%), inherited renal diseases (9.2%), and renal calculi (7.9%). 67% of the parents were no educated, 75% were insured, 56.6% were close relatives and had an average monthly income of 1150000 Rials. Eight of the patients were non-Iranians.Conclusions: Early diagnosis and appropriate management of the most common causes of CRF might prevent the disease or retard the progress to end stage renal failure.    

Background: The prevalence of emotional - behavioral disorders in the normal sibling of mental disabled children is 1/6 –2 times as the normal population. This can affect deeply the future of these children. The aim of this research is to consider cognitive- behavioral intervention as a way to decrease the sibling’s problem.Methods and Materials: This study was performed as randomized clinical trials on 32 siblings (aged between 6-12 year old) of mental disabled children in 2003 in child guidance clinic, Isfahan. The data collection tool included clinical interview according to DSM-IV- TR criteria and Rutters questionnaire.Results: Generally, the prevalence of emotional- behavioral problems of siblings of mental disabled children were 53.2 percent, the mean score for Rutters questionnaire was 17.08±5.6 and 14.66±5.63 before and after intervention respectively (P=0.001). But there wasn’t significant difference between pre and post test in control group (P= 0.4). Conclusions: The results showed that cognitive and behavioral interventions, reduces the emotional and behavioral problems in the sibling of mental disabled children.

  Background: Achalasia is a motility disorder of unknown etiology. Diagnostic techniques include Barium esophagram, simple and widely available, radionuclide transit/emptying scintigraphy, a low-cost procedures, easy to perform and widely available, well tolerated and require minimum cooperation by patients and esophageal manometry that continues to be used widely in clinical practices, primarily because of its perceived value. Aim of this study was to compare methods of manometry, barium swallow and scintigraphy before and after pneumatic dilation.Methods and Materials: 17 patients with achalasia of cardia were evaluated both symptomatically and objectively (esophageal manometry, timed barium esophagram, and scintigraphic emptying index) before treating them with pneumatic dilation and after. The degree of patient symptom improvement post therapy was recorded and correlated with improvement of three methods indices. The degree of improvement after treatment was determined as the percentage of reduction of symptoms, divided into two groups (1) <80% improvement; (2) success: ≥80% improvement.Results: 12 (70.6%) of patients had score improvement of ≥80%. All the diagnostic indices were significantly different between pre and post therapy. But, there was not significant difference between two groups of symptom improvement for indices of barium swallow or scintigraphy and also any association or correlation between patient symptom score and barium height improvement or emptying index improvement.Conclusions: We yielded 70.6% short-term good result after PD, similar to other studies. Our results showed that transit or barium study should not be relied upon in isolation for assessment of the efficacy of treatment.      

Background: Barbers in Iran may often be exposed accidentally to the blood or bloody fluids of the customers. The aim of this study was to determine the prevalence of HBV infection in the barbers.Methods and Materials: This study was a case-control survey. We conducted a seroepidemiological study to determine the prevalence of HBs Ag and antibody against HBc Ag (anti- HBc) among the103 barber and 110 control subjects in the Zahedan, a city in south eastern of Iran.Results:The prevalence of HBV was found to be higher in the barbers (27%, CI=95%, 18.3, 35.7) than in the comparison group (9.98%, CI=95%,4.3,15.7). Twenty – one (75%) contaminated barbers Hepatitis B had more than five years duration of occupation. A significant relationship was found with the duration of occupation and Infection in the barbers (P<0.001). Among the seropositive subjects, it was found, that the most of them (89.3%) had been exposed to scissor cuts. (P=0.005)Conclusions: Our data suggest that HBV infection may constitute occupational hazards for the barbers.    

Background: One of the routine methods in diagnosis of physical growth and study of obesity and wasting prevalence in children is, through body weight and height indicators and its comparison with NCHS standard respectively.Methods and Materials: According to a descriptive study 2067 girl students from primary schools aged 7-11 years were chosen in a randomized and systemic method from two different areas of Zahedan. Hence weight and height were measured. In order to termine under weight, stunting and wasting different indices as: body weight for age, height for age and weight for height on the basis of NCHS standard were employed. On the basis of below 3rd percentile NCHS standard was determined malnutrition. Furthermore obesity was determined by body mass index too, in this regard below 5th percentile was considered wasting and above 95th percentile obese.Results: The results on the basis of weight for age, weight for height and height for age were 15.6% (under weight), 9% (wasting) and 15% (stunting) respectively. According to percentiles of the weight for height 11.2% and 14.2% of the students were waste in lower and higher class respectively. According to increasing of the age, the different percentiles of weight and height growth were more changed as compared with NCHS standard. However on the basis of body mass indexes 1% of students were obese and those in higher class had better situation than those in lower class.Conclusions: Therefore it is concluded that obesity is not a major problem as compared to wasting. Besides it seems the reduction of those indicators were showed different degree of protein energy malnutrition in the children. Hence it is usually recommend further studies and applied from regional standards.

Background: Diabetes mellitus as a most common metabolic disorder of human has a progressive prevalence that in this disease hyperglycemia from different causes produces several chronic complications in multiple organs by different mechanism. Normoglycemia is the way of prevention of complication that can induce by treatment with oral hypoglycemic agent (O.H.A) or insulin. In type II diabetes the patient treated with O.H.A the failure of treatment is important problem that maybe primary or secondary. Resolving of this problem is changing the treatment to insulin therapy. Before this changing we can add some accessory drug to O.H.A regimen for better controlling of blood sugar. One of these drugs is Chlroquine. In this study we decided to evaluate the effect of Chlroquine on level of blood sugar of DM II.Methods and Materials: During one year 55 patient in 2 groups as case (25 patients) and control (29 patients) treated with Chlroquine and placebo for 3 months. At first point and end of first, second and third month of study we measured the fasting blood sugar (FBS) & two hours post prandial blood sugar (2hppBS) and evaluate the change of FBS and 2hppBS in each group and between of two groups.Results: The mean age of the case and control group are 53/53±6/44 & 53/58± 7/83 and mean BMI of two groups are 26/25±3/6 & 24/95±3/25. Mean duration of disease of two groups are 7±4/68 & 6/44±5/3. Those two groups of patients for these parameters and also for basic FBS & 2hppBS are statistically equal. At the end of three months of study FBS & 2hppBS in each group significantly decreased (P<0/001). But this different between two groups are not significant (P=0/661 for FBS & P=0/782 for 2hppBS). But in the end of the first and second months FBS in case group is significantly lower from control group (P=0/006 for first month & P=0/05 for second one).Conclusions: Although in other studies that done Chlroquine has reported effective in decreasing of blood sugar of patient with DM type II, but in this study has not approved. Reasons of this difference maybe because of different of duration of study or use of hydroxychlroquine instead of Chlroquine or don't being of control group in pervious study.      

Hydatid disease is caused by the Echinococcus Granulosus. On occasion man is an intermediate host in whom the disease is manifested by the presence of one or more hydatid cysts, usually asymptomatic. In this case it was presented as a pancreatic cyst and discovered on ultrasonography and CT scan as pseudo cyst and after successfully operation hydatid cyst of pancreas was definite diagnosis.