فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال ششم شماره 2 (پیاپی 22، تابستان 1389)

Photorefractive Keratectomy (PRK) is one of the widely used refractive procedures which was first introduced in the late 1980's to correct myopia. Although some alternatives such as laser in situ keratomileusis (LASIK) have been introduced and become popular in the late 1990’s, PRK remains an excellent option for the correction of myopia and hyperopia with its modifications such as laser subepithelial keratectomy (LASEK) and epithelial LASIK, to refrain from possible complications of LASIK.(1) The aim of this study was to evaluate PRK efficiency in terms of the safety and predictability in the treatment of myopia and hyperopia using TECHNOLAS 217Z100.In this clinical trial study, 188 myopic and hyperopic patients who referred to Mashhad Laser Therapy Center in 1386 for PRK surgery were retrospectively studied in duration of one year. Those patients who were qualified according to the inclusion criteria entered the study. Then, the necessary data about the patients like refraction, visual acuity and other information were recorded into a questionnaire. During the study, those cases who could not meet the requirements of the surgery were excluded from the study. The subjects of the study underwent the follow-up procedure for one day, one month, 3 months, 6 months and 1 year after the surgery. Finally, all the data were recorded and analyzed using SPSS software. Descriptive statistical methods and ANOVA Repeated Measurement were used at the significant level of P<0.05. In the myopic group, 39 males (26%) and 111 females (74%), with the mean age of 28.35 6.9 years (20-50) were followed in this study. The difference of vision was significant before and after the operation. (P<0.05) The follow-up results after 6 months showed vision stability. 98.8% of the patients had vision of. 20/25 PRK efficacy on myopia showed that the preoperative mean myopia improved after 6 months. In the hyperopic group, 38 patients with the mean age of 40.1±11 years were followed. The mean hyperopia was measured as2.96+0.98 and the mean astigmatism was -1+0.71.After one year, the mean hyperopia was reduced to 0.42+0.72 and the mean astigmatism to -0.7+0.34.The uncorrected visual acuity was 0.27+0.2 which was changed to 0.9+0.1 after one year. The difference was significant before and after the operation (P=0.001).According to the results, PRK surgery using TECHNOLAS 217Z100 is a safe and stable procedure for correcting myopia and hyperopia.

Regarding the high incidence rate of hyperlipidemia in the society and the adverse effects of its complications including the occurrence of hearing loss in some of the patients, we decided to do this research. This is a cohort study, in cooperation with ENT units of Islamic Azad University Mashhad Hospitals, which was carried out in 2008-2009 in Mashhad to assess the effect of hyperlipidemia on hearing. Ninety hyperlipidemic cases and 90 controls that were matched in terms of both age (two groups 30-50 years and 50-70 years) and sex entered the study. All the cases answered the questionnaire before the tests of audiometry. Then, those who were diagnosed with impaired hearing due to other factors rather than hyperlipidemia were excluded from the study. Audiologic exams on 180 cases (including both the case and control groups) included pure tone audiometry, diapasonic tests and otoscopy. This study revealed that there was a significant difference in hearing loss in 5 frequencies (250, 1000, 2000, 4000, 8000 HZ) between two groups of case and control (P<0.05). Hypertriglyceridemic patients showed a distinct hearing loss in 4 frequencies (250, 2000, 4000, 8000 HZ) comparing the control group and hypercholesterolemic patients (P<0.05). Hypercholesterolemic patients were found to have hearing loss just in 1000 HZ of frequency, as compared to the control group and hypertriglyceridemic patients. Also, the findings of this study suggest that the sex of the patients had no influence on hearing loss (P>0.05).According to our results, regular and periodic tests of audiometry are recommended for the hyperlipidemic patients to find out a history of audiologic problems and ultimately prevent the subsequent complications.

The Physiological effects of fasting on athletes have been of an interest to some researchers and different results have also been obtained. In some researches, the effects of weight training and practice in heat on blood factors, fluids and electrolytes were investigated and it was found that the plasma volume was reduced and the concentration of blood and electrolytes were increased. The purpose of this research was to study and compare the effects of weight training on hematological factors among the students of Physical Education in fasting and non- fasting conditions. This study is a semi-experimental research. The population of the study includes male physical education students of Islamic Azad University of Mashhad. Having voluntarily completed the initial questionnaire, 15 of the participants were randomly chosen as the statistical sample. Recued tests were taken twice: three days before Ramadan and in the fourth week of Ramadan (before and after the exercise sessions). The training protocol included a session of weight training (circuit training). The exercise intensity, time of training and temperature were controlled prior to the exercise sessions. Data analysis was done by using one variable analysis of variance (F test at the alpha level of 5%. A) Ramadan fasting had no significant effect on the subjects’ body weight, fasting blood sugar, hemoglobin, hematocrit, red blood cells, platelets and white blood cells. B) Training had significant effect on the subjects’ body weight, hemoglobin, hematocrit, red blood cells, platelets and white blood cells, but had no significant effect on their blood sugar. C) Fasting and training have significant interaction effects on the subjects’ weight, blood sugar, platelets and white blood cells and had no significant effect on the subjects’ hemoglobin, hematocrit and red blood cells. Training in fasting condition could probably cause some changes in hematological factors due to the reduction of body water, but changes in blood sugar are more obvious. Therefore, to prevent reducing the rate of blood sugar, it is recommended that the intensity of training be less than usual in fasting condition.

Exchange transfusion (ET) is an effective mode of therapy in the treatment of hyperbilirubinemia, but is associated with some complications in 5-10% of the patients, especially in preterm newborns. The most important complications following exchange transfusion are: Acidosis, thrombocytopenia, hypocalcemia, hyponatremia, hypoglycemia and transmitting infectious agents. This study aims to determine some complications of exchange transfusion in neonatal hyperbilirueinemia in NICU of 22 Bahman 22nd Hospital in order to promote its safety and efficacy.In this study neonates with undergone exchange transfusion due to hyperbilirubinemia were evaluated over a period of 36 months in NICU of 22 Bahman 22nd Hospital from July 2005 to July 2008 in Mashhad. The questionnaires were completed according to the by patients’ data. The data were then and analyzed for statistical results.Of the 28 neonates who entered the study, 3 required more than one ET. Complication of ET occurred in 24 neonates (85.7%).The most common complications were being metabolic acidosis (67.9%) and thrombocytopenia (50%).In order to avoid complications following exchange transfusion, it should be emphasized to have laboratory tests done. For instance, tests of platelet count and arterial blood gases are needed so that in cases of complications, the available information can facilitate the treatment. They can be treated on time

The increasing tendency for urban settlement and adapting to inappropriate lifestyles, such as insufficient physical activities, lead to the accumulation of calorie intake which, in turn, may induce diseases like diabetes, heart disease, hypertension and cancer. On the other hand, due to the crucial roles of lipoprotein and triglyceride in the development of obesity and their positive relationship with atherosclerosis, special attention should be paid to these risk factors. The aim of this study was to determine the association of BMI with serum lipid and lipoprotein. In particular, this study intends to answer this question: Which type of obesity (overall or central) associates with lipid profile?We carried out this case-control study on 336 patients admitted by the internal section of Shahrivar 17th Hospital during the years of 1387 and 1388 HS. Having taken a test of lipid profile, those patients who were not identified with exclusive factors were asked to fill out a questionnaire. Their measurements of weight, height, waist circumference, hip circumference and other necessary data were recorded.The findings of the study suggest that in women Body Mass Index (BMI) indicating overall obesity has positive relationship with total cholesterol, triglyceride and LDL (P=0.0454, P=0.0327, P=0.0418, respectively) while such a relationship with HDL is negative (P=0.0419). In men, however, there wasn`t any relationship between BMI and lipid profile. Women’s waist to hip ratio (WHR), indicating central obesity, showed positive relationship with total cholesterol and triglyceride (P=0.0246, P=0.0001), but negative relationship with HDL (P=0.001). In men, waist circumference (WC), as an indication of central obesity, had a significant negative relationship with HDL (P=0.0370). As a whole, it was found that central and overall obesity cause negative change in lipid profile, but hip circumference indicating low obesity does not. Among the factors affecting lipid profile, age and sex were also investigated that showed relationship, but were not used for screening.Both BMI and WHR are used for recognizing the risk factors. Therefore, anthropometric indices can be used for identifying persons with atherosclerotic risk factors. Also, the existence of higher rate of negative change in women requires more attention.

Diabetes Type II is considered as the heterogeneous group of the metabolic diseases which contribute to inducing chronic hyper-glycemic and other disorders concerned with the metabolism of carbohydrates, fat and protein. This disease is a result of disorders in either or both of secretion insulin and insulin function. It is characterized by the long-term symptoms of vessels, nerves, kidneys and eyes. The present research intends to investigate the influence of the selected aerobic exercises for eight weeks on platelet, aerobic power, TC/LDL ratio, TC/HDL ratio and fibrinogen in middle-aged male individuals with Diabetes Type II from TabasThis is an applied research study of the method of Semi Experimental. Twenty subjects were randomly selected out of a population of 1500 persons ranging in age from 40 to 55 years old. The subjects’ rate of blood sugar was ranging between 120 and 250 deciliter..They were of the average height of 170 (165-175) centimeters and the average weight of 80 (75-85) Kilograms. The subjects’ Body Mass Index was estimated less than 25. They were randomly divided into two groups: the control group and the experimental group. The selected aerobic activities included: the 12-minute Cooper Test using Third Mill and Work-Meter Bike. Before starting the exercises and after 12 hours of fasting, ten milliliters of blood was bled from the arm vein of the subjects of both groups. Similarly, the second phase of bleeding was done after eight weeks of exercising. Paired t-Test was used to analyze the data. A significance level of p<0.05 was set for this research and the normality of data was tested using Kolamograph method. The selected aerobic exercises do not have any significant effect on the rate of platelet (P>0.409), fibrinogen (P>0.985) and TG/LDL (P>0.900) ratio in the patients with Diabetes Type II, but it has a significant effect on TG/HDL ratio (P<0.000 (and the aerobic power (P<0.000).Physical activities with an intensity of 60% to 80% HRR have the desirable effects on some blood factors in the patients with Diabetes Type II. Therefore, it is recommended that diabetes specialists prescribe exercises as a supplementary treatment along with medicinal treatment.

Rubella is an acute serious viral infection in pregnancy. Rubella and its resultant congenital Rubella syndrome (CRS) are still regarded as two of the important public health problems around the world. Islamic Republic of Iran has implemented a nationwide vaccination program against measles and rubella in order to eradicate CRS since 1382 HS. Thus, performing useful researches and collecting appropriate data are imperatively needed to achieve this goal. In the same line, the aim of this research is to determine the immunity level against rubella in pregnant women who referred to the Gynecology and Obstetrics Clinic of Bahman 22nd Hospital. The study was an analytic descriptive one carried out on 73 women who referred to Bahman 22nd Hospital and the samples were selected randomly. Blood samples taken every day were immediately processed for the serum separation. The patients were 16 to 44 years old (Mean age=26.7±6.5). Only 1.4% of the patients (n=1) had been infected with the rubella virus while the other 98.6% had not. Overall, 90.4% (n=66) of the participants were immune to rubella, 8.2% (n=6) were suspected and 1.4% (n=1) were not immune. According to the findings, although the general immunity level is acceptable, it seems this level of immunity is not necessarily the result of the mass campaign vaccination, only. As the occurrence of the sporadic cases alongside the decrease in the immunity level is probable, a screening program for determining the immunity levels of rubella before marriage or pregnancy and the vaccination of susceptible persons are definitely necessary.

The right use of blood is necessary because of the high cost of correct blood screening, blood grouping, and cross match.The purpose of this study is to evaluate the rate of the reserved and cross matched blood before elective surgeries which were done in Bahman 22nd Hospital. It also aims at evaluating the standard guideline for ordering blood.This is a retrospective study from 1380 to 1388 that evaluates evaluating 6145 files of the patients hospitalized in 22 Bahman 22nd Hospital for surgery during the years of 1380 to 1388. The elective operations include General surgery, Gynecology, orthopedic, ENT, Urology and Neurosurgery. The number of patients, the number of reserved and cross matched units and the number of transfused units was recorded for each group of patients collected in each groups. Finally, the number of reserved blood units in that period of time and in each group was compared with the standard guideline. Also the number of transfused blood units was evaluated. The ratio of cross matched to transfused blood units lower than 2.5 was considered as standard. And The obtained data were analyzed, using with SPSS. A total of 1557 blood units of blood were reserved for 772 patients. 1305 units (66.47%) were cross matched, but just 126 units (8.1%) were transfused. The effective factors in increasing the possibility of transfusion were the ages <20 & >80 years old, Hb ≤ 12, the type of surgery and the surgeon. Although after the application of the guidelines in1385, there was 64.44% decrease in the rate of cross matching rate due to the decrease in the number of patients who were cross matched, but the average of cross matched units for each patient did not change. The total of C/T index of the hospital decreased from 14.1 to 3.7.The appropriate correct blood reserving can decrease the unnecessary blood reserves, lower the pressure on blood banking centers and prevent blood wastage.