مجله علمی پزشکی جندی شاپور
سال ششم شماره 2 (پیاپی 53، تابستان 1386)

This study was conducted to assess the effect of multi-component intervention to prevent post operative delirium I patients who underwent open–heart surgery. In this clinical intervention study 32 patients (45 to 70 years of age) who underwent open–heart surgery were divided into two groups of 16 patients (case and control). Six risk factors included: cognitive, visual and auditory impairment¸ immobility, dehydration and sleep deprivation were assessed in both groups for three consecutive days starting from the second after operation. A standard protocol was used for case group. Incidence of delirium was determined by clinical interview; based on DSM-IV-TR; twice a day (morning and evening). The collected data were analyzed by t-test and S- plus statistical methods. The median of total number of risk factors and immobility in case group were significantly reduced in comparison to control group0 There was reduction in the trends related to other risk factors and incidence of delirium in the case group. The finding of this study demonstrates that primary prevention of delirium is an effective treatment strategy among post-open-heart surgery0

Fordyce’s granules present as multiple yellowish white or white papules which can be seen within oral mucosa especially buccal mucosa and upper lip. They are ectopic sebaceous gland covered by epithelium. This condition is seen in approximately 82% of the population. Fordyce’s granules can be diagnosed clinically and no biopsy is usually required. The main objective of this research was to compare blood cholesterol and triglycerides levels in subjects with Fordyce’s granules and the ones without Fordyce’s granules. In this case–control study 98 samples were allocated into two group: group A, included 50 subjects (45 males and 5 Females) with Fordyce’s granules and group B, included 48 subjects (38 males and 10 females) without Fordyce’s granules. Blood cholesterol and triglyceride levels were measured in both of groups. The results were analyzed by' t-test.The results showed that there was no significant difference in blood triglycerides and cholesterol levels in both groups.The finding of this study suggest that Fordyce’s granules are only ectopic sebaceous glands with normal anatomical variations and their presence or absence has no relationship with the diagnostic index for increased blood triglycerides and cholesterol.

Knowledge of prevalence of psychiatric disorders in any society is important for proper planning of service strategies. Chronic debilitating diseases requiring dialysis are proven to cause cognitive–emotional disorders. The aim of this study was to evaluate the prevalence and severity of depression among dialysis patients Sixty patients with chronic renal failure who were under routine dialysis were the subjects of this study which was carried out over 4 weeks period. The data collected using two types of questionnaires. The first was on the social status and other was Beck depression inventory for scoring depression symptoms. The data were analyzed using SPSS and Chi square taking p<0.05 as significant. Among the 60 patients studied (23 females and 37 male), 5 patients (8.3%) had a Beck score<10 and were not depressed. Fifty five patients (91.7%) had a Beck score 11-40. The data showed that the prevalence of depression was 5-6 times higher than the general population. Our results emphasize previous works that depression has a negative impact on quality of life in patients with chronic physical illnesses. We suggest that psychiatrist, psychologists and social workers should be involved in dialysis management teams. Having a consultation-liaison-psychiatry in a hospital is an unavoidable necessity.

Problems such as recurrent caries, pulp reaction and marginal micro leakage occur in posterior resin composite restorations because of insufficient micro hardness of resin composite. The purpose of this in-vitro study is comparing microhardness of light-cured composites in class 2 cavities by four restoration curing techniques. Standardized class II cavities in mesial was made in forty non carious, upper human premolars. Each tooth was mounted with artificial teeth in acrylic resin and divided randomly into four treatment groups. Group 1: Metal matrix with wooden wedge and irradiation from occlusal and after that removing matrix and irradiation from bucal and lingual. Group 2: Transparent matrix with reflective wedge and irradiation from bucal and lingual. Group 3: Metal matrix with wooden wedge and irradiation from occlusal using light tip which was connected to tip of light–cure unit. Group 4: Metal matrix with wooden wedge and irradiation from occlusal using narrow cylindrical Bio-glass for light transmitting from occlusal to gingival. The teeth were sectioned mesio-distally through the center of the restoration with diamond disk. The samples were embedded in epoxy resin. Vickers hardness was assessed in nine point 100, 500, 2500 microns from gingival and as far as 100, 750, 1300 microns from axial wall. The data was statistically analyzed by ANOVA. Mann- Whitney test was performed to compare the groups with each other at < 0.05 significance level. Group 2 showed the most hardness which was significantly different from other groups. Group 1 showed the least hardness. The results obtained in this study indicated that using metal matrix with wooden wedge is not suitable compared with transparent matrix with reflective wedge. But because of limitations of transparent matrices and wedges such as stiffness and overhang formation, using light conducting instruments with metal matrix and wooden wedge results in more composite hardness.

Testosterone enanthate (TE), due to its anabolic effects, is widely used by youths and athletes as a stimulating drug on the increasing weight and muscle strength. Previous studies showed that the high doses of TE may have some effects on the various tissues, especially on heart muscle. The aim of this study to evaluate the effects of high doses of TE on the histological changes of cardiac muscle, creatine-kinase (CK-BM)enzyme and glycogen storage of heart muscle in rats. For this purpose, 120 male Charles River rats were divided to five groups: group I was used as control non-treated group, in group II rats were gonadectomized and received TE (5mg/100g of BW as I.P. injection), in Group III rats were gonadectomized and receiving vehicle (olive oil). Group IV were sham-operated non gonadectomized rats receiving the same does of TE as group I, group V were sham–operated non gonadectomized rats receiving vehicle. In each group, blood samples were taken after 60 days and the left ventricles of the cardiac muscle were removed and prepared for histological and histochemical studies. The serum levels testosterone and CK-MB enzyme measured by ELIZA technique. This research shows that myocardial cells and nuclei diameter, density of glycogen in cardiac cells and CK-MB enzyme were increase in rats that received (TE) significantly (p<0.05) and p<.0001 (for hormone and enzyme measurements). This research shows that use of TE as high doses can be very dangerous in youths and athletes because increasing of CK-MB and glycogen storage are signs of infarcts and storage glycogen diseases respectively.

Hyperalgesia is considered as one of the marked signs of subchronic diabetes mellitus that could affect the life style of the patients. Considering the anti-diabetic potential effect of the medicinal plant Withania somnifera (WS) (Ashwagandha), this study was designed to investigate the analgesic effect of WS on formalin-induced nociceptive responses in diabetic rats. Rats were divided into six groups: non-treated control, WS-treated control, streptozocin (STZ)-induced diabetic, sodium salicylate (SS)-treated control, diabetic and WS-treated diabetic groups. For induction of diabetes, STZ (60 mg/Kg, i.p.) was administered as a single dose. The treatment groups received orally Withania somnifera -mixed rat pellet (6.25%) for two months. The results showed that diabetic rats exhibited a higher score of pain at both phases of the formalin test and WS-treated diabetic rats exhibited a lower nociceptive score at both phases of the test (p<0.05). While, SS administration significantly reduced pain score only at chronic phase of the test in the diabetic group (p<0.01). Taken together, these results indicate that two-month administration of Withania somnifera could attenuate nociception in an experimental model of diabetes mellitus and this may be considered as a treatment for painful diabetic neuropathy.

Hypertension is one of the common complications after kidney transplantation that arises from various etiologies. Hypertension causes an accelerated atherosclerosis after transplantation and is a major factor for cardiovascular morbidity and mortality and chronic allograft failure. The aim of this study was to evaluate the prevalence and the role of common risk factors before and after transplantation on post transplant hypertension. All of the patients were visited monthly or every other month during the first year after transplantation. History and physical examination and necessary laboratory measurements were done (with special emphasis on blood pressure levels). Patients with blood pressure above 140/90 were diagnosed as hypertensive for whom antihypertensive agents were prescribed. Correlation was carried out between risk factors with development of hypertension which included age and gender of donor and recipient, recipient weight, hypertriglyceridemia, hypercholestremia, diabetes and cigarette smoking before and after transplantation. Past history of hypertension and allograft function with hypertension were also studied. Two hundred and seven (70.5 % males) patients were recruited in this study. Hypertension was cumulatively detected in 73.4, 76.5 and 84.5 % of cases after three, six and 12 months of transplantation. In all time intervals studied, no significant statistical correlation was found between age and gender of donors and recipients, recipient weight, history of diabetes, hypertriglyceridemia and cigarette smoking before and after transplantation. However, there was a significant correlation between development of post-transplantation hypertension with hypercholesterolemia after 6 and 12 months of transplantation (p<0.039 and <0.004), history of hypertension before transplantation after 12 months (p<0.043) as well as with function of allograft (p<0.04).This study revealed that hypertension after transplantation has a high prevalence and history of hypertension, function of allograft and hypercholesteremia after transplantation are risk factors. In addition, due to the high risk for cardiovascular morbidity and mortality associated with hypertension in these patients, it is advised that blood pressure must be measured routinely during the follow up periods and where possible the underlying cause be managed and hypertension should be aggressively managed by non-pharmacologic measures, minimization of doses of steroids and cyclosporine and pharmacologic therapy.

Menstrual disorders in adolescents, in particular in the first two years after commencement of menstruation, are common. During this period most of the cycles are unovulatory. The aim of this descriptive study was to report the prevalence of this disorder among school girls in mid school. The data were collected using randomized block sampling method by completing a questionnaire regarding personal and familial details, menstruation status, presence of concomitant conditions and important evidences in physical examination. Data were evaluated by variance and correlation tests. A total of 244 girls in their mid school level were enrolled in this study. Mean age and mean age of menarche were 13.6 ± 0.72 and 12.3 ± 1.22 years respectively. Prevalence of menstrual disorders was 45.9 %. Oligomenorhea was most common, while menometrorhagia was the rarest type of disorder. Most of the menstrual disorders were experienced at thirteen years of age and during the first year after menarche. There was a significant correlation between the age at menarche and menstrual disorders (younger age correlated favorable with fewer menstrual disorders) (p <0.05). Similarly there was a significant correlation between the age at menarche and BMI (younger age correlated favorable with higher BMI) (p <0.05). No significant correlations between menstrual disorders and BM, nor between economic status and menarche as well as with menstrual disorders. Only five cases suffering from menstrual disorders had concurrently other symptoms and signs including acne, hirsutism and history of chronic diseases.The findings of this study suggest that menstrual disorders in adolescent are common and the majority of these symptoms are due to unovulatory nature of these cycles. However, should these disorders continue beyond two years after menarche, other significant etiological factors need to be considered and diagnostic evaluation and appropriate treatment plans need to be carried out.

Anthropology is a branch of biological sciences that estimates the quantitative measurement of different parts of the body. Cephalometry, which is part of anthropology concern with the anatomical index of head and neck. The human brain develops mostly in embryonic period with high speeding 6 years of life. Due to the complication of nervous system, there are some questions: What is the intelligence? Whether high intelligent people have larger brain? In this study we tried to fine out the correlation between head size, brain volume and head circumference. in this study 560males and 497 females at the age 9-11 years in Ahwaz city were examined. Selection of people was randomly with convenient sampling. The length, wide, height, and circumference of the head were measured with the cephalometric equipments. From length, wide and height of head, the brain volume was calculated. For determination of intelligence Raven Children Test (Psychometric Test No.1) was used. SPSS for windows, T test, Mann-Whitney and Pearson method were used for analyzing the data.in this study it was found the relationship between head circumference and intelligence was not significant especially in females (P>0.05) Pearson method analysis showed weak correlation between brain volume and intelligence in male but this result was not confirmed for females. The mean of head circumference was 1 cm longer than females. The mean of brain volume was 141.4 cm3 in males. The difference between the brain volume in females and males was significant (P<0.001). The mean of intelligence in females was higher than males.According to our finding the brain volume in males was greater than females; the intelligence in females was slightly more than males. It seems that the intelligence had no correlation with brain volume and head circumference. It seems that other factors may affect the intelligence.

Psoriasis is a common skin disease in which occurrence rates of clinical features of nail psoriasis vary considerably in the literature. The present study was undertaken to evaluate the frequency of nail involvement in psoriatic patients, to assess the types of nail changes in psoriasis, furthermore to find eventual relationships between nail involvement and some clinical parameters, and finally compare our clinical findings with the few reports available in the literature. From January 2003 to October 2005, patients suffering from psoriasis with nail involvement, attending at a private dermatology clinic, and at the outpatient Clinic of Dermatology in Imam Khoumeini Hospital, Ahwaz, southwest of Iran, were included in the study. The diagnosis was made clinically and in some cases based on histopathological studies.In our study, 500 patients were studied and 296 (59.2%) patients, 177 males (59.8%) and 119 women (40.2%), had nail changes. The mean age of patients was 35±16.95 years and the mean duration of the nail involvement was 6.9±6.88 years. Men involvement percent was a little more than women (59.8% vs 40.2%). The most common clinical type of psoriasis was plaque type psoriasis (67.2%). The most common nail abnormality observed on both finger nails and toe nails was onycholysis (82.8%), followed by pitting (72.6%), subungual hyperkeratosis (72%), nail thickening (37.5%), discoloration of the nail (36.5%), onychodystrophy (12.8%), oil spot (3.7%), Beau’s line (7.8%), nail loss (1%), and splinter hemorrhage (0.7%). Of the 296 patients, 227 patients (76.7%) had not involvement of the proximal and lateral nail folds, and 69 (23.7%) had involvement of the proximal and lateral nail folds. The frequency of nail involvement and nail changes in our patients is nearly similar to those in textbooks of dermatology and literatures. About, a third our patients with nail changes, had nail fold involvement, resulting in increased severity of nail changes in these patients.

Impaired glucose tolerance (IGT) and diabetes mellitus (DM) is a frequent complication in patient with  thalassemia. It is believed to be a consequence of damage inflicted by iron overload. The aim of this study was to evaluate the prevalence of diabetes mellitus and glucose intolerance and its relation to predisposing factors. A total of 195 transfusion dependent β thalassemia patients > 5 years of age referring to Ahwaz Thalassemia Research Center were prospectively interviewed. For diagnosis of DM and IGT the ADA and WHO criteria was used. The prevalence of impaired glucose tolerance was19% (37 of 195) and that of diabetes was 16/4% (32 of 195). 37 patients (19%) had positive family history of diabetes.In patient with serum ferritin above or under 2000 μg/l diabetes or impaired glucose tolerance were found in 49% and 20.8%. We found that in patients with large liver and spleen size prone to glucose intolerance.The finding from this study showed that early and regular use of deferoxamine in β thalassemia patients with serum ferritin level above 2000 μg/l, liver and spleen enlargement and positive family history of diabetes, reduces the body iron burden and can help protect against diabetes mellitus.

Anxiety is common in depressed children and adolescents. Reboxetine is only norepinephrine reuptake inhibitor that may be useful for depressed adults with co-morbid anxiety. Thus this study is carried out to assess effect of reboxetine on anxiety symptoms of depressed children and adolescents. This open trial is performed in twenty, outpatients with major depressive or dysthymic disorder with anxiety symptoms. Easy sampling was used. Dose of reboxetine was 4.36±1.20 mg/day. Hamilton Anxiety Rating Scale (HARS) was used to assess anxiety.The 20 patients selected in studies (7-17 years old, mean 12.80 ± 2.82 years) (female=10, male=10). Following reboxetine administration, HARS score and its somatic and psychic factors were significantly reduced (p<0.001). In addition, anxiety symptoms were reduced about 43.22% during first week and 69.63% after 8 weeks of treatment. Reboxetine does not exacerbate anxiety symptoms but quickly improves them during first week of administration. The effectiveness increases with prolonged use. Double blind -placebo controlled studies are needed to establish this conclusion.

Coronary heart disease is one of the most common heart diseases which leads to many people to disability or death. Psychological factors have an important role in this field. Daily stressors gradually will decrease the immune system and mental health. Also some personal and psychological factors have known as resistance resources against stress. One of the important moderating factors of stress is hardiness. The aim of this research is study the relationship between stress, hardiness, and coronary heart disease. For this purpose, 80 coronary heart patients (40 males and 40 females) and 80 healthy subjects (40 males and 40 Females) completed the Personal Views Survey and Life Event Scale. Analysis of data showed that coronary heart patients and normal group were significantly different in the personality types. The patients with coronary heart disease had higher scores in stress. Also, there were significant differences between patients and normal group. The patients with coronary heart disease experienced more stress than normal group, but normal group had higher scores in hardiness. The relationship between stress and hardiness was significantly negative. These results showed that coronary heart disease patients experienced stress more than normal group. Hardiness is a resistance resource and a moderating factor against stress.

Karoun river catchment area is the most important hydrological system of Iran, which originates from intermediate mountains of Zagross, and passes 900 of its 1200 kilometers length through Khuzestan province in the south west of Iran. In this path, river pass through some cities such as Izzeh, Masjed Soleiman, Gotvand, Shoushtar, Ahwaz, Abadan and Khorramshahr and then finally discharges in Persian Golf via Arvandrood and Bahmanshir rivers. This river is the main irrigation, industrial and municipal water supply in Khuzestan province. The aim of this study was to analyze both bacterial contaminations as well as the physiochemical parameters. In this research, bacterial, chemical and physical parameters in the 6 intake parts of Ahwaz water treatment plants were investigated by laboratory methods over a year.The results showed the southern areas of Karoun basin have a mass microbiological pollution and the Veiss water treatment plant intakes have the most total coliform with the annual average of 65712 MPN and Ahwaz number 2 water treatment plants intakes with annual average of 42157 MPN have the pollution of total coliform.. In addition, the concentration of some chemical and physical parameters in row water is beyond the limit at the process of lower part of the river are shown increasingly with less amount of different.

A lack of adequate mineralization of growing bones results in rickets. Rickets may result from the deficiency of either calcium or phosphorus. The term vitamin D-resistant or refractory rickets excludes patients in whom rickets rapidly responds to moderate amount of vitamin D. Hypophosphatemic rickets (HPR) is characterized by renal phosphate wasting, hypophosphatemia and defective bone mineralization. Familial HPR is the most common form of refractory rickets. In recent years, though the overall incidence of rickets registered has a declined trend; the incidence of non-nutritional rickets has surpassed nutritional rickets. In this report three cases of vitamin D resistant rickets with advanced skeletal changes that were left undiagnosed for many years are presented. The first case was a 10.5 year-old girl, admitted owing to respiratory failure secondary to severe chest deformity. The second and third cases were 8 and 12 year-old girls with HPR who had been referred with advanced rachitic changes including severe bowlegs unresponsive to multiple doses of vitamin D. The final diagnosis was made on the clinical basis, X-ray and laboratory findings including renal phosphate wasting. These cases were confirmed by a dramatic clinical and biochemical response to therapeutic intervention which included oral phosphate, active form of vitamin D and polycitrate to correct metabolic acidosis and hypokalemia in the first case. Presently, all the patients returned to school with minimal problems. The finding of this study suggests that HPR should be considered in any child with rachitic changes particularly in those who do not respond to usual doses of vitamin D and in any older child with severe skeletal deformities.