مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال نوزدهم شماره 3 (پیاپی 80، امرداد و شهریور 1390)

Taking into account the importance of micronutrients in health and growth of the infants, the concentrations of zinc, copper, and iron in breast milk of mothers belonging to different economic classes and their effects on infants’ growth were investigated.

Milk samples and information on personal characteristics, anthropometric and 24-hour food recall were collected from 90 lactating women belonging to 3 different socioeconomic classes who had exclusively breastfed their 90-120 day old infants. Concentrations of trace elements were analyzed using atomic absorption spectrophotometry and dietary information of subjects was analyzed by Nutritionist III software program. Statistical tests included Multiple Regression, ANOVA test and Independent t-test.

The mean zinc concentrations in mothers’ breast milk belonging to high, moderate and low socioeconomic groups were 1.6, 1.9 and 2.3 mg/l, respectively. Copper levels were 0.41, 0.47 and 0.85 mg/l, respectively and iron levels were 0.75, 0.8 and 0.9 mg/l, respectively. Group comparisons showed significant differences (P<0.05). Although association between mineral concentrations and WAZ or HAZ of infants was not significant, the WAZ of infants whose mother's milk zinc concentration was more than 2 mg/l was significantly higher than WAZ of other infants (P<0.03). Despite no significant correlation between trace element intake and trace elements in milk, negative and significant correlations between maternal age and milk minerals concentrations were observed.

The concentration of studied trace elements in milk of mothers with low economic status was higher but was not related to intakes and it was probably related to mother's age. So, dietary consultations for older lactating mothers are needed.

Mental retardation is one of the most important problems of general health. The purpose of this study was to evaluate inheritance pattern of mentally retarded patients in Yazd city.

In a descriptive cross- sectional study, all medical records and pedigrees of 320 mentally retarded children whose parents had referred for genetic consultation to the Welfare center of Yazd city were reviewed.

Of the total, 62.8% of the parents had consanguineous marriage. Mean inbreeding coefficient of offsprings was 0.0713 in third degree related parents versus 0.0156 in non-related parents. Mental retardation was seen in 43.4% of first– degree relatives of children (6.6% of parents and 36.8% of siblings, respectively). Frequency of mental retardation did not differ significantly in both sexes. Pedigree showed inheritance pattern in 43.4% of patients (autosomal recessive, autosomal dominant and x-linked inheritance pattern were seen in 33.75%, 6.9% and 2.8%, respectively), while 37% of patients had no definite inheritance pattern. Abnormal karyotype were seen in 19.4% of patients, 28 of whom(8.75% of all patients) had Down syndrome. The prevalence of autosomal recessive inheritance in patients with consanguineous marriages and non family marriages was 62.8 % and 10%, respectively (P=0. 002).

Since multiple cases of mental retardation were seen in families and rate of consanguineous marriage was more in parents of mentally retarded children, genetic counseling in consanguinity marriages and families of mentally retarded children can prevent incidence of mental retardation in these families.

Many simulation studies have been conducted in the hospitals and first in the emergency departments to increase the productivity. The first issue in the field of service quality and hence the patient right is “waiting time”. The goal of this study was to reduce patients waiting times, emergency service timing, modeling and improving using discrete event simulation.

This was a descriptive - analytical study by the cross-sectional method on 150 patients referred to the emergency department in a public hospital. All necessary data were collected using questionnaire and through observation. Simulation model was designed using Arena software.

Our computer simulation model indicates that the maximum waiting time is the time waited for the test request till the results are received by the MD and also the time is necessary for the consultation and examination purposes. Among the five different scenarios, alternative 5 is more interesting economically since it requires only three additional staffs to bring down waiting times.

According to research results, to reduce patient waiting time, the Triage processing in the emergency departments and the employment of emergency medicine expert, and the ordering of the diagnostic processes in the early stages of treatment as such as laboratory ordering for emergency patients are of main necessity.

Immunological processes are most important in recurrent spontaneous abortion(RSA). According to studies T lymphocytes and natural killer cells(NK cells) are two effective cell groups in RSA. The aim of this study was to investigate the percentage and absolute number of natural killer(NK) cells in women with RSA with unknown etiology. 24 Women with a history of recurrent pregnancy losses with unknown etiology. We compared the percentage of peripheral blood NK cells with a group of fertile patients. Lymphocytes from peripheral blood were isolated by ficoll paque density centrifugation. Lymphocytes were stained using anti CD56 and(FITC)-anti CD16 and CYQ-CD3 monoclonal antibodies for identification of NK cells and was used anti CD56 and(FITC)-anti CD69 for detection of activated NK cells. We used BD FACS calibure flow cytometry for data analysis. On the basis of the obtained results, absolute number of CD16+56+ cells showed significant increases in Recurrent spontaneous abortion(RSA) in comparison with control group(P= 0.43). Also absolute number of CD16+56bright cells had significant increase in RSA(P=0.00). There was no significant difference(P= 0.08) of CD16+56dim cells between RSA and control group. In RSA, the absolute number of CD69+cells significantly increased(P=0.02). Also, results showed significant increase in the absolute number of CD56+/CD69+ cells in RSA(P=0.04). The results suggested that the higher percentage of NK cells in peripheral blood of RSA patients compared to control group may indicate the same increase in number and cytotoxicity of uterin NK cells.

Myocardial infarction as a leading cause of death in most populations is associated with blood clot formation in coronary artery, and rapid clot lysis is important for patient treatment. Some reports have indicated the effects of some trace elements on blood coagulation and clot lysis. The aim of this study was to evaluate the effects of zinc, copper and aluminum on in-vitro coagulation and clot lysis by streptokinase.

The citrated fasting fresh-pooled plasma prepared from healthy individuals was divided to zinc, copper, aluminum and control groups. Calcium chloride and streptokinase were used for induction of plasma coagulation and Fibrinolysis, respectively. Clot formation and lysis were monitored turbidimetrically, and quantitative parameters including lag time for coagulation, clot lysis, time of coagulation and time for half lysis were calculated after plotting a kinetic curve of time versus absorbance. SPSS software and independent t-test were used for statistical analysis.

In comparison with control, addition of zinc reduced lag time of coagulation(216.8±4.4 vs 229.2±2.6 sec, P= 0.001) and copper reduced coagulation time(194.4±3.7 vs 280±3.5 sec, P= 0.001). Addition of aluminum increased lag time for coagulation(563.6±8.8 Sec, P= 0.001), lag time for clot lysis(194±3.6 sec, P= 0.001), coagulation time(484±7 sec, P= 0.001), and time for half lysis of clot (328.4±6.1 sec, P=0.001).

Results indicated that essential trace elements including zinc and copper at low levels do not have important effects on coagulation and fibrinolysis, but aluminum as a toxic element affects these processes and partially inhibits them even at very low levels.

Some viral infections have been suggested to trigger or cause autoimmune diseases. One of these viruses is parvovirus B19 which can have various rheumatologic manifestations. In this study we investigated the association between parvovirus and rheumatoid arthritis (RA), systemic lupus erythematosis(SLE), systemic sclerosis(SSc) and undifferentiated arthritis at the Rheumatological Clinic, Imam Khomeini hospital.

In this sectional case-control study, IgM and IgG antibodies against parvovirus B19 were measured with ELISA in 41 patients with RA, 28 patients with SLE, 13 patients with SSc, 8 patients with undifferentiated arthritis as well as 90 healthy controls. The ELISA kit (DRG, Germany) was semi-quantitative and qualititative.

Parvovirus B19 IgM was detected in one patient with RA, one with SSc and four in the control group. IgG anti- B19-specific antibody was detected in 58.5% of RA patients, 67.9% of SLE patients, 69. 2% of SSc patients, 87.5% of undifferentiated arthritis patients as compared to 53.3% of controls. The results were compared between the patient and control groups(p>0.05).

According to the results, there was no significant correlation for the antibody titer against parvovirus B19 in the patient and control group. The highly positive response of IgG against parvovirus in undifferentiated arthritis implies the need for more research.

Injuries of the peripheral nerve system affect the neurons cell body leading to axon injury. Cannabis sativa plant has anti oxidant and anti apoptotic effects. Therefore the aim of present study was to study the neuroprotective effect of alcoholic extract of cannabis sativa leaves on neuronal density of alpha motoneurons in spinal cord after sciatic nerve injury in rats. In this experimental research, animals were divided into four groups; A: control, B: compression, C: compression+ treatment with 25 mg/kg alcoholic extract, D: compression + treatment with 50 mg/kg extract (n=8). At first, sciatic nerve compression in B, C and D groups was achieved for 60 seconds using locker pincers. Alcoholic extract was injected intra peritoneally in the first and second weeks after compression. Then 28 days after compression, under profusion method, the lumbar spinal cord was sampled and the numerical density in each group was compared with the compression group. The data was analyzed with the use of Minitab 14 software and ANOVA statistical test. Neuronal density showed a meaningful difference in the compression and control groups(P<0.001). Neuronal density in treatment groups(25, 50 mg/kg) also had a meaningful increase(P<0.001) as compared to the compression group. Alcoholic extract of cannabis sativa leaves has a neuroprotective effect on spinal cord alpha motoneurons after injury. This could be due to growth and regeneration factors present in the alcoholic extract of cannabis sativa leaves that induce regeneration process in injured neurons or prevent degeneration.

Hirschsprung's disease(HD) is a common congenital disease. In 80% of cases, the recto sigmoid junction is involved. Recently, one-stage transanal endorectal pull-through(TAEPT) procedure has been popular, but it could have several complications. In this research, we have studied the complications of this procedure. During a four year period, 86 infants clinically suspected to have HD were admitted at our center. HD was confirmed by rectal biopsy and all were candidates for TAEPT operation. A Swenson-like procedure was performed and in 30 cases, prophylactic Hegar dilatation was done 2 weeks after operation. Anal stricture was seen in 12 cases(14%) of which 10 cases were treated by anal dilation and 2 cases were corrected by surgical management. Entrocolitis was seen in 4 cases(5%) who were treated by medical management. In 2 cases, retrocolic abscess was present that was treated by spontaneous drainage via tube drain. There was no anastomotic stricture after starting prophylactic anal bouginage. TAEPT has many advantages and few complications. It seems that one of the most common complications is anastomotic stricture that responds well to prophylactic bouginage. We recommend prophylactic anal bouginage with Hegar probe 2 weeks after operation. A long-term follow-up is needed to evaluate the outcomes of these operations.

Immunological processes play an important role in recurrent spontaneous abortion(RSA). According to studies, T lymphocytes and natural killer cells(NK cells) are two effective cell groups in RSA. The aim of this study was to study the percentage and absolute number of natural killer(NK) cells in women with RSA of unknown etiology. A total of 24 women with history of recurrent abortions of unknown etiology were studied and their peripheral blood NK cell counts were compared with a group of fertile patients. Lymphocytes from peripheral blood were isolated by ficoll paque density centrifugation. Lymphocytes were stained using anti CD56, (FITC)-anti CD16 and CYQ-CD3 monoclonal antibodies for identification of NK cells. Anti CD56 and(FITC)-anti CD69 were used for detection of activated NK cells. BD FACS caliber flow cytometry was used for data analysis. On the basis of the obtained results, absolute number of CD16+56+ cells were significantly higher in Recurrent spontaneous abortion(RSA)as compared to the control group(P= 0.43). The absolute number of CD16+56 bright cells was also high in RSA(P=0.00). There was no significant difference in CD16+56dim cell count between RSA and control group(P= 0.08). In RSA, the absolute number of CD69+ cells was significantly high(P=0.02). Results also showed a significant increase in the absolute number of CD56+/CD69+ cells in RSA (P=0.04). The higher percentage of NK cells in peripheral blood of RSA patients as compared to the control group may indicate the same increase in number and cytotoxicity of uterine NK cells.

Ghrelin hormone is a polypeptide with 28 amino acids that is secreted along the gastrointestinal tract, mainly in fundus of stomach. Some physiological functions of ghrelin include increase of appetite and food intake, energy balance, stimulation of growth hormone secretion and heart output and decrease in blood pressure. Recently, relation of ghrelin and bone mineral density has been considered. This descriptive study included 33 adult persons above 20 years of age. Bone mineral density was determined with dual energy x-ray absorptiometry in femur and lumbar regions. T-score over than -1 was considered as normal case. Ghrelin levels were determined by ELISA method. The mean of age, body mass index and serum ghrelin were 40±10.6years, 27±3.6 kg/m² and 100.5±128 pg/ml, respectively. Correlation of ghrelin and variables was not statistically significant except weight (p=0.05). Range of serum ghrelin levels varies with age. In the present research, there was no relationship between ghrelin levels and bone mineral density in femur and lumbar regions. More studies with larger number of samples are proposed.

Epilepsy is a brain disorder that has neurobiological, cognitive, psychological, and social consequences for affected patients. The purpose of this research was to determine the efficacy of cognitive behavioral therapy(CBT) on modification of dysfunctional attitudes in patients with epilepsy. In the study, 20 epileptic patients were randomly assigned to two experimental and control groups. CBT during 8 weekly sessions was applied for the experimental group with a focus on cognitive restructuring, modification of cognitive distortions and training of behavioral techniques. Dysfunctional attitudes scale(DAS) was applied as the pre-test, post- test and in the follow- up for both groups. Analysis of covariance was applied for analysis of data. Data analysis showed that the mean scores of DAS in the experimental group as compared to the control group was significantly increased during post-test and follow-up(p<.05). Cognitive-behavioral therapy is remarkably effective in modifying dysfunctional attitudes in epileptic patients.

Diabetes is one of the most prevalent metabolic diseases in the world. It affects 6.6% of world population and about 3 million individuals in Iran. Cumin (Cuminum Cyminum L) is a plant used in traditional Iranian medicine to cure obesity, and some recent studies have suggested that Cumin could have a role in diabetes treatment and reduction of lipid levels. In this study, we investigated the Cumin oil effects on serum glucose and lipid levels of rats. We divided 24 male rats of Wistar race into 6 hexadic groups; the control group with normal regimen(group a), the Cumin oil group with normal regimen(group b), the control group with high fat regimen(group c), the Cumin oil group with high fat regimen(group d). The consumed dosages of Cumin oil were 400 µg/kg and 3mg/kg, respectively which was administered by Gavages (tube feeding). Samples from the hungry rats were taken during three various periods including the first day of the study, 20th day (the beginning of the medicine usage) and 55 th day (the end of the medicine usage) in order to measure their serum glucose and lipid levels. The results of this study showed a significant decrease in glucose(p=0.007), cholesterol(p=0.001), triglyceride(p=0.002), LDL (p=0.004) levels and a significant increase in serum HDL levels(p=0.05). Cumin oil administered via Gavages can significantly affect the serum glucose and lipid levels.

Clinical pelvimetry is very uncomfortable for the patient and is associated with subjective error, while external pelvimetry is a simple and acceptable method for patients. The objective of this study was to compare the diagnostic accuracy of clinical and external pelvimetry in prediction of dystocia in nulliparous women.

In this study between December 2008 and January 2009, 447 nulliparous women with a single pregnancy in vertex presentation and gestational age 38-42 weeks referring to the Ommolbanin hospital of Mashhad were included. External pelvic dimensions were assessed at the time of admission and clinical pelvimetry was performed by another examiner. These measurements were not available to the clinician in charge of the delivery. Dystocia was defined as caesarean section and vacuum or forceps delivery for abnormal progress of labor (active uterine contractions, arrest of cervical dilatation or cervical dilatation less than 1 cm /h in the active phase for 2 hours, prolongation of second stage beyond 2 hours or fetal head descent less than 1cm/h). Statistical tests included Fisher exact test and Chi- square test.

The highest sensitivity obtained from clinical pelvimetry was 33.3% and related to diagonal conjugate less than 11.5 cm. The sensitivity of external pelvic dimensions was higher than clinical pelvimetry that was highest for the Michaelis transverse diameter(60.72%).

External pelvimetry in comparison to clinical pelvimetry is a better method for identifying dystocia in nulliparous women and can replace clinical pelvimetry in antenatal care programs.

The purpose of this in vitro study was to introduce the fiber reinforced composite bridges and evaluate the most suitable site and position for placement of fibers in order to get maximum strength. The study included 20 second premolars and 20 second molars selected for fabricating twenty fiber reinforced composite bridges. Twenty specimens were selected for one fiber layer and the remaining teeth for two fiber layers. In the first group, fibers were placed in the inferior third and in the second group, fibers were placed in both the middle and inferior third region. After tooth preparation, the restorations were fabricated, thermocycled and then loaded with universal testing machine in the middle of the pontics with crosshead speed of 1mm/min. Data was analyzed by Kolmogorov-Smirnov test, Independent sample t test and Kaplan-Meier test. Mode of failure was evaluated using stereomicroscope. Mean fracture resistance for the first and second groups was 1416±467N and 1349±397N, respectively. No significant differences were observed between the groups (P>0.05).In the first group, 5 specimens had delamintation and 5 specimens had detachment between fibers and resin composite. In the second group, there were 4 and 6 delaminations and detachments, respectively. There was no fracture within the fiber. In the fiber reinforced fixed partial dentures, fibers reinforce the tensile side of the connectors but placement of additional fibers at other sites does not increase the fracture resistance of the restoration.

Multiple Sclerosis Disease is the most common neurological demyelinization disorder in young adults that leads to their disability. Because of the side effects of treatment drugs, it seems that another method should be used. Correct nutrition is one of these methods. The aim of this research was to determine the effects of nutrition on activity of daily living in MS patients referring to the Iranian MS society in 2010. In this quasi- experimental study (before and after investigation), 40 MS patients were selected on basis of purposive and accessible sampling method. The data was collected via questionnaires. The intervention comprised of correct nutrition algorithm education for 12 weeks. All questionnaires were filled before and after the intervention by subjects and then pre/post intervention data was analyzed with SPSS 16 software. Statistical tests included Student paired and T tests. The statistical analysis showed that there was a significant difference between mean score of ability of activity of daily living of MS patients before and after intervention(P<0.001), thus confirming the hypothesis of the study. According to results, it is recommended that nutrition pattern (simple, cheap without side effects and noninvasive procedure) should be used to improve the levels of activity of daily living in MS patients.