مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال پانزدهم شماره 3 (پیاپی 60، پاییز 1386)

Pseudoexfoliation syndrome (PEX) is the most common identifiable cause of secondary glaucoma, the prevalence of which varies considerably among different ethnicities. The aim of this study was to assess the prevalence of PEX in diabetic patients older than 50 years.

In this descriptive, cross-sectional study 400 diabetic patients older than 50 years referred to the Yazd Diabetes Research Center were selected consecutively. After completing a questionnaire, ophthalmologic examination was performed with slit-lamp, 3-mirror lens and Direct Ophthalmoscopy.

Of the total of 400 patients, 24 patients (6%) had PEX. PEX was significantly higher in older diabetic patients (P=.007). No significant association was observed with the other variables, including sex, duration of diabetes and retinopathy (p=0.7). Also, prevalence of glaucoma in patients with PEX was 14.8%.

In our study the prevalence of PEX was 6%. On comparison of results with similar studies on non diabetic patients of the same age group in our region, the prevalence of PEX in diabetic patients is less than non diabetic patients in Yazd.

Traumatic ulcers are one of the most common causes of referral to emergency wards and interfere with wound healing. Even in a complete sterile condition, all of the ulcers may be contaminated with bacteria, but a few of them progress and cause clinical manifestations. There is a controversy on the use prophylactic antibiotics in traumatic ulcers. In this study we compare the efficacy of oral and injectable forms of antibiotics in prophylaxis of infection.

In this clinical trial study, 237 cases suffering from grade II traumatic ulcers were selected by simple random method and divided into 2 groups first group was administered 1 gram cephazoline prior to suturing and received no other antibiotics , while the second group received 500 mg cephalexin capsule before suturing and continued the treatment for 24 hours. (500 mg QID) .Patients were followed up on day 7, 10 and 30 after discharge from hospital for infection of the wounds. The collected data was analyzed by SPSS 11 software using Chi-squire and Fisher exact tests.

According to the findings, confounding variables such as sex, age, width of the wound, traumatic cause and site and also the time course until referral to the emergency ward were similar in both groups. Prevalence of infection in the group receiving oral and injection forms of antibiotic was 2.5% and 1.7%, respectively, difference of which was not significant.(P=0.683)

As the prevalence of wound infection is similar in both groups, oral forms of antibiotics can be used instead of injectable forms for wound infection prophylaxis.

Unstable angina as a clinical condition includes a major group of patients manifested with acute coronary syndrome. Misdiagnosis of this clinical syndrome causes myocardial infarction (MI) and death. Conventional and advanced forms of treatment are used with the aim of rapid stabilization of unstable angina. Although infusion of glucose - insulin - potassium (GIK) solution has had good results in acute MI, no major trial has studied its effect in unstable angina. The main goal of this study was evaluation of the effectiveness of GIK solution on prognosis of hospitalized unstable angina patients.

This randomized clinical trial included patients with class II and III unstable angina (two groups of 94 patients, each ) with a mean age of 62.47±13.20 years and Female /Male ratio of 1.35 admitted in the CCU’s of Yazd from September 2003 to May 2004 .

There was no significant difference between the study and control groups regarding mean age, sex ratio and unstable angina class (P=0.15, P=0.77 and P=0.76). The study group had significant reduction in recurrent chest pain and duration of hospitalization (P=0.001 and P=0.02). The most common adverse effect of GIK solution was pain at infusion site.

Use of GIK solution causes early stabilization of unstable angina patients without any significant or life threatening adverse effect.

Colorectal cancer is the most common cancer of the alimentary system. In women, it is the second leading cause of mortality after breast cancer while in men, it is the third leading cause of death after lung and prostate carcinoma. Prevalence is more in population older than 50 years and increases in older people. Therefore, best treatment and prognosis is early diagnosis of disease.

This study was a retrospective, cross-sectional study that included files of 191 patients of Shahid Rahnemoon and Afshar hospitals (two main hospitals) in Yazd, Iran from 1992 till 1999. The aim was to evaluate the abundance and distribution of colorectal cancer with respect to staging, age, occupation, residence, clinical signs and method of treatment. All of the patients had a cancer pathology report.

Of the total of 191 patients with colorectal cancer, 186 cases were adenocarcinoma and 5 cases were lymphoma. Prevalence rate in men was more than women and their age range was between 28 and 94 years. 127 patients (67%) were in the 60 – 69 years age group , while 7.3% were in the 20 -39 years age group. 106 patients (55.5%) were men and 85 patients (44.5%) were women. 64.9% were urban dwellers and 35.1% were rural. Surgical treatment included abdominoperinneal resection (A.P.R) in 55 patients (28.8%), anterior resection (A.R) and anastomosis in 40 patients (20.9%), right and left hemicolectomy, each in 25 patients and rectosigmoiedectomy and anastomosis in 18 patients(19.4%). Results of treatment were as follows:177 patients (92.76%) had relative recovery post operation, 5 cases (2.6%) were discharged from the hospital against medical advice, 3 cases (1.6%) died and 6 cases (3.1%) were discharged with poor condition after laparotomy.

Most of the patients with colorectal cancer referred with rectorrhagia, main type of cancer was adenocarcinoma (97.4%) and the most frequent surgical procedure performed was A.P.R. Further research projects in the field of diagnosis, treatment and prognosis of these patients can be helpful in the treatment of these patients.

Seizure is the most common pediatric neurology problem that occurs in 10% of children. The purpose of this study was to determine the recurrence rate of seizures after one year and its relationship with paraclinical findings of the first attack.

In a historical cohort analytic study , 131 children with first seizure admitted to Shaheed Sadoughi Hospital between March 2004 to August 2005 were evaluated for recurrence rate during one year and its relationship with serum levels of sodium, potassium , glucose, calcium , Hb , MCV and PMN during the first attack.

79.4% of cases were in febrile seizure group and 20.6% in first unprovoked seizure group (FUS).Of the total, 27.84 % of patients had seizure recurrence ( 27.9% in febrile and 25.9% in afebrile group). Mean survival recurrence rate was 10.11±0.32 SD months (10.25±0.33 SD months in febrile group and 9.57±0.83 SD months in FUS). Survival analysis showed that seizures recurred later in older patients. Younger age and lower Hb levels in the febrile seizure group and lower MCV in the FUS group were associated with an increased risk of recurrence.

In this study, anemia and microcytic RBC were risk factors for seizure recurrence. Therefore, more studies should be done so as to decrease seizure recurrence by treating and preventing anemia.

Arteriovenous fistulas (AVF) make chronic hemodialysis easy, but the complications are unpredictable. Ischemic neuropathy due to arterial insufficiency is one of the most important complications of AVF. This study was designed to evaluate ischemic neuropathy using electro diagnostic method in the extremity carrying fistula.

In this cross-sectional study, 37 hemodialysis patients at the hemodialysis center of Shahid-Mohammadi hospital (Bandar-Abbas) were enrolled. All of the patients had only one AVF in one extremity. NCV of median and ulnar nerves of both upper extremities were evaluated and the intact extremity of all patients served as the control group.

In patients with distal AVF, ulnar motor conduction velocities were significantly increased (p: 0.034). Distal and proximal amplitudes of ulnar nerve were decreased only in non-diabetic and hypertensive patients (p<0.05). Median sensory nerve action potential was increased, distal amplitude decreased (p: 0.04) and sensory latency was increased (p: 0.02). In patients with proximal AVF, ulnar proximal amplitude and median motor conduction velocities were decreased (p: 0.05). There was a negative correlation between the age of AVF and development of neuropathy. In most patients with neuropathy, AVF age was less than one year.

Ulnar nerve is more sensitive to ischemia than median nerve and sensory fibers are more sensitive than motor fibers. The site of fistula had no affect on the rate of development of ischemic neuropathy. We recommend using electrodiagnostic study for screening of ischemic neuropathy every 6 months in hemodialysis patients.

Iron deficiency anemia is an important limiting factor for the number of donations in regular donors. Limited data is available on the iron status in Iranian donors. This study was conduced to evaluate the prevalence of iron deficiency and its related factors in blood donors at Shiraz blood transfusion centre in 2005.

This descriptive study was done on all blood donors who donated their blood at Shiraz BTO in 2005. We selected 200 first time blood donors (100 female & 100 male), 200 blood donors who had history of one blood donation every year for at least 3 years and 200 blood donors who had history of 3 to 4 times blood donation per year. Then we filled out a questionnaire and measured Hb, ferretin, MCV and MCHC.

The results showed that reduction in iron stores was directly related to the number of donations. (P<0.05). In this study, 34% of female first time blood donors and 11.9% of male first time donors had decreased iron stores.34% of female first time blood donors, 47.9% of female blood donors with history of one blood donation a year and 77% of female blood donors who had history of 3 time blood donations in one year had decreased levels of iron. 11.9% of male first time blood donors, 14.5% of male blood donors who had history of one blood donation a year and 37.5% of male blood donors who had history of 3 blood donations every year had iron deficiency or iron deficiency anemia .

It seems that blood donation affects the iron status and if not compensated, it may cause complication in blood donors. The prevalence of iron deficiency in female blood donors is more who therefore require more attention. Iron store levels are more related to number of blood donations per year rather than the number of blood donations in a lifetime. Therefore, these donors as a group require more attention.

Diabetes can affect organs including the oral mucosa. There is a disagreement about the prevalence of oral mucosal disease in diabetic patients. We therefore decided to investigate more about that. The aim of this study was to determine the prevalence of soft tissue pathologies by assessing burning mouth and xerostomia in diabetic patients on the basis of type of diabetes and control status of diabetes.

This descriptive, analytic study was done by visiting 486 known diabetic patients who were referred to the Endocrine Clinic in summer of 2005. Their demographic information with history of systemic diseases accompanied by the amount of HbAIC and duration of disease was recorded in their questionnaire. Diagnosis of oral lesions was done by clinical examination. Burning mouth was assessed by visual analog scale in persons who suffered and subjective xerostomia was evaluated by standard questionnaire. Data collection was done by software SPSS 10, and statistical analysis was done by X2 and logistic regression test.

In this study, 34 patients were type I and 434 were type II patients with mean age of 47.84±9.77 years. Frequency of all candidasis lesions was 15.4% which included denture stomatitis 5.3%, angular cheilitis 4.1%, median rhomboid glossitis 1.5%and papillary atrophy of tongue 4.5%. Frequency of non-candidal lesions was 20.1%, which included fissured tongue 10.5%, geographic tongue 7.9% and lichen planus 1.7%. 6.2% of patients suffered from glossodyna. 15.6% of patients had xerestomia. By logistical regression test, we found that type of diabetes affects denture stomatitis, angular cheilitis, tongue atrophy and amount of HbA1c.

All of the pathologies were greater in type I than type II diabetes patients. Level of HbA1c had an important role in appearance of oral lesions and level changes can cause problems in the mouth. Thus, patients should maintain their oral hygiene and control their glucose regularly

EBV is categorized as Herpesviridans and by nature is a Lymph crypto Virus. Studies have demonstrated that EBV will infect 80 to 90 percent of patients during the first year and there is a close relation between kidney malfunction and EBV infection. Reactivation of the virus excites the immune system, and ultimately leads to rejection of kidney. The purpose of this study was to determine the prevalence and identify the affecting factors of EBV infection among renal allograft recipients.

This descriptive study was conducted on 68 renal allograft recipients hospitalized in Imam Khomeini medical center from 2001 to 2004. Blood sample was taken from subjects before kidney transplantation and it was being taken every 3 months during the first year after transplantation. Elisa Serologic tests were implemented to determine the antibody virus EBV antigens, such as VCAIgM, VCAIgG and EBNAIgG. Information about patients was obtained from their medical records and necessary forms were filled. Types of prescribed immunosuppressive agents and the status of kidney rejection was closely observed to identify the factors affecting rejection.

This study showed that EBV infection was previously developed in 85.3 %of subjects (58 patients) and Active Infection was found in14.7 % of subjects (10 patients). EBV Seronegativity and Primary infection was not found in this sturdy. Active infection and secondary EBV was detected in 58.8% of subjects (40 patients) during the first year after transplantation. 95.6 % (65 of recipients) before transplantation were seropositive for EBNAIgG and after transplantation, 100% (All of them) were positive. 92.6 % (63 of recipients) before transplantation were seropositive forVCAIgG and after transplantation, 96.9% (66 of them) were positive. 95.6% of recipients (65 of them) were seropositive for EBNAIgG before transplantation, while after transplantation the rate was 100% (all of the recipients). Active and secondary infection was detected in 65.8% of recipients (23 patients) receiving Cyclosporine, Prednisolone and Azatioprine and in 33.3 %of patients receiving Cyclosporine, Prednisolone and MMF and in 57.9 %of patients receivingCyclosporine and Prednisolone. During the first year after transplantation 19 of patients developed an acute rejection of which 6 (31.5%) had history of previous infection and the rest 13 (68.5%) were infected by active virus. On comparison of this group with those who did not develop acute rejection, there was no statistical significant relation between type of infection and the rate of the acute rejection. Although reactivated EBV was detected in 53.9 % of recipients (14 of them) who were treated by ALG, there was no statistical significant difference from those 27 recipients who did not get ALG.

Just like other countries, this study indicates the activity pattern, in which this virus develops from hidden to active and then secondary during the time axis after transplantation. To determine the cause of reactivation of virus and secondary EBV, all related affecting factors such as ALG, acute rejection and immunosuppressive drugs were studied, but none of them played an effective role in reactivation of the virus

Estrogen and progesterone are supposed to modify pain sensitivity. However, the actual role of each of these steroid hormones in this respect is not well known. Plasma concentrations of these hormones show variation during estrous cycle. The role of alpha2 receptors in tonic pain has been pointed out. The aim of the present study was to investigate the agonist and antagonist effect of alpha2 adrenergic receptors on tonic pain sensitivity during all stages of estrous cycle in female rats.

Xylasine as alpha2 agonist and yohimbin as alpha2 antagonist were used via intraperitoneal route (IP). Adult rats weighing 180-200 grams were used. Animals were maintained on 12h reverse light/dark cycle for 7 days prior to the experiment. Water and food was available ad libitum. Formalin test was performed by subcutaneous injection of 50 l formalin (2.5%) solution into the hind paw. Formalin test was performed in all stages of estrous cycle for 60 minutes. Animals were divided into four groups 1- control group (intact animal), 2- Sham group (animals received 0.2 ml normal saline by IP route), 3- Agonist groups (animals received 0.2 ml xylasine 1, 3 mg/kg body weight by IP route) and 4- Antagonist group (animals received 0.2 ml yohimbine 1, 3 mg/kg body weight by IP route). Data were statistically analyzed using 2 way ANOVA test followed by Tukey's test as post-hoc test. P<0.05 was considered significant.

Results showed that xylasine significantly (p<0.05) decreases pain sensitivity in all stages of estrous cycle. Analgesic effect of xylasine was maximum in estrus stage of estrous cycle and minimum in metestrus stage of estrous cycle. Yohimbine significantly (p<0.05) increases pain sensitivity in all stages of estrous cycle. Hyperalgesic effect of yohimbine was maximum in metestrus stage of estrous cycle and minimum in estrus stage of estrous cycle.

These results indicate that alpha2 adrenergic system and endogenous steroids have an important role in pain sensitivity.

Cell culture is a process in which the cells ware isolated from original tissue, dispersed in liquid media and then placed in culture plate where the cells adhere together and propagate. Today, this method is used for assessment of cell toxicity, its mechanisms and effect of different compounds on intracellular components.

Clonogenic assay was used for assessment of cell toxicity and amount of cell death after a specific time during which cells were exposed to different compounds. Thus, IC50 in caner cell lines (HePG2, SKOV3 and A549) and normal cell (LLCPK1, CHO and HGF1) was assessed after exposure to cisplatin, acetaminophen and arsenic.

Results showed that acetaminophen has maximum resistance and minimum sensitivity in CHO line with IC50=16.7±1.06 HePG2 with IC50=18.6±1.29. On the other hand, cisplatin showed minimum resistance and maximum sensitivity in HePG2 with IC50 = 0.87±0.07 and HGF1 with IC50 = 1.6±0.21 and lastly, arsenic showed minimum resistance and maximum sensitivity in A549 with IC50 = 4.59±0.29 and LLCPK1 with IC50= 1±0.37.

According to the evaluated IC50, there were differences between results of sensitivity of cell lines exposed to the three drugs (P<0.05). Entirely, resistance in cancer cell lines was lower than normal cells. The results showed the importance of cell defensive mechanisms encountering different substances like glutathione.

The most important subcutaneous fungal infections in man are caused by injury due to contaminated thistles and thorns. From an epidemiological point of view , it is important to recognize the fungi as well as their frequency of them in various thistles and thorns

The present research has been conducted on thorns and thistles of 16 regions including cities and villages of Isfahan province. 800 samples have been collected. Specimens were inoculated and incubated at 25◦C in S & SCC medium. In order to isolate and identify the fungi, cultures in specific media, intraperitoneal injections of mice and disc diffusion test have been applied.

Over one year of study, 1676 colonies of actinomycetes and fungi were recognized. The most common fungi were as follows: Alternaria (22/4%),Aspergillus(11/8%) , Cladosporium (10/8%),Esteril mycellium(10/6%) and Penicillium (9/7%). The prevalence was most in Shahreza city(10/2%) , while the least was in Ardestan(3%). The most prevalent yeasts were Candida tropicalis (50%) , Rodotrula rubra (12/5%) , Candida kerusei(11/4%),Trichosporon candida (7/9%) , Unknown yeasts (6/8%), Candida gillermondi (5/7%), Saccharomyces cervisia (3/4%), Geotricum candidum and Trichosporon glabrata (Candida glabrata ) each one (1/1%). The prevalence was most in Khansar city(19/2%). In this study, 4 species similar to Coccidioides immitis, Phialophora verrucosa (4 species) and Exophiala jeanselmei (3 species) were identified.

In this study done for the first time in this area, pathogenic and opportunistic fungi were isolated. Furthermore, Exophiala jeanselmei and Nocardiopsis dassonvillei were isolated for the first time from thorns in the country.

Diabetes is the most common disease related to metabolism disorders with long term complications. It needs lifelong specific self-care, as it causes a promotion in quality of life and decreases disease costs. The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The model has been used for studying diabetes self care behaviors. The aim of this study was determination of predictors of self-care behaviors among diabetes patients referred to Yazd diabetes research centre based on extended health belief model.

This cross-sectional study carried out on 120 diabetic patients referred to Yazd diabetes research centre who were entered in the study by convenience sampling. A questionnaire was used for data collection with a private interview which included questions regarding extended health belief model constructs including perceived benefits, barriers, severity, sensitivity, threat, self-efficacy, social support, metabolic control and locus of control and some demographic variables.

There was a positive significant correlation between model variable of perceived benefits, severity, sensitivity, threat, self-efficacy, social support, metabolic control and internal locus of control with self-care behaviors, and also a negative significant correlation between perceived barriers (P=0.001),chance locus of control (P=0.037) and self-care behaviors. The above variables explained 45.3 % of variance in diabetes self-care behaviors, with self-efficacy as the strongest predictor.

The results of this study approved the effectiveness of extended health belief model in predicting self-care behaviors among diabetic patients, which can therefore be used as a framework for designing and implementing educational intervention programs for control of diabetes.

Diabetes mellitus (DM) is a metabolic disorder resulting from a defect in Insulin secretion, insulin action or both. Despite the fact that it has a worldwide high prevalence, morbidity and mortality, it is regarded as a non–curable but controllable disease. In addition to different synthetic drugs, plant remedies and dietary traditions play an effective role in treatment. Teucrium polium L. is one of the 300 species of the genus Teucrium and found mainly in the Mediterranean and Western lrano- Turanian sphere. lt is widely distributed in Jordan and Palestine. The leaves, 1-3 cm long, are sessile, oblong or linear, the stems are ending in shortly paniculate or corymbose inflorescences, and corolla is white or pale cream colored. This case describes a 74year old man with diabetes since 20 years. He was treated by glibenclamide 5mg/day. He stopped this drug and started daily consumption of tea containing the medicinal plant, teucrium polium. One month after initiation of this therapy, he developed an acute icteric hepatitis like illness. After 8 weeks, the patient recovered clinically and bilirubin, ALT and AST levels were normal.