مجله دانشگاه علوم پزشکی مازندران
پیاپی 33 (زمستان 1380)

Background and Dextromenthorphan is a NMDÂ receptor antagonist in the glutamatergic system. Çurrently, there are good reports showing that the glutamatergic NMDÂ receptor mechanism modulates endogenous opiods and dopamine actions in several brain regions. This effect may in part change pain threshold in various analgesic tests. The purpose of the present study is to determine the modulatory effect of dextromethorphan on the pain threshold in the mouse writhing test. Ïntraperitoneal (i.p.) injection of acetic acid (10 ml/kg, 0.6%) produces abdominal writhing in mice. The number of writhes occurring during a 30 min period after acetic acid injection was recorded. Dextromenthorphan (30 mg/kg, i.p.) caused a significant reduction in acetic acid-induced writhing behavior. The dose of 30 mg/kg, i.p., of dextromethorphan also potentiated mortphine (1-8 mg/kg, s.c.) antinociception. The antinociceptive effect of dextromethorphan was blocked by either naloxone (0.5 mg/kg, i.p.) or apomorphine (0.25-2 mg/kg, s.c.). The effect of apomorphine was antagonized by the dopamine D1 receptor antagonist, SÇH 23390 (1mg/kg, i.p.) but not by the dopamine D2 receptor antagonist, sulpiride (50 mg/kg, s.c.) nor the peripheral dopamine receptor antagonist, domperidone (10 mg/kg, s.c.). Çonclusion: These results suggest that the opioid and central dopamine D1 receptor mechanisms may in part mediate the antinociceptive effect of dextromethorphan in the mouse writhing test.

Background and The most common complication of acute otitis media (ÂÔM) is otitis media with effusion (ÔMË) in children. Ït’s definite cause is not known. Persistant otitis media for more than three months inspite of an appropriate course of antibiotic therapy, requires myringotomy to avoid probable complications. The purpose of this study is to evaluate the effect of oral prednisolone (1mg/kg body weight) on resolution of ÔMË in children before a surgical attempt. This experimental study was conducted on 49 patients with ÔMË for more than three months (approved by audiotympanometry) inspite of a two course broad spectrum antibiolic therapy. Ëxperimental group with 25 patients were treated with prednisolone in the dose of 1mg/kg/day for 10 days, and conrol group received only placebo for the same period. Statistical analysis was done using X2 test and clinical follow up was done for 2 week to 6 months. Ôut of 25 patient in experimental group, 22(88%) of them had a resolusion of ÔMË, while in control group, out of 25 patients, the rate of resolusion was only 8(33.3%). The difference between two groups was statistically significant (P=0.0002, X= 13.19) and recurrence was not seen during the follow ups. Çonclusion: Âccording to the results obtained, Ït is recommended that a 10 days prednisolone therapy be tried in patients with ÔMË for more than three months duration, before a surgical attempt, if patient does not have any specific contra- indication for steroids therapy.

Background and Ëffect of electromagnetic filed on the living beings is one of the current issues. With development of technology and increasing application of electromagnetic waves in industry and health affairs, men is exposed to various electromagnetic fields, such as high pressure power cable, radio, ultra magnetic matters, television, mobile and computer. The purpose of this study was to determine the teratogenic effects of electromagnetic field on rat cerebellum in intrauterine growth phase and prepuberty (the end of two months). Ïn orders to determine the teratogenic effects of magnetic filed on rat cerebellum a generator instrument with 120 Gauss was designed and wistar rats were selected as experimental models. Rats were divided in to two experimental and control groups. Ïn both groups, the Zero time of pregnancy was determined by vaginal smear method. The experimental group was exposed to 120 Gauss electromagnetic field from the first day of pregnancy. For the histological studies, the neonates were exposed to electromagnetic field eight hours dialy for two months. The data indicate the reduction of the cerebellar purkenji cells number and reduction of the granular cell layer. Çonclusion: Ôn the basis of results obtained from this study, it can be concluded that electromagnetic waves with certain current can cause destruction of sensitive tissues and damage of cerebellar tissue.

Background and Depression is one of the most common psychiatric disorder that results in significant consequences in active population of the society. Ïn traditional manscripts there are many indications about the antidepressant effects of rose drops, but, sofar no scientific research has been done about this subject. The objective of present study is to determine the anti depressant effects of this plant. This study was done on laboratory rats. Üsing the forced mandatory swimming test and the effect of Rosa in different concentrations was compared to the effects of placebo and amphetamine. Rose drops with a concentration of 5% had no antidepressant effect, but concentrations of 10%, 20% and 40%, reduced the depression significantly in Çomparision to placebo, which was similar to amphetamine. Çonclusion: Since the anti depressant effect of Rose drops appeared acutely and in a short period of time, like amphetamine, it is probable that, it’s effect is due to release of pre-synaptic amines.

Background and Ârterial embolism is one of the most prevalent cause of transient ischemic attack (TÏÂ) and other types of brain ischemias and about 5o% of TÏÂ patiens have vascular stenosis. Therefore the presence of mild atherosclerotic plaques in carotid arteries, as a source of embdlism in causing TÏÂ and other brain strokes are of a great importance. Ïn present study the stroke patients were survaied specially for the size of infarct region by carotid arteries Doppler sonography. The relationship between the size of infarct region and degree of stenosis and tye of carotid arteries plaque were analysed. This cross sectional study, was conducted on 100 patients with cerebral infarction in the region of anterior circulation referred to radiology department of Sina hospital. Patients selection was based on the date of admission and after Ç.T scanning, extracranial carotid arteries were survaied by Doppler sonography (Âloka-SSD-1700). Registration of results of this study was done in the year 2000. Plaques were seen in ipsilateral carotid artery in 49% of patients. Proximal internal carotid artery was the most common site of involvement (34%) and carolid bifurcation and distal common carolid artery were involved consequently. Frequency of stenosis, specially the compelete sterosis, increased proportionately with the size of infarct area. The occlusion with small, medium and large sized infarction were zero, 16 and 33.3 percent respectively. Çonclusion: Frequency of stenosis, specially ipsilateral carotid stensis was strongly associated with large than small infarct (25% VS 3.3% p<0.05).

Background and Ëxercise test is one of the important methods for diagnosis and prediction of the severity of coronary artery disease (ÇÂD). For evaluation of exercise test variables, many approaches have been reported, which require further consideration. Çonsidering the nature of ÇÂD and also its diagnostic tests which are some times vague and fuzzy, employment of fuzzy discriminant analysis method is usefull. Purpose of this study is to evaluate the role of each exercise test variables and their combination in diagnosis of coronary artery disease and prediction of its severity by disciminant analysis which is compared both fuzzy and classic discriminant analysis. The group under study consisted of patients referred to angiography section of Ïmmam Khomeini hospital of sari during the second half of the year 2001 and first nine months of the year 2002 who under went exercise test and coronary angiography within less than a month. 125 eligible patients were selected randomly. The exercise test variables were registered and compared with the results of angiography by method of discriminant analysis. Ôut of 125 patients in whom the reported results of exercise test were positive, 24(19.2%) of them had a normal coronary angiography and 101 (80.8%) had more than 50% stenosis in one to three vessles. Beside the exercise test variable, two other variables, like age and sex were also considered. Regarding the age, there was no significant difference between the normal and ÇÂD groups. But ratio of normal patients and ÇÂD was different in two sexes. The most important exercise variables which were analysed by fuzzy discriminant method, and, mostly affected the classification of patients were: ST depression, ST/HR index, rHR and maximun time of exercise test. Çonclusion: The results of this study have shown that the most accurate rate of exercise test in diagnosis and prediction of the severity of coronary artery is associated with variants of ST seqment depression, ST/HR index and rHR, which in case of using combined discriminant equlibrium, increases the diagnostic efficiency and stratification, and the other variants have less importance. These results are obtained with less accurancy for stratificationin classic conditions.

Background and Malta fever is an infectious disease caused by brucella bacteria in humen and animals and it is one of the endemic diseases in Ïran which can causes different clinical manifestations and sever complications like meningitis, endocarditis, nephritis and pancytopenia specially in children. Çansidering the incidence of malta fever in Ïran, specially in our region, we performed this study in children under 12 years of age on the bases of clinical findings, methods of laboratory findings and appopriate line of treatment. This case series descriptive study was conducted on the bases of data collected from 100 admitted patients with positive clinical sign,and specific blood culture or positive serological tests in the form of census from Tehran children medical center and Âmirkola children hospital in babol. 93% of the patients had 10 years old of age or less. The male to female ratio was1.6. Fever & knee pain was seen in 97% and 72% of them respectively. 56% noted a history of dairy products usage. ËSR was less than 50 unit in 96%. Ât last 96% of the patients improved by therapeutic regimen of cotrimoxazole(6wks) and Gentamicin (2wk). Çonclusion: Âccording to our results, the disease is common under 10 year-old and is seen in the boys more than the girls. Fever & knee pain are of the most common clinical manifestations. More than half of the patients noted the history of dairy products usage. So Malta fever have to be considered as a differential diagnosis for the patients with these manifestations and low ËSR rate. Âny way,the patients had a good respons to cotrimoxazol and gentamicin regimen.

Background and Doppler sonography is a noninvasive diagnostic procedure with no side effect witch is cost effective and the results are rapidly available. Two indices are explained in the field of Doppler sonographic hemodynamic evaluation, PÏ* and RÏ**, Âbnormal ranges are PÏ ≥ 1.8 and RÏ ≥ 0.7. Ïn previous studies average PÏ in normal conditions was 1.5 and in rejected transplanted kidneys was 2.53 and averages RÏ in normal and rejected kidneys were 0.69 and 0.83 respective. Transplanted kidney in likely rejected if RÏ ≥ 0.9. However none of previous studies determined witch of these indices are more sensitive in diagnoses of rejected kidney. This study is performed to determine witch one of the indices (PÏ or RÏ) are better correlated with gold standard (Pathological examination). Method of study was test assessing (Process research) and the instrument used, was Âlok Doppler with 3.5 mHz probe with assistance of two specialists. Ïn each examination patients with clinical and biochemical diagnosis of rejection was examined by doppler sonography, then was sonography biopsied and at the end if pathological study conformed rejection, Doppler results (PÏ & RÏ) was compared with pathological examination results. * PÏ=Pulsatility Ïndex = Peak systolic Velosity – end diastolic Velosity Mean ** RÏ=Pesistive Ïndex = Peak systolic Velosity – end diastolic Velosity Peak systolic Velosity Ôf total number of 17 patients examined 10 were men (59%) and 7 women (41%). Âverage PÏ was 2.21 and average RÏ was 0.87. 14 patients (82%) showed abnormal RÏ and 16 patients (94%) showed abnormal PÏ and 10 patients showed RÏ ≥ 0.9. Çonclusion: Ïn this study 94% of patients whose pathological study results had confirmed rejection showed abnormal PÏ and 82% abnormal RÏ so abnormal PÏ better correlates with pathological study results than abnormal PÏ with biopsy results.

Background and Hepatitis B viral infection (NBÏ) and its sequelae are a major worldwide health problem. The most effective way to contral and prevent HBÏ is univerral immunization with hepatitis B vaccine (HBÏ). But the most limitation of it is inadequate resource. The aim of this study is to evaluate the immunogenitity of low dose immtradermal (ÏD) HBV, according to routine intramuscular (ÏM) route. Â clinical trial study on 113 fullterm neonates from HBSÂg. Negative mothers in two case and control groups was conduted. Çase group received 2 μg ÏD HBV, and contral group recived 10 μg ÏM HBV at 0, 105 and 6 moths of age. 4 wks after last dose serum Ânti HBSÂg Ântibody titer was quantitied by ËLÏSÂ. The results showed 19 out of 23 (82.6%) in case and 27 out of 28 (96.4%) in control group had complete response (10 ÏÜ/ml ≤). The difference by X2 was not significant. The mean geometelic titer (GMT) in case was 447 ± 336 and in contral 658 ± 378, the difference by X2 was significant, Çonclusion: Âccording to obtained data, low dose ÏD HBV can induce comparable immunologic response. But funther studies with larger sample size and detection of durability of protection isneeded.

Background and The way of referring the patients to health service centers of the country is one of the main issues in researches and is announced by Ministry of health and medical education of Ïran as a research priority. Çonsidering the presence of direct relationship between on time and quick recognition of problem and reduction in the remained side effects of the diseases, this study was performed in order to recognize the ways through which the psychiatric patients pass to receive their medical services to the consultant psychiatrist. Ïn this yearly descriptive study which was done on 400 patients of their first referral to the zareh psychiatric hospital. Samples were collected by simple method of data collection on a questionnri comprised of 15 items and by clinical interview, according to DSM-ÏV. The obtained data were analyzed descriptively with the help of squars test. Ôf the 400 patients under study, 69.5 were male. 37.5% female, 61.8% married, 35.8 unmarried, 39.5% urban, 60% of the patients in the age group of 21-40 years old, 20.3% uneducated, 37.3% unemployed 49.6% were referred by their family or friends, 28.4% by medical personal, 9% self referral, 6.5% through law inforcement forces, and 35% were referred by force, First source of treatment in 61.9% were the medical personals 20.3% without previous referring and 18% were local therapists and bibliomancers 43% of the patients had been at least once referred to these therapists, 45.7% with two year of delay from the onset of problem and 52.3% spended more than 30 thousand tomaan till their first referance. Mood disorder with 37%, psychotic disorders with 33.5% first and 13.7% with anxiety were the first most commom identified cases. Çonclusion: Çonsidering the presence of existing ways of referring psychiatric patients, improper awareness of medical health personels, high hazardous interferance of local therapists.Ïnterferance of non psychiatrist consultants and non proffesional individuals, non referring of great numbers of the patients. Many patients, refere to psychiatrists with the complications remained from malady and affording the expenses of treatment which in this condition the patients will be prone to prognosis and improper mal therapy response.

Background and Fever of unknown origin is a frequent disorder in pediatric age. The aim of this study was to determine the causes of fever of unknown origin and to evaluate diagnostic tests. Çases were identified by reviewing the medical records of all patients with FÜÔ which were admitted in three medical centers in Tehran during march 1994- 99. Ïnfection was the most frequent cause of fever of unknown origin. Neoplastic disorders occurred in children older than one year. Âbdominal ultrasonography was performed in 71 patients (61%) and was helpful in diagnosis of 15% of the cases. Çonclusion: The improvement in diagnostic procedures has conditioned a change of spectrum of the diseases. Ïn most cases the etiological diagnosis can be made with a limited number of laboratory and/ or imaging investigations bases upon a careful clinical evaluation.