مجله دانشگاه علوم پزشکی گیلان
پیاپی 78 (تابستان 1390)

Morphine effect on reaction to some microbial infections by modulation of immune response. To evaluate the effect of acute morphine injection on Leishmania major infection in sensitive (BALB/c) and resistant (C57BL/6) mouse strains. In this experimental study, a low dose (2mg/kg) and a high dose (10mg/kg) of morphine in two doses were injected to two groups of each mouse, the first concordant with parasite inoculation and the second 15 days later (N=5 for each group). As controls, groups of mice received naloxone before injections of morphine and also a group of mice received saline. Local reaction at the site of parasite inoculation was measured once a week. Local reaction at the site of parasite inoculation increased till fifth week, then decreased and back to the normal size, In contrast, local reaction increased continuously and became multiple in control groups and mice which received low dose morphine. Local reaction did not increase substantially in mice which injected with 10mg/kg morphine so that there was a significantly difference between them and control group (P<0.05). The results of this study showed that acute morphine injection didn’t have a significant effect on the reaction to infection with Leishmania major of C57BL/6 mice, but had a biphasic dose-dependent effect on BALB/c mice reaction to infection with this parasite.

Nowadays 10-15% of couples are infertile. One of effective methods in treatment of infertile couples is intra cytoplasmic sperm injection (ICSI). Patients who are candidate for receiving this method have confronted following questions:-Is there the rate of ectopic pregnancy and multiple pregnancy more than in this method in comparison with natural method?-Is there any relationship between maternal age, cause of infertility and number of transferred embryo to arising of this problem? Investigation the association between age, causes of infertility, number of transferred embryo with ectopic pregnancy and multiple pregnancy in infertile couples under Intra Cytoplasmic Sperm Injection (ICSI) treatment in Kosar infertility center of Urmia. In this descriptive-analytical study the pregnant women due to ICSI who referred to kosar infertility center were selected during 2003-2007.The studied variable consisted of: age of mother, cause of infertility, number of transferred embryos, ectopic and multiple pregnancy and were gathered from their files and contact with them. These data were analyzed using SPSS version 13, chai-square, T test and fisher test. P<0.05 was considered significant. Among 280 patients 224 persons were assessed. The prevalence rate of EP was 3.6%, twins’ pregnancy was 26.9% and triple or more pregnancy was 6/5%. There was a significant relationship between age and EP (p=0.02), but there was no relationship between cause of infertility and number of transferred embryo with EP. There was no relationship between the accession of multiple pregnancy and maternal age. There was a statistically significant difference between number of transferred embryo and multiple pregnancy. (p= 0.03) Maternal age can influence on rate of EP, but not on multiple pregnancy. The cause of infertility and the number of transferred embryo didn’t effect on EP but it can increase the prevalence of multiple pregnancy.

Femoral neck fracture following osteonecrosis is a common problem. Recently, some reports implicated the success of using hyaluronic acid (HA) in prevention of cartilaginous destruction, and the potential ability of HA in prevention of osteochondronecrosis. To determination the effect of intra- articular HA injection after femoral neck osteotomy In this observational study, 20 dogs were followed after femoral neck osteotomy fixed with pins. The dogs were randomly divided in two groups. Case group received 10 cc HA and control group received 10 cc of normal saline in two doses with 1 week interval. The substances were injected into the hip joint. The dogs were sacrificed after 8 weeks; the osteochondronecrosis were investigated by MRI and pathology. Data were analyzed using Fisher’s exact test and independent t test. P<0.05 was considered as significant. One dog died before research completed in both groups. Osteochondronecrosis was seen in 2 dogs in case group and 5 dogs in control group (p<0.15). Although there was no significant difference between two groups but HA injection decreased the incidence of osteochondronecrosis 2.2 fold (RR=2.2). Positive Predictive Value(PV) and Negative Predictive Value(NPV) for MRI were 33.3% and 58.3% in diagnosis of osteonecrosis. It seems that HA injection is efficient in prevention of osteochondronecrosis after femoral neck osteotomy.

A most common cause and distressing problem in patients who reffered to electrodiagnosis clinic is foot drop. This disease can have diverse etiology. Electrodiagnostic examination is a useful study in recognizing the site of injury, the degree and type of lesion and predicting the degree of recovery. Distribution of etiology and location of lesion are different in various studies. To investigate the etiology, site and type of lesion in foot drop patients who referred to poorsina hospital Electro Diagnostic Examination (EDX) clinic. In this descriptive cross sectional study 58 acquired foot drop patients who reffered to Electro Mio Graphy (EMG) department were investigated clinically and electrodiagnostically. Their muscle strength was 3 or less than 3 according to Medical Research Council scale. Among 58 patients, 30 patients (51.7%) were male and 28 patient (48.3%) were female. The mean age of them was 41.64 (standard deviation was 14.97). The mean age of patients was higher than which expected from other studies and female’s mean age was significantly higher than male’s mean age (P=0.02). Distribution of various causes and locations of injury was significantly different among age groups (P=0.001 and P=0.005 respectively). The most common cause of foot drop was peroneal neuropathy in patients younger than 35 and L5 radiculopathy in older patients. 33 patients (56%) had pain (17 radicular pain and 16 non radicular pain) as a main complaint beside foot drop. The most common location of damage was L5 root and the most common known etiology was trauma. Contrary to most of other studies, L5 radiculopathy was the most common cause of foot drop. It seems that etiology and location of lesion are dependent to the specific population and age of them. In most patients clinical distribution of pain was consistent with electrophysiological localization of lesion; therefore EDX study was most useful in patients that didn’t have any pain with foot drop.

Endotracheal intubation is the optimal way for airway management. Before tracheal intubation, laryngoscopy must be done on the patient for visualization of glottis, vocal cords and inlet of trachea. If laryngoscopy is done appropriately and airway class has lower score according to Cormack & Lehane classification (C&L), the hemodynamic changes will be low and safe. The laryngoscopes are many kinds but the most common is Macintosh which has two blades; standard blade and English blade. In this study we compared these two blades but further investigations are needed for choosing the best blade in different situations. Comparison the standard blade and English blade of Macintosh laryngoscope in airway classification of elective surgical patients. In this clinical trial with replacement interventional study, seventy patients who scheduled for elective surgery and general anesthesia with endotracheal intubation were chosen. They randomly divided to two groups (35 patients in each group) according to series of cards that was written group I or group II standard and English blade. They was chosen with anesthesia nurse after induction of anesthesia and neuromuscular blocking, At first, laryngoscopy was carried out with standard blade then with English blade in group I and with English blade then standard blade in group II. The view of the glottis was graded according to (C&L) classification for each blade during laryngoscopy procedure. (grade 1; visualizing all parts of glottis and vocal cords, grade 2; only posterior extremity of glottis was visible, grade 3; only epiglottis was seen, grade 4; no recognizable structures. Grade 3 and 4 were considered as difficult laryngoscopy in this study). The trachea was intubated at the second attempt during laryngoscopy procedure. The grading of glottic view were compared, and analyzed with SPSS (V10) and Mc Nemar Test. Among 70 patients, difference in the view of glottis was seen in 15 patients. Lower grade according C&L classification and more complete view of glottis was seen in 13 patients with English blade and 2 patients with Standard blade. There wasn’t seen grade IV of difficult laryngoscopy but grade III of difficult laryngoscopy was seen in 3 patients, the glottis view was more appear in 2 patients with English blade and 1 patient with standard blade. The view of glottis and airway classification base on (C&L) for English blade was: class I in 60 patients (85.7%), class II in 9 patients (12.9%), and this view for standard blade was: class I in 50 patients (71.4%), class II in 18 patients (25.7%). This differences were statistically significant (P= 0.006) between two kind of blades. According to this study, laryngoscopy with English blade of Macintosh provided lower grade of airway and more complete view of glottic opening in comparison with standard blade.

Oral anticoagulants are frequently prescribed to decrease the tendency for thrombosis and embolism in susceptible individuals such as patients who underwent heart valve replacement. These components may have side effects sometimes intensify by individual and environmental factors. To investhgate the prevalence of complications of Warfarin and to determine their relationship with some individual and environmental factors in heart valve replacement patients in Guilan. This descriptive study was conducted through a prospective plan during May 2008- January 2009. The sample consists of 104 patients who underwent heart valve replacement, living across the Guilan proviance. Data were collected via a questionnaires completed by patients and results of blood test measured International Normalized Ratio (INR) Data were analyzed in SPSS using orderd regression logistic statistical method and chi- Square test. Among 936 collected records in nine stages of sampling, 56 cases (6%) showed moderate and severe increase in INR, women 1.85 times more likely to have increased INR. Among 38 cases of bleeding, 32(80%) occurred in this group of Patients, and the probability of bleeding in females was quite large (3.35). Among the factors included in this study, garlic, digestive tract medications and pain killers more likely intensify the anticoagulation effects of warfarin, increase the INR range and bleeding. On the contrary, consumption of soya, oil and cigarette smoking attenuate the drug effects on INR. With regard to results of this study that showed the effect of individual and environmental factors on warfarin therapeutic and adverse effects, it is recommended that patients underwent heart valve replacement and other user of this drug should receive necessary training and warnings.

Today, internet is a usual and common method for identifying and fulfilling of unknowing practices. Internet network has prepared rapid and comfort access to information. Internet addiction is a new and attractive subject that regarded as behavior-based addiction recently. Internet addiction prevalece and related risk factors in students of Arak university of medical sciences This analytical cross sectional study was conducted on 426 students who were selected with two stages sampling method.Data was collected by a standard internet addiction questionnaire, then data was analyzed by chi square, t-test and Pearson coefficient statistical tests. Significant level was consider as 0.05. The overall prevalence of internet addiction was calculated as 10.8%, which moderate and severe internet addiction were equal to 8% and 2.8% respectively.There was a significant relationship between iInternet addiction with sex, marital status, father job, rate of knowledge about computer and internet and educational term (p<0.05). But there wasn’t any relationship bet ween it whit parents education, residential place, educational major, level and faculty of education (p>0.05). Because of internet addiction lead to wasting leisure and useful time of students, it was affects the educational situation insecurity, so it is nesessary to endeavor for planning and improving of internet usage.

In the last three decades prenatal ultrasound is the most important technology to evaluate Pregnancy, however it had an important role to evaluate and treatment of high risk pregnancies, but there wasn’t coordinate idea for doing it in low risk pregnancies. Ultrasound should only implemented in pregnancy where indication is presented. Routine ultrasounds lead to unnecessary interventions and exorbitant costs of health systems in low risk pregnancies. To determine the reasons of maternal request for ultrasound in low risk pregnancy. In a cross- sectional study, 204 low risk pregnant women who referred to Alzahra hospital were selected during March 2008 till 2009.They had no scale of high risk pregnancy according to reference books.Questionnaires were completed through interview and investigating their blood examination and their documents. Questionnaire included several sections: demographic Characteristics, the number of ultrasound and the causes of implementation. Finally the findings were analyzed using chi square and ANOVA test and SPSS software. Among the studied population, 100% of cases was performed ultrasound at least once. The need for ultrasound was ordered by specialists (55.1%), the health center staff (21.3%), the patient (13.3%), the midwife (6.9%) and General Physician (3.41%). The most important causes to ultrasound consist of: confidence of determining the gender of the fetus, health condition, and time of delivery and normal growth of the fetus, respectively. In primigravid patients the frequency of ultrasound was more than multigravid patients (p=0.001). Frequency of ultrasound in women who covered in insurance centers was more than other group (p=0.029). The frequency of ultrasound in women with high education was more than low education group (p=0.003). Ultrasound is common in low risk pregnant women. Specialists, Health center staffs and the patients emphasize on it as a routine means for maternal care. However it seemed unethical and may lead to high expenditure of time and financial issues. Women have specific causes for implementation of ultrasound that are affected by socioeconomic, obstetric and individual factors.

Traumatic brain injury (TBI) is a risk factor in creation of mental disorders.Therefore, psychometrhc study is necessary to provide a mental disorder screening tool in these patients. To assess the factor structure, clinical cut-off point and psychometric properties of ‎28- Itemes version for General Health Questionnaire (GHQ-28) in patients with TBI. In descriptive- longitudinal study, 238 patients (43 females and 195 males) were chosen by nonprobability and consecutive sampling method. Each of them completed modified version for GHQ-28. After 4 months pursuit 155 patients (65.1%) reffered to a psychiatrist in order to determine the nature of mental disorder due to TBI, according to structured clinical interview based on DSM-IV diagnostic criteria. Data was analyzed by ROC curve, independent T tests, factor and discrimination analysis methods, Pearson’s correlation, Cronbach's alpha coefficients and split half reliability(Spearman- Brown’s and Guttmann’s). The results showed that cut off point, sensitivity, specificity and area under the curve was 16.5%, 62.2%, 60% and 0.66% respectively by using the conventional scoring method, for the Likert scoring method same values were 40.5%, 72.2%, 57.1% and 71.0 respectively. Reliability coefficients of mentioned questionnaire by Cronbach's alpha and split half reliability method, to conventional scoring method were 0.89, 0.76 and by Likert scoring method were 0.92, 0.81, respectively.According to factor analysis by oblique direct method, Four factors were extracted from the GHQ-28 which were named, social dysfunction, depression, physical symptoms, anxiety and insomnia respectively. The correlation coefficients among these questionnaire sub-scales and the total score founded level optimum were between 0.46 – 0.81 (P<0.0001). Factor analysis indicated that four major factors are the basis of Modified Version for GHQ-28 and psychometric properties implicated their capabilities for screening of mental disorders in patients with TBI.

One of the most common peripheral nerve entrapments is known as carpal tunnel syndrome. Nerve Conduction Velocity (NCV) study and Electrodiagnostic test is the most sensitive diagnostic for CTS which is a quantitative and independent method to patients report and its outcomes are usually equal in various patients. It showed a nerve conduction delay in 70-90 percent of patients. Comparison of nerve conduction velocity (NCV) in the forearm between normal hand and with CTS. In this prospective study, 89 patients with Clinical diagnosis of CTS patients without any underling diseases were selected among patients who referred to Poorsina electro-diagnostic clinic. Data was collected through questionnaire, clinical examination and their NCV files, and then they were analyzed by Paired-T-test and SPSS. During 4 months, 89 patients with clinical and electro diagnostic of CTS were selected.48 patients (53.9%) were female and 41 patients (46.1%) were male. The ratio of female to male was 1.17%: 1.55(61.8%) of them suffered from CTS symptom in right hand. The average of (NCV) in right hand of patients was 58.11±12.10(m/s)and in left hand of them was 51.31 ± 12.56(m/s). According to our data distribution based on Paired sample T-test for average comparison, the P-value is equal to 0.0001 which showed a significant difference between CTS forearm and the health one. This difference was from 4.74 m/s to 7.35 m/s. In the other word, it showed a 6.04 reduction in NCV related normal hand. Nerve Conduction Velocity decreased significantly trough CTS forearm toward health one.

Intravenous (IV) drug abusers are at risk of HIV/AIDS because of their high risk behavior such as using shared syringes. This people suffered from psychological problems, but didn’t pay attention to progress of prevent, control the disease and take care of them. We studied the relation between, anxiety and stress of this groups with and without HIV/AIDS.

To compare the depression, anxiety and stress in IV drug abusers, with and without HIV/ AIDS.

In this cross-sectional study, 30 samples with history of Intravenous drug use, and 30 samples with HIV/ AIDS disease were randomly selected and evaluated by the depression, anxiety and stress scale. Data was analyzed by Manova and SPSS Ver.16.

The findings showed that there was no significant difference between IDUs groups with and without HIV/AIDS (P <0/001).

Intravenous drug users is associated with psychological problems, High percentage of people with HIV/ AIDS have a history of injecting drug, According to the results, treatment of addiction is very important in this group so suggested to create comprehensive planning and new insights demands.

Kikuchi- Fugimoto or Histocytic necrotizing lymphadenitis is a rare and self – limited disease with fever and cervical lymphadenopathy which often appears in young women.At the first time this disease was described in Japanese articles in 1972, but then some cases were reported from the other parts of the world Differential Diagnosis of this disease with other benign and malignant cases of cervical lymphadenopathy is very important.Case report: This report is about an eighteen –years –old girl with long time fever, weight loss, night Sweat and cervical lymphadenopathy. The diagnosis of Kikuchi–Fugimoto disease was reported By Pathologist in cervical lymph node biopsy

In order to familiarize the otolaryngologist- head and neck surgeons, other Surgeons, internal and infectious disease specialists and general physician, this reported was done.