Zahedan Journal of Research in Medical Sciences
Volume:6 Issue: 3, 2005

Glucagons - like peptide-1 (7-36) amide (GLP-1) is the main product of the glucagon gene expression in intestinal L cells. GLP-1 is released from the intestine into the circulation in response to the ingestion of food and is the most potent stimulator of glucose-induced insulin secretion. GLP-1 receptors have also been detected in discrete areas of rat brain and intracerebro ventricular injection of GLP-1 has been shown to inhibit feeding in fasted rats.Methods and Materials: This study is an in vitro study. Used rats are male and their weight is 200 to 220 grams and each group has 7 rats. In this study HPLC techniques were employed to evaluate the effects of GLP-1 on monoamine metabolism in rat brain as a neuropeptide.Synaptosoms were prepared from homogenates of combined hypothalamus and brain stem from rats in each group. The synaptosomal pellets incubated for 15 minutes in ashaker bath at 37 C. The effect of GLP-1 on synaptosoms was tested by adding 50 μL of GLP-1 5x10 –7 M to the incubation medium. For this group a control group was prepared by adding normal saline instead of GLP-1. The data were analyzed by T- test. GLP-1 decreased levels of serotonin (5-HT) by 20% (P<0.05) after 15 minutes of incubation with combined hypothalamus and brain stem synaptosomes. Level of 5-hydroxyindolacetic acid (5-HIAA), the principal metabolite of 5-HT, and tryptophan, the amino acid precursor of 5-HT decreased by 21% and 37 %(P<0.05) respectively. γ-Aminobutyric acid (GABA) and its amino acid precursor glutamic acid (Glu) were both quantities at the same conditions as above, but a operculum derivatization HPLC technique was used. The increase levels of GABA (14%) and Glu(6%) by GLP-1 was not significant. The results suggest that decreased synaptosomal levels of 5-HT and 5-HIAA caused by GLP-1 are due to diminished availability of tryptophan by the neuropeptide.

Within the past few years out breaks of cholera has occurred in different points of Sistan and Baluchestan province of Iran, especially in the Zahedan district. The objective of this study was definition of the most important routs of transmission of cholera in the rural areas of Zahedan district involved in the cholera outbreak of summer 2003. The outbreak lasted for about 1.5 months. Methods and Materials: A case-control study was performed on 20 patients and 89 subjects as controls. A questionnaire was completed for every subject about individual hygiene, hygiene regulations of the family, the source of the drinkable water, use of chlorination of water, use of soap for hand washing, eating and drinking outside in feasts (such as weddings), getting ice from street vendors, and travel history. Stool culture for detection of cholera was performed for all cases and also for consent controls. In multivariate analysis age (OR = 0.8, P = 0.004), eating food in parties (OR = 34.5, P = 0.020), absence of soap in hand-washing place (OR = 4.7, P = 0.000) and household size (OR = 1.3, P = 0.002) were significantly associated with cholera. In univariate analysis, getting ice from street vendors (P = 0.032) also had relationship with catching cholera. Different routs of transmission of cholera are mentioned in reference books; however every outbreak has its own special circumstances. The most important points with regard to this outbreak were the importance of individual hygiene (especially using soap in hand washing), control of production and distribution of ice by street vendors, and the importance of eating and drinking in ceremonies even feats and weddings. Warning of people about these points may play key role in controlling a cholera outbreak.

The risk of asthma prevalence has increased dramatically in children in developed countries over the last three decade. The studies in developing countries have also detected an increased prevalence. There is limited data from ISAAC study in Iran. Considering ISAAC Study in Birjand in 1996, this study will reveals prevalence and time-trend of asthma in Birjand. Methods and Materials: For this purpose, a descriptive study was conducted. By simple sampling, 3540 subject aged 13-14 years, including all from 22 intermediate level schools were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) from across Birjand city in 2002. Subjects were studied by video questionnaires. In this method, the audiovisual presentation of the questionnaires included five scenes of asthma symptoms in different situation. After each scene, the subjects ticked the answer whether or not they experienced the same problems with breathing as the child in video. Analysis of data was done using descriptive analytic and chi-square test. There were 3,540 students including 49% females and 51% males from 22 intermediate schools. One girl school refused to participate in study. The amount of missing data was less than 1% each scenes. The prevalence rates in video questionnaire for any wheeze ever in life, and current wheeze in last 12 months, were 18%, 10.1% respectively. The prevalence of night cough in last 12 month, speech limiting wheeze at rest in last 12 month, and one or more time a month of any wheeze was 4.5%, 2.2% and 7.4% respectively. The prevalence of any wheeze ever in life, and current wheeze in last 12 month was higher in females compared with males (P<0.001). The results of this study on asthma symptoms, suggest an increase in the prevalence of asthma symptoms in Birjand when compared with prior study in this region. The results are suitable for comparison with other ISAAC studies. It also represents a baseline for further analytic epidemiological research.

Hyperbilirubinemia is one of common and important problems in neonatal period. Spectrophotometry is the common method for evaluating serum bilirubin level. In this study transcutaneous bilirubinometry which is a non invasive newer method and seems to be more proper for diagnosis, screening and controlling of treatment process of hyperbilirubinemia were studied.Methods and Materials: In a cross-sectional study, 162 newborns (101 term and 61 preterm neonates) who were been admitted because of ichter in Ali-Asghar hospital of Zahedan, came into this study. Bilirubininometry was been achieved by means of both bili test and spectrophotometry, before and after phototherapy in all cases, and then these measures were been compared. For statistical analysis X2, t-test, willcoxon sign rank, and mann-whiteny tests were used. The test showed that the average of transcutaneous bilirubin before of phototherapy is in term newborns and preterm newborns consequently 20/0 ±4/6 and 17/2±6/56. Also, the average of serum bilirubin before of phototherapy is in term newborns and preterm newborns consequently 16/8 ±4/5 and 14/6 ± 5/96. On the other hand, the average of transcutaneous bilirubin after of phototherapy is in term newborns and preterm newborns consequently 13/3 ± 3/7 and 10/04 ± 2/45. Also, the average of serum bilirubin after of phototherapy is in term newborns and preterm newborns consequently 9/8 ±2/2 and 8/01±2/5.So, there was not significant difference between bilirubin levels in before mentioned two methods. There was a similar pattern of changes between serum and transcutaneous bilirubin before and after of phototherapy and there isn’t significant difference between them. Like some other studies, this study proposes bili test as a useful measure for screening and controlling of treatment process and recommend it as a substitute for serum method in Zahedan’ s new borns.

Rib Fracture does not usually require surgical intervention, using various pain management methods including nerve blocks reduce pain and improves pulmonary function. In a single blind clinical trial study, we compared intercostal block and interpleural block regarding their effects on pulmonary function in rib fracture. Methods and Materials: 86 patients with unilateral fracture of more than two ribs in the range of 20-50 years, presented to Khatam-al-anbia hospital from 1380 to 1382, were randomly divided into two groups: intercostal block (40) and interpleural block (46). In the intercostal block group, the patients received 3ml of bupivacaine 0.25% and in the interpleural block group; the patients received 2mg/kg of pethidine after increasing the volume to 20 ml. The procedures repeated every 8 hours for 48 hours. Pulmonary function was evaluated by FEV1 and FVC using spirometry. Patients in the intercostal block group were 40 (23 males and 17 famales) and in the interpleural block group 46 (26 males and 20 females). The average age of the patients in the intercostal and interpleural group was 31.15 and 32.76 years, respectively. In both groups pulmonary function (FEV1and FVC) improved after block but comparison of the two groups revealed better results in the interpleural group (78.60 vs 74.90 for FEV1 with P<0.01 and 78.56 vs 75.17 for FVC with P<0.01 in the interpleural and intercostal group, respectively). Mean FEV1 and FVC did not have a significant difference in the both groups (66.21% in the interpleural block vs. 63.90 in the intercostal block for FEV1 and 66.39% in the interpleural block vs. 64.33% in the intercostal block). Both intercostal block with bupivacaine and interpleural block with pethidine could improve pulmonary function in rib fracture. Although pulmonary function improvement was statistically more significant in the interpleural block group, it does not seem to be clinically significant.

Since present available treatments for infantile spasms (IS) are far from adequate, and also side effects of the current therapeutic regimens are frequent and serious, the ongoing search for better protocols is understandable.Methods and Materials: We compared the therapeutic and adverse effects of vitamin B6 given in high doses with prednisolone in a randomized controlled double blind clinical trial. Vitamin B6 (40mg/kg/24hr) and prednisolone (1.5mg/kg/day) were tried in 22 and 15 patients respectively, and the patients were followed for at least 6 months. Response to treatment was slightly better in the prednisolone group but the difference was not significant (P=0.4). On the other hand adverse effects were also seen more frequently with prednisolone. We conclude that high dose vitamin B6 should be looked at as a justified and worth-trying method of treatment. It seems that it can be safely used where there is contraindication to use other antiepileptic drugs or where they have failed, and even in fresh cases of IS.

The Widal test is widely used for the serological diagnosis of typhoid fever in areas of endemicity, such as Iran, but the results of a single Widal test, are virtually un-interpretable unless the sensitivity and specificity of the test for the specific laboratory and patient population are known, so we have evaluated the validity of a single acute-phase Widal result for the diagnosis of typhoid fever in Iran and calculated the likelihood ratio at each titers of the Widal test. Methods and Material: The study was performed at the Bu-Ali Hospital in Zahedan, in the region of southeast Iran. Patients were grouped into two categories: 149 blood and or bone marrow culture-positive typhoid cases, and 226 nontyphoidal febrile cases. The results of two groups were analyzed by the test performance, namely, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio for positive and negative results. Widal test was negative in 47% of typhoid patients and 83% of non-typhoid patients. The ratio for H agglutinin was 19 and 65%, respectively. Mean interval for patients was 13 and in non-typhoid patients it was 14.2 days. Sensitivity of O agglutinin was low even with titters of 1:80 (49%), but its specificity was high (90%). H agglutinin had a higher sensitivity and a lower specificity. Likelihood ratio of positive O agglutinin with different titters was relatively good. H agglutinin with titters higher than 1/80 had good likelihood ratio, but likelihood ratio for negative results of titters 1/40 and 1/80 of H agglutinin was desirable and it was not desirable for other titters. In hospital conditions, positive results of Widal test highly increase post-test probability, but negative results do not decrease the possibility of typhoid significantly.

Students are major part of population that their physical and mental health provides health and dynamic society. For achievement this criteria, teachers have essential and main role if they possess required knowledge. Therefore study was conducted to determine teachers’ knowledge about students’ health needs.Methods and Materials: A cross- sectional study was designed in 2003 and 400 teachers of Zahedan primary school was selected randomly. A 30-item questionnaire was developed including questions about environmental health and students’ physical and mental health. Data was analyzed using SPSS 11. The teachers’ knowledge about environmental health in three categories low, moderate, and high respectively was 71.5%, 28.5%, and 0.0%. About students’ physical health it was 19% low, 78.3% moderate, and 2.8%high. The knowledge about students’ mental health was 22% low, 61% moderate, and 17% high. The teachers’ knowledge had no relation with their education level. Results showed teachers’ knowledge about school health is not adequate. Therefore teaching teacher about school health specially students’ mental health as an effective strategy is recommended.

Night Sweats are a common outpatient compliant, yet literature on the subject is scarce. Tuberculosis, brucellosis and lymphoma are diseases in which night sweats are a dominant symptom, but these are infrequently found to be the cause of night sweats in modern practice. While these diseases remain important diagnostic considerations in patients with night sweats, other diagnoses to consider include human immunodeficiency virus, gastroesophageal reflux disease, obstructive sleep apnea, hyperthyroidism, hypoglycemia, and several less common diseases.Antihypertensives, antipyretics, other medications, and drugs of abuse such as alcohol and heroin may cause night sweats. Serious causes of night sweats can be excluded with a thorough history, physical examination, and directed laboratory and radiographic studies. If a history and physical do not reveal a possible diagnosis, physicians should consider wright, a purified protein derivative, complete blood count, human immunodeficiency virus test, thyroid – stimulating hormone test, erythrocyte sedimentation rate evaluation, chest radiograph, and possibly chest and abdominal computed tomographic scans and bone marrow biopsy.