مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال چهاردهم شماره 3 (پیاپی 56، پاییز 1385)

Today, Lasik surgery is one of the most common and effective procedures for correction of refractive errors. Less than 1% of patients undergoing Lasik operation suffer from serious and 3-5% suffers from mild complications. Also, results of lasik in most centers are promising. With the recent inauguration of the Lasik center of Yazd, it was decided to evaluate the results and complications of this surgery.

In this descriptive outcome study, cases were selected randomly and data from files of 230 operated eyes was filled in a specially formatted questionnaire. Data of patients who had been operated upon between March 2003 and March 2004 was gathered and evaluated using SPSS software program with Chi square and Fisher statistical tests. Patients were followed up for 3 months. Residual refractive error in the range of ± 0.5 was considered as complete treatment and more than ± 0.5 considered as relative.

From the total of 230 eyes, 122 eyes were of women and 108 eyes belonged to men. 24 cases (10.4%) were myopic, 188 cases (81.8%) myopic-astigmatism, 5 cases (2.2%) hyperopic and 13 cases (5.6%) hyperopic-astigmatism .204 eyes were in the age group of less than 40 years and 26 eyes were in the age group of more than 40 years. Based on visual acuity well-being, 225 eyes (97.8%) were treated completely and 5 eyes (2.2%) were treated relatively. Complete eradication of refractive error, 3months after surgery in myopias was 96%, myopic astigmatisms 88%, hyperopias 60% and hyperopic astigmatisms 62%. At 3 months of follow up, 224 cases (97.4%) were without any complications and the rest had few minor side effects.

Lasik operation is a safe and effective procedure for correcting refractive errors with limited complications. Results are comparable with similar studies.

It seems that improvement in care and new treatment and screening methods along with better control of diabetes mellitus (DM) has led to a change in incidence of diabetic complications, especially diabetic retinopathy .This study was performed to assess the 4 years incidence rate of diabetic retinopathy in patients with type II diabetes and factors affecting its progression.

In this prospective study on diabetic patients referring to Yazd diabetes center, 120 type II diabetic patients without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), post prandial blood sugar, triglyceride and cholesterol levels were measured, and height, weight and blood pressure (BP) were recorded. Then the patients were followed with yearly eye examinations for 4 years.

Four year cumulative incidence of diabetic retinopathy was 47.5% (95%CI: 38.6 – 56.4). The retinopathy was mild, non proliferative diabetic retinopathy (NPDR) in 43 (35.8%) where as 10(8.3%) patients had moderate NPDR and 3(2.5%) patients had severe NPDR. Only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in second year, 24.4%in third year and 7.4% in fourth year. Duration of diabetes, FBS and systolic BP had a statistically significant relationship with grades of diabetic retinopathy, but there was no significant association between age, sex, Body mass index (BMI) , triglyceride and cholesterol levels, method of treatment, smoking and diastolic BP with grades of diabetic retinopathy.

Duration of diabetes, blood glucose levels and systolic blood pressure are main risk factors of diabetic retinopathy.

Treatment in chronic constipation is highly dependent on colon transit time (CTT), which not only determines the cause but also determines the correct treatment policy. The aim of this study was evaluation of CTT in constipated patients.

43 patients with chronic constipation who did not respond to high fiber diet were enrolled in the study. Patients with history of drug induced constipation, Parkinson disease, multiple sclerosis, cerebrovascular accident, hypothyroidism, diabetic mellitus, opium addiction or previous abdominal surgery were excluded from the study. The subjects were administered 30 radio opaque markers orally (capsule form) in the morning and X.Ray was done 120 hours later. In normal patients we expect only 20% of markers (6 markers) to be retained in the colon lumen after 120 hours. Patients with more than 6 markers in colon lumen after 120 hourswere defined as abnormal CTT and were classified as colon inertia or abnormal defecation according to the position of the retained markers in the colon lumen.

40 patients completed the study. 16 patients were male and 24 were female. 22(55%) patients had normal CTT. 7 patients (17.5%) had colon inertia and 3 (7.5%) had abnormal defecation, while 8 patients (20%) had both of them. No significant difference was observed between males and females.

The pattern of CTT in constipated patients can be determined cost effectively.

Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control.

In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% (1.5mg/kg followed by 1.5 mg/ kg /h infusion) was started 30 minutes before operation, and continued 1hour after operation. In control group, normal saline (placebo) was used. After 24hours, pain of patients and systemic analgesic consumption was assessed and analyzed.

Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24hours after operation.

Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA (Patient Controlled Analgesia) and measurement of blood levels of lidocaine were limitations of this study.

Chronic renal disease (C.R.D) is a pathophysiological process due to progressive and irreversible decrease in number and function of nephrons in the kidney. Anemia is one of the most important complications in CRD patients. Anemia is caused mainly due to diminished production of erythropoietin (EPO), which is treated by weekly injection of the EPO. L-carnitine added to EPO can increase the efficacy of EPO.

Present study, from March 2003 until September 2004 (18 months), evaluates the effects of L-carnitine added to EPO in 30 patients at Shaheed Rahnemon hemodialysis center of Yazd. Each patient was administered one oral table (250 mg) of L-carnitine, twice a day along with EPO for 90 days. EPO was in the form of injection 2000 iu/sc after dialysis.(three times per week). One questionnaire was completed for each patient, which included demographic characteristics, type of disease, duration of the hemodialysis, Hb and Hct levels, transferrin saturation and ferritin levels. Hb ,Hct and transferrin saturations were measured on days 1, 45 and 90. Results were analyzed by paired t test and analysis of variance.

Results of this study showed that the mean Hb levels and Hct were significantly raised up to 1.1 mg/dl (P.value<0.001) and 2.7% (P.Value<0.001), respectively. In addition, significant decrease of 5.75% in transferrin (P.Value< 0.001) and 121ng/ml in ferritin levels (P.Value< 0.001) was observed. Efficacy of EPO plus L-carnitine was affected only by duration of hemodialysis and not by age, sex or causes of CRD.

L-carnitine added to EPO increases the efficacy of EPO after 3 months.

Atopic dermatitis (AD) is a multifactorial chronic and inflammatory disease present all over the world. Only a few epidemiologic studies on AD have been carried out in the eastern world, while most of the published papers belong to western countries. To determine prevalence of AD in 7-11 year-old school children in Ahwaz as there has been no previous study in this region.

In this descriptive study, 2500 children aged between 7 and11 years (1250 boy and 1250 girls) were examined on the basis of Hanifin and Radjka criteria. Collected data was analyzed to detect frequency of AD on the basis of Radjka and Hanifin major and minor criteria.

Of the total, 3.9% suffered from atopic dermatitis (4.3%girls and 3.4%boys) and all of them had major criteria, itching and chronic recurrent dermatitis.

Considering the prevalence of AD in children of Ahwaz, it is proposed that programs and measures for reduction of external aggravating factors and similarly, education of the patient’s families can reduce the complications and improve the quality of life in these children.

Even though there is a high prevalence of carpal tunnel syndrome patients, there are very few reliable papers on the study of normal values and changes in sensory and motor latency parameters of the median nerve in the wrist region on the basis of age of patients .This retrospective study was on the basis of 5 years data (1998 -2003) from the electro diagnostic department of Sh. Sadoughi teaching hospital of Yazd.

In this analytic and observational study, subjects included 1200 patients referring to the electrodiagnostic clinic and also randomly selected healthy patients. Exclusion criteria included systemic diseases such as diabetes, radiculopathy of cervical spine , peripheral neuropathy , positive Phallen test or Tinel sign and atrophy in the thenar region of the hand. Subjects were divided to ten groups on the basis of age. ( 10-80 years ) Sensory and motor latency parameters of median nerve were studied in each age group. All data was evaluated using SPSS statistical software and ANOVA , LSDREST curve regression tests were used for analysis. All values less than 0.05 were considered significant.

In this study, normal values for distal motor latency of median nerve were between 2.5-4.2ms with a ±2SD and mean value of 3.3ms. Increment in this value was mild (0.1ms per decade) after 5th decade of life. This value was calculated using the formula: Distal motor latency: Normal value for distal sensory latency of median nerve was 2.7-3.7ms with a ±2SD and mean value of 3.2ms. Increment in this value also was 0.1ms per decade after 5th decade of life. This value was calculated by the formula: Distal sensory latency:

It seems that age has a meaningful relationship with distal motor and sensory latencies in the wrist region and therefore in the future, electro diagnostic evaluation along with other increments in these parameters according to age should be considered when evaluating patients with carpal tunnel syndrome.

Candidiasis, as an opportunistic infection, is caused by the Candida species. Although Candida albicans is classified in the body as an endogenic flora, it plays an important role in creating Candida related diseases. Candida vulvovaginitis in pregnant women, diabetes mellitus patients and those using multiple antibiotics and contraceptive drugs demonstrates the high resistance of the organism against conventional medication. On the other hand, recurrent vaginitis disintegrates the long-term process of treatment in majority of the patients. The present research was done with the aim of determining the optimum conditions for susceptibility testing before retreatment of patients.

10 isolates of Candida albicans obtained from 31 suspected patients suffering from recurrent Candida vaginitis were incubated with ketoconazole at two pH of 7.2 and 5.5 and two temperatures of 35ºC and 27ºC. The Microdilution broth test technique was used. The RPMI 1640 medium within the 96 well microplates with range of 12 tests was used to determine the MIC50 , MIC90 and MFC of the drug.

The obtained MIC50, MIC90 and MFC for ketoconazole at these conditions (T=35ºC and pH=7.2) were 0.25 to 1 µg/ml, 1 to 4 µg/ml and 64 to ≥ 512 µg/ml respectively, while these values at 27ºC, pH 5.5 were 1 to 8 µg/ml, 8 to 64 µg/ml and 512 to ≥ 512 µg/ml, at 35ºC and pH 5.5 the values were 1 to 8 µg/ml, 4 to 32 µg/ml, 256 to ≥ 512 µg/ml, while at 27ºC and pH 7.2 the values were 1 to 2 µg/ml, 8 to 32 µg/ml, 128 to ≥ 512 µg/ml, respectively.

The obtained results confirmed that conditions with temperature of 35ºC and pH 7.2 resulted in better treatment outcomes than other conditions.

The aim of this study was to evaluate the correlation between serum levels of ovarian and gonadotropin hormones, age and number of follicles with follicular alkaline and acid phosphatase activity in infertile women under controlled ovarian hyperstimulation.

After collection of follicular fluid and calculation of the number of follicles, the specific activity of alkaline (ALP) and acid phosphatase (ACP) was determined according to the total protein in 19 women at the time of puncture. Also at that time, the levels of progesterone, estradiol, and follicle stimulating hormone (FSH) and leuteinizing hormone (LH) of their sera were measured. The correlation of follicular ALP and ACP with each serum hormone levels, women age and number of follicles was calculated using non-parametric analysis.

The ALP has a correlation with progesterone (P=0.01) levels but doesn’t have any correlation with the other factors. However, the ACP activity has a correlation not only with follicular number but also with estradiol and progesterone levels (P=0.05).

Thus ACP activity is more affected by ovarian hormone than ALP and it can affect the ovarian microenvironment and oocyte development.

In different investigations, the destructive effect of ultrasonic scalers on the margins of composites has been studied, but there are very few studies on the effects of ultrasonic scalers on the microleakage of poly-acid modified composite resin and resin modified glass ionomers. The main purpose of this study was to evaluate the marginal microleakage of class V preparations restored with resin modified glass ionomer and poly-acid modified composite resin before and after scaling with an ultrasonic scaler.

This in vitro study was performed on 160 premolar teeth. Standard class V cavities were prepared on the buccal surfaces of the selected teeth. Occlusal and cervical margins were placed entirely in enamel and cementum, respectively. Teeth were randomly divided to two groups of eighty, each. For one half of each group, (40 teeth) resin modified glass ionomer and for the other half, polyacid modified composite resin was used. Each one of the binary groups was subdivided to two groups. First subgroup was restored with Fuji II Lc (Fuji Japan) and Vitremer (3M USA ) and the second subgroup was restored with F2000 compomer (3M USA) and Compoglass(Vivadent Germany). For bonding to enamel, dentinte,cementum Singlebond (3M USA) and Adhese 2 (Vivadent Germany) were used and all of the restorations were done according to instructions of the manufacturers. In ten teeth of each group, ultrasonic scaling was done and in the other ten teeth, scaling was not done. After that, all of the teeth were thermocycled and immersed in fuschin. After cutting the microleakage was evaluated. The data was analyzed by Mann – Whitney, Kruskal – Wallis and Wilcoxon tests and significant border was 0.05 .

The results showed that the degree of microleakage in enamel margins of poly –acid modified resin composites was lower than resin modified glass ionomers and in all groups and subgroups, the microleakage in enamel and cementum after scaling was significantly more than the groups without scaling.

Use of resin modified glass ionomers in class V restorations has no advantages over polyacid modified composite resins.

Intensive care unit is one of the most stressful wards for patients and it is estimated that 30 to70 percent of patients experience severe physiologic stress during admission. Some of the physiologic responses to stress include increase in metabolic rate with consequent increase in body temperature, increase in cardiac output and contraction power and subsequently increase in blood pressure, heart rate and sodium accumulation, bronchodilation and increase in respiration rate. Control of homodynamic condition and vital signs is an essential and important practice in intensive care units for stabilizing physiologic indicators. Massage is one of the methods that can be used for this purpose. The purpose of this research was to determine the effect of foot massage on physiologic indicators including pulse, respiration rate, mean arterial pressure, temperature and arterial blood oxygen saturation.

46 patients with brain stroke who were hospitalized in the intensive care unit of Tajrish Shohada hospital were studied.The validity of information record form was determined with content validity and the validity of instruments was established using valid marks. The reliability of instruments was assessed with test-re-test after calibration. Information was collected on second, third and fourth days after ICU admission at 4 to 6 pm. For this purpose, the physiologic indicators were controlled and after 10 minute, the patients underwent 5-minute foot stroke massage and then at 10 and 30-minute intervals, physiologic indicators were controlled again. Data was analyzed by ANOVA statistical method.

Findings showed that pulse rate, respiratory rate and mean arterial blood pressure significantly decreased after 5 minute foot massage (p< 0.001) and the value of these indicators 10 minutes after foot massage was less than the values 10 minute before massage. Also, arterial oxygen conc. 10 minute after foot massage was more than the conc.10 minutes before massage and values at 30 minutes after foot massage were more than the values10 minutes before and 10 minutes after foot massage (p<0.001), Decrease in temperature on third and fourth days of ICU admission 10 minutes and 30 minutes after foot massage as compared to 10 minutes before massage was significant, but alterations were little and clinically, we can say that body temperature did not alter and approximately remind constant. Data analysis also showed that alterations in values of physiologic indicators during the three days of manipulation were the same and there was no difference between the alterations on different days (p<0.001).

In general, parasympathetic activity after foot massages results in alteration of body physiologic responses. Decrease in heart rate, mean arterial pressure and respiratory rate along with increase in arterial oxygen concentration showed that patients were less anxious and more relaxed.