مجله دانشگاه علوم پزشکی بابل
سال دوازدهم شماره 4 (پیاپی 57، مهر و آبان 1389)

Polycystic ovary syndrome is one of the most common items in endocrine diseases and involved patients are at the risk of diabetes and atherosclerosis and cardiovascular disease. The most common clinical features of PCOS are insulin resistance, hyperandrogenemia, non ovulation and infertility. Since obesity is the most common cause of insulin resistance and hyperandrogenemia, so this study was designed to evaluate the effects of weight reduction and treatment with metformin and flutamide on insulin resistance indices and hyperandrogenism and lipid serum in overweight-obese PCOS patients.

This double blind clinical trial study was performed on 40 overweight-obese women with PCOS. After a one month diet, according to a control trial double blind design, the patients were randomly allocated to treatment with placebo, metformin (500mg/TDS) and flutamide (250 mg/BID) for the following 6 months while continuing hypocaloric dieting. At baseline and at the end of the study anthropometric parameters, hirsutism and menses, sex hormones, SHBG, lipid and insulin sensitivity determinations were measured and compared in two groups.

Metformin (12.2±6.07 kg) has a significant effect in decreasing body weight (p=0.000), BMI (p=0.000), waist circumference (p=0.000) and hip circumference (p=0.000) and hirsutism (p=0.000), total testosterone (p=0.032). Flutamide (6.5±5.1 kg) has effectively decreased body weight (p=0.000), BMI (p=0.000), waist circumference (p=0.000) and waist/hip circumference (p=0.005) and hirsutism (p=0.000), total testosterone (p =0.024), cholesterol (p=0.011) and LDL levels (p=0.013).

The results of this study showed that safe drugs such as metformin and flutamide reduced in anthropometric indices and hirsutism. Metformin has been more effective in reducing weight, BMI, waist and hip circumference rather than flutamide.

Major depressive disorder is a common and destructive mental disorder with relatively long episodes, high tendency to be chronic and recurrence, and responsible for many physical and mental disabilities that has the lifetime prevalence of about 17% to 19%. With regard to the improvement of non responder patients to routine treatment following a single dose injection of ketamine, this study was done to investigate the effect of ketamine on patients with major depressive disorder (MDD).

This clinical trial study (semi-experimental design) was performed on 60 patients with MDD according to DSM IV-TR criteria. A single intravenous dose of ketamine (0.5 mg/kg) was given to the patients. Depression level of all patients was assessed before injection, on the days 2 and 7 after injection of ketamine and at the end of 1st and 2nd months based on Beck and Hamilton Depression Scale. Criteria for response to treatment with ketamine was reduction of 50% or greater in Hamilton and Beck scores.

The results showed that mean score for Hamilton test before injection, on the days 2 and 7 after injection was 28.71±9.12, 20.57±10.88 and 16.85±10.70, respectively and mean score for Beck test before injection, on the days 2 and 7 after injection was 32.28±13.96, 25.05±14.10 and 19.71±13.40, respectively that significantly decreased as compared to before injection (p<0.05). The results of the scores decreased over 50% in about 20% of patients on the second day and 40% on the seventh day after injection of ketamine. Improving symptoms of depression in these patients was not associated with other variables such as age, sex, marital status, residence place, education level and season of injection.

With regard to easy administration, rapid effect and appropriate duration of action of intravenous single dose of ketamine in patients with MDD, it can be a good alternative for acute phase treatment of major depression.

Diabetes mellitus is one of the most important risk factors for incidence of nephropathy, retinopathy, neuropathy, and cardiovascular disorders. Use of medicinal plants and their effective constituents for attenuation of hyperglycemia and restoration of lipids to normal level is very important. In this study, the effect of chronic administration of favonoid hesperetin on serum glucose and lipids in diabetic rats was investigated.

In this experimental study, male Wistar rats (n=40) (250-270 g) were divided into 5 groups, i.e. control, hesperetin-treated control, diabetic, and hesperetin- or glibenclamide-treated diabetic groups. For induction of diabetes, streptozotcin (STZ) was administered (60 mg/Kg; i.p.). Hesperetin was administered i.p. at a dose of 10 mg/kg one week after diabetes induction for 6 weeks. Serum glucose, triglyceride, total cholesterol, LDL- and HDL- cholesterol levels were determined before the study, and at 3rd and 6th weeks after the study and compared.

There was a significant reduction in serum glucose level at 3rd and 6th weeks (20.1% and 23.6% respectively) in hesperetin-treated diabetic group as compared to untreated diabetics (p<0.05). In addition, there was a significant reduction for serum total cholesterol in hesperetin-treated diabetic group as compared to untreated diabetics (20.4% and 17.1% respectively) (p<0.05). Regarding serum triglyceride, there was only a non-significant reduction (11.7%) in hesperetin-treated diabetic group as compared to untreated diabetics at 6th week. On the other hand, hesperetin administration did not significantly increase HDL-cholesterol level in treated diabetics at 6th week and in contrast significantly reduced LDL-cholesterol level (29.2%) relative to untreated diabetics (p<0.05).

Chronic administration of hesperetin had a significant antihyperglycemic effect and lowers serum total cholesterol and LDL-cholesterol and these changes are time-independent.

In vitro maturation (IVM) of oocyte is a promising technique to reduce the costs and avert the side-effects of gonadotropin stimulation for in vitro fertilization (IVF). In vitro follicular culture systems at various developmental stages allow the identification of these factors and the understanding of their mechanisms of action. The aim of this study was to evaluate the influence of FSH hormone on preantral follicular growth and differentiation during in vitro follicular culture using the rodent (mouse) model.

This semi experimental study was performed on 30 numbers of six to eight week Syrian mice. For preparation of preantral follicular, the ovaries were removed aseptically and placed in petri dishes filled at room temperature with the basal medium. Special quantities of FSH (5, 20, 40, 60, 100,140, 180 and 220M IU/l of FSH) was added to the culture mediums (containing 25-30 follicles) during separate experiments. Effect of gonadotrophin (FSH) was evaluated on the growth and viability of the follicles and oocyte maturation after 6 days.

During present study, 100 mIU/ml FSH showed highly significant effect on follicle and oocyte growth as follicle survival rate also increased (91%) as compared to the follicles survived when the culture was grown without this gonadotrophin (28%). The survival rate of the follicles increased (30%) up to day 6 as compared to days 2 (17%), 4 (24%) and 8 (29%), p<0.05. Oocyte maturation (61%) and germinal vesicle breakdown rates (81%) also showed a significant increase.

The results of this study show that the follicular growth rate was increasing linearly up to the day-6 but after this it became almost constant. A gradual constancy of these rates was noticed during the last 2 days of culture in TCM199 medium, implying that these culture conditions were not enough to sustain a long-term follicular culture and follicles needed some growth enhancers.

The cast crowns replace lost tooth structure. Probably, recurrent caries occurs at the preparation margins and give rise to crown failure, affected by several factors, such as dental prosthesis design. The aim of this study was to investigate and compare of dental caries depth at full and partial crown margins.

In this experimental study, eighteen sound human maxillary premolars were assigned randomly into three groups (control, partial and full), prepared based on standard preparation and crowned under a 5-Kg load. After marginal adaptation assessment, the crowns were exposed to a demineralizing solution (pH 4.5) for 10 days. Then crowns were debounded and teeth were decalcified in 5% nitric acid. Each margin was serially sectioned into a thickness of 5 µm. For depth of lesion evaluating, light microscopy (40X magnification), with 0.001 mm accuracy, was used.

No significant difference was observed between mean caries value of full crowns and partial crowns (289.026±250.207 µm vs. 276.688±180.513 µm). Vertical margins of partial crowns presented higher mean value of caries depth than horizontal margins of these crowns (p= 0.03). But, due to less vertical margins, only 31% of total partial crown caries was assigned to those.

According to the results, although, despite to higher margins in partial crown, there is no difference in secondary caries between partial and full crowns. In conclusion, when some of axial tooth walls are intact, partial crown is more beneficial to preserve tooth structure and aesthetics.

Early diagnosis of thalassemia with chorionic villus sampling (CVS) has an important role in fetal evaluation. Because of increasing risk of fetal loss and other probable risks, it seems that information about the incidence of complications of this method in the mother and the fetus is invaluable. Therefore this study was performed to evaluate the incidence of complications of chorionic villus sampling in Sistan and Baluchestan province, Iran.

This cross sectional study was performed on 137 pregnant women (gestational age of 10-13 weeks) who referred to CVS center of Zahedan University of medical sciences, Zahedan, Iran. Transabdominal chorionic villus sampling was performed with sonographic guide. Samplings were sent to genetic laboratory. Immediately after sampling, the control sonography was performed for detecting the placental hemorrhage at the sampling site, subchorionic hematoma and fetal heart rate. The pregnant woman was discharged after 2 hours rest. Also, the final evaluation was performed on neonates to detect any defects.

The most common early complication of CVS was subchorionic hematomain in 9 (6.5%), that in one of these cases placental abruption was observed and abortion occurred finally. Fetal loss rate was 0.7% (1 case) and no defects were found in neonatal follow up.

The results of this study show that chorionic villus sampling could be dangerous and it should be done carefully and if CVS is performed after 10 weeks of gestation, it does not increase the risk of fetal anomalies.

Liver cirrhosis involves most organs and systems. Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. So the aim of this study was to evaluate the cardiac function by echocardiography in cirrhotic patients and controls.

This case-control study was carried out on 15 cirrhotic patients without ascites, 15 cirrhotic patients with moderate-to-severe ascites (based on clinical criteria, laboratory, ultrasound and endoscopy), and 15 healthy controls. Controls were selected from the relatives of cirrhotic patients. All persons were evaluated echocardiography. Sex, age, blood pressure and echocardiographic findings were recorded and compared.

Heart rate (96.68.39 in without ascites, 89.735.11 in ascites and 766.87 in controls), left atrium diameters (40.22.57 in without ascites, 35.22.93 in ascites and 31.270.88 in controls) and right (42.82.76 in without ascites, 421.51 in ascites and 31.40.91 in controls), left ventricle end systolic (46.733.97 in without ascites, 43.41.8 in ascites and 411 in controls) and diastolic (30.731.94 in without ascites, 31.21.74 in ascites and 27.270.7 in controls) diameters and E/A ratio (0.550.15 in without ascites, 0.670.1 in ascites and 1.280.2 in controls) in cirrhotic patients with and without ascites was significantly higher than control group (p<0.05).

Results showed that liver cirrhosis is associated with enlarged cardiac chamber and diastolic dysfunction.

Surfactant replacement therapy (SRT) recruited for neonatal pulmonary diseases other than respiratory distress syndrome (RDS). Different outcomes were obtained from SRT in neonatal lung diseases. This study was carried out to determine the clinical profile, underlying diseases, complications and the outcomes of the neonates who received surfactant replacement therapy at NICU in Amirkola children hospital, a referral hospital in the north of Iran.

In this cross-sectional study, all neonates who received SRT were included during 2000-2009. The more common type of surfactant used was Survanta, but Curosurf and Newfactan were used because of unavailability of Survanta. Age of the neonate at the time of SRT, underlying pulmonary diseases, duration of mechanical ventilation (MV), any complications such as pneumothorax, nosocomial infection, pulmonary hemorrhage, patent ductus arteriosus (PDA) and also mortality rate were recorded.

Out of 213 SRT cases, the frequency of pulmonary lung diseases were as follows: 178(83.56%) RDS, 18(8.45%) pneumonia, 13(6.10%) MAS (Meconium aspiration syndrome) and 4 (1.87%) CHD (Congenital diaphragmatic hernia). The mean gestational age of neonates was 32.32±3.8 weeks and the mean birth weight was 1970 ±875 gr. The mean age of neonate at the time of SRT was 7.3±2.3 hours after birth. The mean duration of MV was 4.05±3.93 days. The prevalence of complications was pneumothorax (42.48%), secondary sepsis (6.05%), PDA (3.67%) and pulmonary hemorrhage (3.42%). Neonatal death occurred in 85 cases. The mortality rate decreased from 48.87% for the first 8 years of the study to 24.88% for the last two years (p=0.003).

According to the results of this study, RDS was the most common pulmonary disease which required SRT and the survival rate of the surfactant treated neonates increased.

Considering 10-20% of children with epilepsy continue to have seizure despite the appropriate treatment; this study was done to determine the associated factors in response to treatment in children with refractory epilepsy attending in Mofid children's hospital, Tehran, Iran.

This cross-sectional study was done during one year on 150 children with refractory epilepsy in Mofid children's hospital, Tehran, Iran. Demographic and clinical information, history, type of seizure, the number and type of drugs and treatment response were recorded by interview with parents and refer to medical recorded form. Patients who had no seizure in last year defined as a seizure free and patients who had more than 50% reduction in time or number of seizure defined as a relative response and relationship between different variables and treatment response was determined.

The mean age of patients was 83.5±51.14 month and 65 (43.3%) were female and 85 (56.7%) were male. Forty-nine (32.7%) had idiopathic epilepsy and 91 (57.6%) had symptomatic epilepsy. No response and relative response was seen in 74 (49.3%) and 20 (13.3%) respectively and 56 (37.3%) was seizure free. Response to treatment had significant difference between idiopathic epilepsy and symptomatic epilepsy (p=0.049). There was not significant difference between response to treatment with sex, family relation of parents, history of neonatal asphyxia and icter, preterm labor and microcephaly, gestational age, muscle tonicity, early age of onset and family history of seizure.

Results show that symptomatic seizure had significant effect on response to treatment and these patients had worst response to antiepileptic drugs.

Preeclampsia is one of the most prevalent diseases in pregnancy that include proteinuria and hypertension and can be associated with morbidity and mortality in mother and neonate. Endothelial cell dysfunction and inflammation are considered to have a crucial role in the pathophysiologic mechanism of preeclampsia. A systemic inflammatory response involves both the immune system and the clotting and fibrinolytic system. The aim of this study was to determine the association of fibrinogen and C-reactive protein (CRP) with the severity of preeclampsia.

This cross-sectional study was performed on 44 normal pregnant women, 35 cases with mild preeclampsia and 19 cases with severe preeclampsia that referred to Shahid Yahyanejad hospital, Babol, Iran. All of patients were primigravida and single pregnancy, cases over the age of 15 and gestational age of 30 to 40 weeks. Patients didnt receive betamethasone in last week. The diagnosis of preeclampsia is made whose blood pressure reaches 140/90 mmHg or greater with proteinuria (trace or greater in random urine samples). Blood sample were taken from all subjects to measure CRP and fibrinogen and send to single laboratory. Then the groups were compared.

The mean of CRP was significantly different in control (2.28±0.81) and mild preeclampsia group (4.91±5.99) (p=0.03), and there was not significant difference between control (2.28±0.81) and severe preeclampsia group (3.8±3.05). The mean of fibrinogen was not significantly different in control group (360.5±62.35) and mild preeclampsia (344.71±65.07) and severe preeclampsia groups (340.95±78.62).

Results show that CRP increased in mild preeclampsia in comparison with control group but there was not significant difference between fibrinogen level in control group with mild and severe preeclampsia.

Nowadays diabetes is a main public health problem in the world that needs patients cooperating in the therapeutic process and diabetic patient has central role in its management. The aim of this study was to assess self care behaviors and its related factors in diabetic patients.

This cross-sectional study was done on 201 diabetic patients referring to diabetes clinics of Babol town who were selected by easy sampling method. Data was collected by means of SDSCA (Summary of Diabetes Self Care Activities) questionnaire (score range 0-105) consists of two parts of demographic characteristics (age, sex, height, weight, education, job, marital status, etc) and self care behaviors questions (medication, diet, exercise, self monitoring of blood glucose and foot care).

In this study 166 females (82.6%) and 35 men (17.4%) participated. The mean age of participants was 50.61±11.1. Most of patients were housewives 151 (75.1%) and married 174 (86.6%). Eighty-three (41.3%) of patients didn’t have suitable diet and only 47 (23.4%) of them had suitable diet during the week. Also 59 (29.4%) of them didn’t have prescribed physical activity last week, 152 (75.6%) of patients didn’t check their blood sugar according to their recommended plan and 66 (32.8%) of them checked their blood sugar only once a week. In this study, patients with higher educational level had better foot care (p=0.000) and physical activity (p=0.02). Findings showed that patients who had better self care behaviors had lower FBS results (p=0.000) and BMI (p=0.01).

According to the results of this study, attention should be given more to illiterate or low educated persons and there should be proper teaching program to increase self care behaviors.

Headache is the most common type of pain syndrome. About 90% of the whole population has headache attack at least once a year. Severe disabling headache affects 40% of the population worldwide. This study was designed to evaluate the severity of headache and types of drugs requested by affected patients who visiting a day-and-night pharmacy, Babol, Iran.

This was a cross sectional study on 300 patients suffering from headache who visited a day-and-night pharmacy of Babol in 2008. For every patient two questionnaires were filled. The first questionnaire was about patient's demographic information and their opinions about the headache and the relevant drugs. The second questionnaire was a translated standard MIDAS questionnaire for headache severity assessment. This questionnaire is based on calculating the number of the days taking off work or having some restrictions during those working days during last 3 months and scored from 0 to 21 that divided into 4 groups of minimal disability (0-5), mild disability (6-10), moderate disability (11-20) and severe disability (above 21). The score was calculated for each question.

Hundred and seventy three patients (57.67%) were looking for over the counter (OTC) drugs and the rest 127 patients (42.33%) had visited physician and had prescriptions for their headache. The most common OTC drug requested by patients was ibuprofen (48.55%) and the most common drug among the prescribed drugs was dexamethasone (38.58%). Fifty (16.67%) patients had severe disability, 87 (29%) moderate, 117 (39%) mild and 46 (15.33%) patients had a minimal disability from headache.

Most patients who had prescriptions for their headaches had a higher MIDAS score (more disable) compared to OTC patients. Pharmacists play an important role in advising patients to visit a doctor and have prescription.

Muscular involvement presenting as myalgia, myopathy and rhabdomyolysis are the most important side effects of statins. Frequently statins and other antiangina and antihypertensive agent are used as combination in order to preventing and management of atherosclerosis and cardiovascular and cerobrovascular disorders. Here we present a case of rhabdomyolysis after lovastatin and diltiazem consumption. CASE: An 80 year old man with decreased level of consciousness presented to emergency ward of Shahid Yahyanejad hospital of Babol, Iran. Past medical history revealed diltiazem and lovastatin consumption (40mg/daily) from three days before. Diagnosis of rhabdomyolysis was documented according to history, physical exam and laboratory test regarding hyperkalemia and bradyarrhythmia leading to cardiovascular collapse. During successful resuscitation arrhythmia and hemodynamic failure and hyperkalemia was corrected and patient was discharged from hospital without any morbidity after convalescence.

The results of this study showed that combination of statins and diltiazem can potentially lead to serious side effects that can be prevented by accenting on pharmacology consideration in prescribing statins and avoiding conjoins these agents with diltazem especially in old age patient.