مجله دانشگاه علوم پزشکی مازندران
پیاپی 57 (فروردین و اردیبهشت 1386)

Background and Management of cutaneous wounds is an important subject in medicine. Different chemical agents have been used for wound healing but each of them has side effects. In this study, we examined the effects of an experimental ointment derived from a natural product on wound healing. Twenty-four white rabbits divided into three groups as fallows: control, Eucerin and Gazangebine. The ointment was made by Gazangebine extract (9%) and Eucerin in the laboratory. A full thickness wound (2cm ´2cm) was made on the left flank of the test animals. The ointment was applied to the wound area twice daily without any covering as an open wound. Wound area was measured every 3 days until day 18. In this day, rabbits were biopsied to look for histopathological changes. Gazangebine ointment had no beneficial effects on wound contraction. However, it decreased inflammation and neutrophil number (P<0.05, p=0.001) and increased eosinophil number and dermal tissue healing (p<0.05, p=0.000). The results suggest that Gazangebine ointment has positive effects on wound healing.

Background and About 200,000 of Iranian population are infected with Hepatitis C Virus. On the basis of Iranian consensus on management of chronic hepatitis C (CHC) infection in 2004, combination therapy with conventional α-Interferon (IFN) plus Ribavirin is the first therapeutic choice in CHC patients. Data are limited on treatment response rate in most areas of the country. To assess the treatment results, we performed this study in a referral center in province of Fars, in Iran, to compare with the response rates to therapy in Western patients. A total of 118 patients with CHC (males 88%) with mean age of 37.47 (SD 11.4) years, mean Histologic Activity Index of 8.21 (SD 4.5), and mean pretreatment Alt level of 81.26 (SD 72.86) were enrolled in the study. IFN 3 million unit/TIW plus Ribavirin 1-1.2 gr/d were administrated for 6-12 months (depending on genotype), and the patients were followed up for 6 months period to assess sustained virologic response (SVR). The most common route of aquisition of the virus was intravenous drug using seen in 39.8% of patients. 40.7% were infected by genotype 3a, 22 % 1a and 9.3% by 1b. Seventy-three patients completed the course of therapy. End of treatment response (ETR) was achieved in 54 (74%) patients. SVR rate was 48% with a relapse of 13.7%. Hepatic decompensation was seen in 2 (2.7%) patients in follow-up period. With respect to the duration of therapy, genotype of viruses was not significantly different in both responders and non-responders (0.05). Despite the different genotyping pattern, ETR and SVR rates were comparable in Iranian CHC patients treated by combination therapy of conventional IFN plus ribavirin in comparison with Western patients. SVR was greater in cases with pretreatment lower HAI.

Background and There are many reports on anti-thrombotic properties of garlic. Also, regarding the simultaneous consumption of garlic and Warfarine or non-steroid anti-inflammatory drugs (NSAIDs), some warning recommendations are published. The aim of present study was to evaluate the effects of garlic on coagulation tests, and in case of any demonstrative anticoagulation effect, the patients, particularly those with coagulation disorders, could be given appropriate advice on proper consumption of garlic. This was a clinical trial in which 50 volunteer students were selected based on information collected using appropriate questionnaires. The students were tested for coagulation assays including bleeding time (BT), clotting time (CT), prothrombin time (PT), partial thromboplastin time (PIT), clot retraction (CR), and platelets count (PC) before and after consumption of garlic. Data were analyzed using SPPS and T-test. The average values of tests obtained in two stages of experiment were further compared statistically. The results of our study on subjects (30 females and 20 males) with an average age of 21.7 years showed that there was no significant change in values obtained for CT, PT, PC and CR (p>0.05) following consumption of garlic. However, a significant increase in PTT values was found following consumption of garlic (the p values for samples collected after 24 hours and 4 hours were 0.001 and 0.012 respectively). There was also a significant difference (p=0.027) in BT 24 hours after garlic consumption. Regarding the results of similar tests among two genders, no significant difference was found. Following consumption of garlic, there was a significant increase in PIT and BT, the effect being more obvious after 24 hours. The data of present study regarding the inhibitory effect of garlic on platelet activities is consistent with those reported by some other researches which is also indicative of interference of garlic with PIT assays.

Background and Finasteride, a type П– selective 5α– reductase inhibitor, that causes decreasing Dihydrotestestrone (DHT) levels, is effective in treatment of male androgenic alopecia. The purpose of this study was to determine the effect of local finasteride on androgenic alopecia treatment in comparison with oral finasteride. This study was a double-blind clinical trial including 45 male patients involved with androgenetic alopecia according to history and physical examination and possessing the study criteria selected among patients reffered to private clinics and departments of dermatology in Sari city. Patients were divided into two groups: patients in group A (finasteride jel and placebo tablet) and patients in group B (finastride tablet and pelacebo jel) and the eligible reffered patients were gradually and randomly entered the two groups. The treatment period was 6 months. In order to evaluate the drug effects and progressive state of the patients and assessment of drug complications, the patients were followed up by clinical observation and recording of side effects before study and at the end of the first week and then every month after starting the treatment. The variables used to evaluate the therapeutic response were: size of defect, hair count and terminal hair count. The analysis was done using descriptive and X² statistical methods. Of the 45 patients enrolled, 38 completed the entire study period. The average period since the onder of hair loss was 18.8 ± 23.10 months. Every month the size of alopecia area, hair count and terminal hair count between the two groups were compared and there were on significant statistical differences. In the third month of treatment, an increase in terminal hair count were observed in group A (P=0.001), this phenomenon was observed in second months in group B (P=0.015). During the therapeutic period, the size of alopecia area did not significantly change in group A, but in group B, the change in size of alopecia area was significant 4 months after the start of treatment (P=0.027). Increased hair count in two groups were significant in the fourth treatment months (P=0.001 in group A and P=0.000 in group B). In this study, treatment with %1 finasteride jel produced relatively similar moderate therapeutic effects with finasteride tablet (%54.5 against%56) in patients with male alopecia with no significant statistical differences (P = 0.643).

Background and Coronary Artery Disease (CAD) is one of the most common causes of mortality and disability in the world. The results of some studies show that there are differences in signs and symptoms of CAD between male and female. This research was done to compare males and females for these signs and symptoms in 600 hospitalized patients in coronary care units of Kerman Medical University from December 2004 to July 2005. For data collection a questionnaire was used which was designed in five sections: demographic characteristics, disease variables, pictures for determining the points of chest pain, Visual Analog Scale for determining the intensity of pain and measures taken by patients after the beginning the signs and symptoms. This questionnaire was completed by two nurses in different shifts by interviewing the patients. For data analysis T test, χ2, Fisher exact and Man-Whitney U were used. The results showed that the women were older than men (p<0.001). Most women had unstable angina and men had myocardial infarction (P<0.05). There were no significant differences between the chest pain in both genders but neck pain, back pain, fatigue, decrease of appetite, flushing, dizziness, tiredness, visual disturbances, suffocation feeling, palpitation and restlessness were experienced in women more than men (p<0.05). Also dyspenea during the heart attack was seen in most women (44.7% vs 29.4%) but there was no significant difference between two genders for intensity of pain. This study showed that atypical signs and symptoms of unstable angina and myocardial infarction were seen in female more than male. Furthermore this may be followed by some problems in diagnosis and then delay in referring the patients to medical centers. On the other hand, health care workers may not pay enough attention to these atypical signs and symptoms, in women with normal ECG so they might not receive nessaceery services.

Background and Ethambutol (EMB) is one of the first - line drugs used for anti-tubercular therapy but resistance to this medicine is developed in many parts of the world. EMB resistant strains commonly have embB mutations. Purpose of this research was detection of EMB-resistant Mycobactercium tuberculosis strains isolated from patients by MAS-PCR method and comparison with Proportion procedure. One hundred and twenty M. tuberculosis strains were isolated from patients with tulerculosis in Tabriz TB research center. Susceptibility testing to EMB was performed by the Proportion method. DNA was isolated from cultivated cells by SDS-proteinase K modified method. Isolated DNA was used as the template for PCR reaction. One hundred and sixteen strains were susceptible to EMB and 4 (3.33%) strains were resistant to EMB. All EMB resistant strains were multidrug-resistant. The MAS-PCR method was used to evaluate of mutation in the embB306 codon. Mutation was seen at the embB306 codon in all resistant strains to ethambutol. The results showed that MAS-PCR method can be used as a simple and rapid procedure for detecting EMB-resistance in Mycobacterium tuberculosis strains.

Background and The genus Phlomis and Stachys (Labiatae) are widely distributed in Iran. There are no reports on the antimicrobial activity of some of these plants. The medicinal properties attributed to the genus Phlomis and Stachys prompted us to investigate the antimicrobial activity of the methanolic extracts of Phlomis bruguieri, P. herba-venti, P. olivieri, Stachys byzantina, S. inflata, S. lavandulifolia and S. laxa. The antimicrobial activity of these plants were studied using the disc diffusion method (10,50,100, 250, 500, 750, and 1000 µg/disc) and determination of minimum inhibitory concentration (MIC) values (10 µg/ml to 25 mg/ml) against Staphylococcus aureus PTCC 1112, Streptococcus sanguis PTCC 1449, Escherichia coli PTCC 1330, Pseudomonas aeroginosa PTCC 1074, Klebsiella pneumoniae PTCC 1053, Aspergilus niger PTCC 5011 and Candida albicans PTCC 5027. The methanolic extracts of the aerial parts of Phlomis bruguieri, P. herba-venti, P. olivieri, Stachys byzantina, S. inflata, S. lavandulifolia and S. laxa exhibited concentration-dependent antibacterial activity against all tested bacteria. The methanolic extracts were more active against Gram-positive microorganisms (Streptococcus sanguis and Staphylococcus aureus). The extracts did not show any antifungal activity. The results concluded that the methanolic extracts of these plants have a potential source of antibacterial of natural origin.

Background and Educational evaluation is a structured process for determination of quality and effectivness of an educational program. Of the most common and studied methods used for evaluation of academic staff is evaluation by students, however, "self-assessment" of the academic staff has not been videly used and there are few studies about it. So the purpose of this study was to assess the correlation between the results of the academic staff "self assessment" and assessment by the students. This study was an analysis of correlation. Study population was clinical faculty members of Mazandaran University of Medical Sciences, recruited by simple sampling method. Tool of data collection was a questionnaire consisted of demographic and educational variables and questions about evaluation of theoretical and clinical teaching of member of staff. Validiy and reliabiliy of the questionnaire were approaved. Each faculty member was assessed by students and themselves and correlation between them was analysed using SPSS 13. Totally 35 member of staff participated in self assessment, with a mean age of 43.7±7.46 years, 73% male. 95.6% of the staff and only 80.6% of the students have positive attitude toword assessment of the staff by students (p<0.001). Not only there was a weak correlation between the results of staff "self assessment" and their assessment by students (r= 0.020, r=0/125) but also there was a significant difference between them (p<0.001). Differences between these measures was higher in minor teaching departments. There was a weak correlation between measures of members of staff "self assessment" and their assessment by students, so educational intervention, for improvement of competency for "self assessment" should be designed and implemented.

Background and Emergency contraception is a method which used after unprotected intercourse and declines the rate of unintended pregnancy. In spite of efficacy and safty of this method, its rate of use is low. Major obstacle of regular use of this method is insufficient information of the health care providers, which in turn, causes low prescription of this method and consequently insatiable practice. This research is a correlative study to assess the knowledge, attitude and practice of practitioners and midwives working in health centers of the main cities of Mazandaran province about contraception. In this research 150 research units were selected using a multiple sampling method A questionnair was used for data, collection, completed by experienced persons who at health centers. To analyze the data descriptive statistics and c2, T-test, regression analysis and correlation were used. The results showed that the level of knowledge of subjects were: 35/5% good, 38% medium and 26% poor. Negative correlation was seen between knowledge and age and job background but no correlation between knowledge and other factors. Also most of the subject’ had a positive attitude toward emergency contraception (60.7%) and 39.3% of them had a negative attitude about this method. 54.4% of subject’ had a good practice and 45.6 % had a bad practice. Practice showed a statistical correlation with gender and job however there was no was correlation between practice and other factors. Data indicated the necessity of regular retraining courses or workshops on family planning spechially about emergency contraception to increase knowledge of research units about this method.

Background and Nowdays in almost all organizations, resources are allocated based on traditional methods, personal experiences and mental reasoning power. This causes some dissatisfaction among people and have no generalization ability and mathematical basis. The objective of this research was to propose a fuzzy goal programming model in resource allocation at the university-education affairs of ministry of health and use of mathematical theory method to make the quantity and quality of human reasoning closer to mathematical reasoning. This is a cross-sectional objective-based research for resource allocation taking into consideration the goal limitations. The objective goal function was on the basis of minimum square goals deviation. Decision making matrix questionnaire was used for data collection and the data were analyzed using expert-choice software Matlab. After running the model, the optimal results from each goal were obtained with some modifications compared with that in 1384. In the model (F(x) =). Each general variable of the number of students and the number of academic staff in comparison with goal (117000 in comparison with 116690 and 10850 person in comparison with 9855 person respectively) is obtained using quadratic programming method. Use the fuzzy goal programming lead to making optimal resource allocation. The goals of program with respect to resource allocated contains contradictions in comparison with optimal condition. According to this study, it seems that goal programming has a significant effect on optimizing and increasing the level of satisfaction and conformity with conditions and positions.

Background and Warts are benign epidermal lesions, caused by human papilloma viruses (HPVS). These lesions occur in different body surfaces with different shapes, and they are sometimes predisposing factors for some kinds of malignancies. Determining the frequency of all kinds of cutaneous warts in male students of primary, guidance and high schools in Behshahr in 2003-2004 was the main objective of this study. In this descriptive study, 1200 male students of primary, guidance and high schools between 7 to 18 years of age were randomly allocated and divided into 3 groups each with 400 students. Subjects of each group were examined by a dermatologist, according to valid clinical and diagnostic indicators about affliction to all kinds of cutaneous warts. Epidemiological and clinical data were collected in questionnaires and were analyzed using descriptive statistical tests and SPSS software. Our study showed the total frequency of warts to be 10.4%. They were most common in students of high school with 12.3%. One hundred and nineteen cases were common wart, 20 plantar, 5 flat, 4 filiform and 1 was anogenital wart. Epidemiological studies can play a basic role in interventional health therapeutic studies in society for reduction of incidence, morbidity, and mortality of dermatological diseases, followed by improvement of society health.

Background and Skin disorders are the most common preseting health problems. According to dermatological researches, only scant studies estimated the prevalence of skin diseases in the general population. This study was performed to assess the prevalence of skin diseases in Sari, Mazandaran, North of Iran. This retrospective study was carried out on all of the patients referred to Boo-Ali Sina hospital in Sari, in 2003-2004. All data such as diagnosis of skin problem, age, sex, marrital status and job were recorded. Diagnoses were classified according to the international classification of diseases (ICD-10). Results were analyzed with descriptive statistics using SPSS software. A total of 4460 patients with mean age of 28.01±16.2 years including 1807 (40.4%) men and 2653 (59.7%) women were studied. Most of the patients (33.4%) referred in summer. The most common observed skin disease was appendices disorders (24%) the most common of which acne (55.8%) and androgenic alopecia (30%). The second common problem was infections (23.3%) and dermatitis (19.8%) was the third. Irritant contact dermatitis (82.7%) was the most common form of dermatitis. We found that prevalence and distribution of skin disorders in the study area are different from those of other parts of Iran. More studies are needed to identify common skin disorders in Iran.

Although impaired glucose tolerance affects 36% and overt diabetes mellitus can be seen in 30% of cases with acromegaly, diabetic ketoacidosis is rarely reported in patients with this disease. We present an unusual complication of acromegaly: a 22 year old woman with amenorrhea (6 month ago) and blurred vision of left eye (4 month ago) referred to Ghaem neurology clinic in Mashhad. With a growth hormone (GH) level of =100ng/ml, Insulin like growth factor-1 (IGF-1) =1560 ng/ml and pituitary macro adenoma in magnetic resonance imaging (MRI), she was candidated for surgery. A few hours before surgery she had dyspnea, loss of consciousness, fever and with blood sugar (BS) =500 mg/ml, Hco3=2.4, PH=7.06 and keton in urine. Diabetic ketoacidosis was diagnosed. The patient was treated with high dose of insulin (500 IU/day) and hydration. After octerotide administration the need for insulin decreased and after pituitary adenectomy, there was no need for insulin therapy and the patient was discharged on metformin (one tablet per day).

Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma which can occur on the palms, soles or beneath the nail plate. Diagnosis of ALM is usually delayed and melanomas can only be diagnosed at advanced clinical stage so the prognosis is often poor. We report a case of Acral lentiginous melanoma which misdiagnosed as chronic ulcer. Chronic lesions even if benign in appearance deserve close observation. Biopsies are required to prevent misdiagnosis, mistreatment and delay in diagnosis.

Cystic mesotheloma is an uncommon lesion of the peritoneum occurring predominantly in women of reproductive age. The case was a 21 years girl presented with 4 years history of mild abdominal distension and periodic pain. The results of the clinical examinations were normal. Sonography and CT scan confirmed gross ascites. The results of paraclinical tests were normal without any positive findings for etiology of ascites. During laparoscopy multiple transparent cysts were found in pelvic and culdesac. All cysts were removed by laparoscopy. Histology confirmed benign cystic mesotheloma. Reviewing the records revealved that this case is the second case of mesothelial cysts that presented with ascites.