مجله دانشگاه علوم پزشکی بابل
سال پانزدهم شماره 1 (پیاپی 70، دی 1391)

Preterm delivery is a serious problem in pregnancy that its incidence is increasing. It is associated with multiple neonatal and long term complications. The aim of this study was to evaluate the correlation between neonatal outcome and umbilical artery pH in order to predict and prevent the neonatal complications that are most likely to occur if there is acidosis.

This case-control study was performed on 181 preterm neonates (27-37 gestational weeks) with acidosis of pH<7. 1 as a case group and 419 preterm neonates without acidosis as a control group who born at Ayatollah Roohani hospital of Babol during one year. Neonatal complications including admission in NICU، respiratory distress syndrome (RDS)، intraventricular hemorrhage (IVH)، retinopathy of prematurity (ROP)، disseminated intravascular coagulopathy (DIC)، necrotizing enterocolitis (NEC)، bronchopulmonary dysplasia (BPD)، sepsis، and neonatal death were compared and analyzed in both groups.

There was a significant relationship between neonatal acidosis and the complications including admission in NICU (OR=24)، RDS (OR=6. 4)، ROP (OR=8. 5)، also there was a significant relationship between acidosis and sepsis، hypoxic encephalopathy، IVH، DIC and neonatal death (p=0. 001) but no significant relationship was observed between BPD، NEC، and neonatal acidosis.

The results showed that in the case of neonatal necrosis، most neonatal complications following preterm birth are likely to increase.

Inguinal hernia repair is one of the most prevalent procedures in general surgery. Several methods have been introduced for inguinal hernia repair that focus on the reduction of complications of surgery and lowering the recurrence of the hernia. However، controversies remain among surgeons about the preferred treatment method. The aim of this study was to compare the outcomes of repairing inguinal hernia with mesh and non-mesh methods.

All patients aged 18 years old and over that admitted for inguinal hernioraphy in Shahid Behesti hospital in Babol during March to September 2010 included in the study. Demographic data، characteristics of hernia، duration of returning to daily activities and the type of repair of each patient entered in the checklist. All patients followed up for one year in case of any complication and recurrence of hernia. Recurrence of hernia due to ascites or due to any increase in abdominal pressure and missed patients during the follow up period was excluded from the study.

Among all 132 cases 129 patients were male and 3 patients were female and the mean age of the patients was 53. 66±16. 89 years. Forty five (34. 1%) patients underwent hernioraphy with mesh and 87 (65. 9%) patients without mesh. The mean time for patients to return to daily activities was 25. 4±4. 7 days in the mesh group and 28. 53±7. 86 days in the non-mesh group (p=0. 048). Rate of recurrence of hernia during the follow up period was 8 cases (6. 1%) that 6 cases had been repaired with non-mesh method and 2 cases were repaired with mesh method (p>0. 05).

Simple inguinal hernias seem to be repaired better with mesh method than non-mesh method.

Prostate adenocarcinoma is the most common neoplasm in men. The most common metastatic sites are usually bones، lung and pelvic lymph nodes. The sensitivity and reliability of detection of lymph node metastases from prostate cancer is important. CASE: The patient was a 65 year old male who referred with three month weight loss (approximately 15 kg)، abdominal pain، and inflammation and pain of right testis associated with difficulty in voiding. In physical examination، right inguinal lymph nodes are palpable. Kidney and liver function test was normal، and prostate- specific antigen was reported 10. 2ng/ml. In abdominal and pelvic sonography and CT scan، right pelvic masses and paraaortic lymph nodes were observed. In digital rectal examination، prostate consistency was normal. The patient underwent transrectal ultrasound guided prostate biopsy that the prostate adenocarcinoma with Gleason score of 10 was reported. Oncology consultation is given due to unusual CT findings، high Gleason score، severe weight loss and abdominal lymphadenopathy. Then different treatments are suggested to the patient and finally he had bilateral orchidectomy. One month after orchidectomy، intraabdominal masses were obliterated and abdominal signs were reduced. Meanwhile، prostate-specific antigen was 0. 34 ng/ml. The patient''s weight increased to about 5 kg، and after a 6 month follow up his general condition was good. Old patients with weight loss، weakness and abdominal lymph nodes need careful clinical assessment especially for prostate cancer.

In beta-thalassemia major patients، iron overload can cause dysfunction in many organs. The aim of this study was to determine the correlation between renal tubular dysfunction with iron overload in beta-thalassemic patients referring to our thalassemia center. In this descriptive-analytic study، beta-thalassemia major patients aged more than ten years were selected. Magnetic Resonance Imaging T2*done for patients. Iron overload of liver designed by MRIT2*. It was considered as two levels; severe and mild to moderate levels. Forty five patients were severe iron overload (case) and forty five patients were mild to moderate levels (control). They were matched for age and gender. Random morning urine samples were collected and the electrolytes، uric acid، creatinine and urinary B2M (beta2-microglobulin) levels were examined. Blood samples for levels of BUN، Cr، Na، K، FBS and Ferritin were taken too. Then، Ca/Cr ratio in urine، Pr/Cr ratio in urine، fractional excretion (FE) Na، FE K and FE uric acid were calculated. Abnormal excretion of these biochemical factors considered as a renal tubular dysfunction. The data was analyzed and p<0. 05 was considered significant. Mean age of patients in case and control groups were 27±6. 106 and 27. 64±7. 834 years، respectively. Serum ferritin level (case; 2300. 46±146. 32، control; 1488. 09±1051. 46، p=0. 002)، the urinary Ca/Cr ratio (case; 0. 11، control; 0. 12، p=0. 01)، and urinary β2M/Cr ratio (case; 502. 18±1053. 21، control; 513. 48±936. 86; p=0. 024) were significant. The results of study showed that iron overload can affect the renal tubular function.

Nanotechnology is the science that today is considered by many researchers and different industries. The produced nanostructures with this science despite several advantages are the main concern of researchers because of their harmful and toxic effects. In this study the effect of silver nanoparticles on the hormones LH، FSH and testosterone in male rats was investigated and it is hoped with observing the obtained results، to find ways to prevent from entry of nanoparticles into the human body. In this study، silver nanoparticles with doses of 25، 50، 100 and 200 mg/kg body weight were orally administered for 28 days to 50 male rats in five groups of 10. Then blood samples were taken from rats. Hormonal tests of LH and FSH were performed by DIAPLUS Inc kit and hormonal test of testosterone was performed by DRG instruments kit and the groups were compared. In this study any significant changes were not observed in the mentioned hormonal concentration up to 100 mg dose of silver nanoparticles. But significant changes in testosterone concentration (reduced concentration) in high doses، i. e. 200 mg (1. 8±0. 5 nmol/L vs. 2. 5±0. 6 nmol/L) were observed that could be due to inhibition effect of silver nanoparticles on the function of testosterone-producing cells (p<0. 05). The results of this study showed that silver nanoparticles changes the LH، FSH and testosterone hormones rate in male rats that this can lead to interference in the metabolism and liver renal failure.

Hypertension is associated with alteration in endothelial function mediated through reduced nitric oxide bioavailability and renal injury. Exercise training has been shown to improve endothelial function in animal models of hypertension and in the patients with essential hypertension. The purpose of this study was to investigate the protective effect of aerobic exercise against some of proinflammatory cytokines in the renal tissue of rats treated with chronic nitric oxide synthase inhibition. In this experimental research، 40 male Wistar rats were randomly divided into four groups: (1) control (2) sham (3) nitric oxide synthase inhibition (infusion of N? -Nitro-L-Arginine Methyl Ester، intraperitoneally) and (4) aerobic exercise (exercise + nitric oxide synthase inhibition) (n=10 for any group). The exercise consisted of progressive running training on the treadmill for 15 to 22 m/min، 25 to 64 min /day، and 5 days/week for 8 weeks. Tumor necrosis factor-alpha (TNF-?) and interlukin-6 (IL-6) levels was measured by ELISA method and the groups were compared. Chronic nitric oxide synthase inhibition significantly enhanced renal TNF-? (2. 53 ± 0. 52 pg/mg) and IL-6 (4. 15 ± 0. 88 pg/mg) levels (p=0. 000). Conversely، aerobic exercise significantly decreased (p=0. 045) this proinflammatory cytokines levels (1. 97 ± 0. 37، 3. 46 ± 0. 80 pg/mg، respectively) in rat kidney. Regular aerobic exercise with moderate intense may exert protective role against systemic nitric oxide deficiency-induced inflammatory renal injury by down-regulating the proinflammatory cytokines.

Nursing is one of the stressful jobs and its employees have high ranking in visit the doctor because of psychological problems. On the other hand stress causes reduced level of serum zinc and complications related to its deficiency. So the aim of this study was to evaluate the effect of zinc supplement on ICU nurses under job stress in educational hospital، Sari-Iran in 2011. In this double-blind randomized clinical trial (RCT)، 90 female ICU nurses who completed Osipow job stress questionnaire and had job stress and had been qualified for study entry، randomly allocated in two equal intervention and control groups. At the beginning of the study، five milliliter blood was sampled from antecubital vein for measuring of serum Zinc. Intervention group received one capsule zinc sulfate 220 mg per 72 hours for four weeks and control group received one capsule placebo in the same way. Again at the end of the 4th week، job stress and serum Zinc level was measured in both groups and compared. In intervention group serum zinc level at the end of the study (88. 25±13. 2 mcg/dl) was significantly increased in comparison to before the study (56. 63±15. 8 mcg/dl) (p<0. 05). But in control group the difference between serum zinc level before (54. 72±15. 1 mcg/dl) and after the study (59. 35±14. 7 mcg/dl) was not significant. There was no significant change in overall value of job stress before (208. 39±31) and after the intervention (206. 65±29) in both study groups. In intervention group، in three dimensions of job stress (role overload، role ambiguity and responsibility) significant reduction was seen (p<0. 05) but in control group there was no significant change in any dimensions of job stress. Considering to the finding of the present study، to reduce some dimensions of job stress in ICU nurses، zinc supplement usage seems logical.

Laparoscopic cholecystectomy has been performed for the management of hepatobiliary diseases. Early laparoscopic cholecystectomy (LC) was contraindication for acute cholecystitis (AC). With improvement in operative skills and advances instrumentation، LC is now a common treatment modality for AC. The objective of this study was to compare the outcome of laparoscopic cholecystectomy in acute and chronic cholecystectomy.

This retrospective study is comprised of 264 patients with acute (38 cases) or chronic (226 cases) cholecystitis admitted at Babol Medical University hospitals and underwent laparoscopic cholecystectomy from May 2006 to September 2011. Patients were diagnosed into two groups: 1- patients with acute cholecystitis and 2- patients with chronic cholecystitis on the basis of clinical، laboratory، sonographic، surgical and pathological findings. Patients were compared for laparoscopic cholecystectomy results، complications، age، gender، operation duration، early and late postoperative complications، duration of hospital stay، and factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy.

The mean age of patients was 48. 87±13. 07 years. From 264 patients underwent LC، 60 (22. 7%) were male and 204 (77. 3%) were female. Conversion to open surgery in patients with acute cholecystitis was 6 (15. 8%) cases and in those with chronic cholecystitis was 9 (4%) cases (p<0. 05). Severe adhesion and inflammation were the main reason for conversion to open surgery. Duration of hospital stay was significantly higher in patients with acute cholecystitis (1. 6±0. 9 days vs. 1. 1±0. 4) (p<0. 05). No significant difference was observed between two groups regarding early postoperative complication. Obstructive jaundice due to the cut of common bile duct was seen in a case with acute cholecystitis and 5 cases had pancreatitis due to retained stone after laparoscopic cholecystectomy in chronic cholecystitis patients.

This study showed that LC is an appropriate safe method for treatment of cholecystitis and can be served as the method of choice and first line therapy for cholecystitis.

Salmonella enterica serovar Typhimurium is one of the most prevalent Salmonella serovars worldwide. Molecular typing of Salmonella serovars is of epidemiologic importance. The current research was carried out to study the genetic diversity of Salmonella typhimurium by enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). In a cross-sectional descriptive study that was carried out from 2007 to 2009، clinical samples including stool and blood were collected from the patients admitted to three hospitals in Tehran، Iran. All Salmonella stains were cultured and diagnosed by standard microbiological methods. Serotyping was carried out by commercially available antisera and the genetic diversity between the strains was determined by ERIC-PCR. Among 650 clinical samples، twenty one salmonella typhimurium were identified. ERIC-PCR differentiated Salmonella typhimurium strains into nine genetic clusters (T1-T9). Thirty three percent of the strains were clustered into T1 (7 isolates) followed by T2 (6 strains، 29%)، T3 (2 strains، 10%) and T4-T9 (each one strain). The results showed that endemic Salmonella typhimurium strains isolated in Tehran could be attributed to divers ERIC clusters and ERIC-PCR has been evaluated as a good approach for molecular typing of Salmonella typhimurium strains.

Ventilator-associated pneumonia (VAP) is the second common infection with high mortality (24-40%) in patients with tracheal intubation. One of the ways to prevent VAP is subglottic secretion drainage (SSD). This study was performed to determine the effect of subglottic secretion drainage on ventilator-associated pneumonia in ICU patients.

This interventional study was performed on 80 patients with ordinary tracheal tube and special tracheal tube for subglottic secretion at ICU of Hazrat Rasool Akram hospital of Tehran، Iran. They were randomly allocated to two groups (n=40). In case group، intermittent subglottic secretion drainage was performed every 1 to 2 hours during 18 hours at first three days and no intervention was done for control group. The incidence of early pneumonia in both groups was compared within the first five days of intubation.

In each group، three patients were excluded from the study because of death following ventilator withdrawal. The incidence of early pneumonia with clinical pneumonia index score≥6 in case group with subglottic secretion drainage was seen in 4 patients (10. 8%) and in control group with no drainage was seen in 7 patients (18. 9%). Increasing rate of white blood cells (greater than 11000 ml) and polymorphonuclear neutrophil (greater than 90% or Bandemia greater than 10%) in case and control group was seen in 6 patients (16. 2%) and 7 patients (18. 9%)، respectively.

The results of this study showed that the incidence of early VAP with a special tracheal tube for subglottic secretion drainage decreased in ICU patients.

Despite the development of science and technology، yet many patients suffer from the complications including nausea and vomiting after anesthesia that can have irreversible effects. The aim of this study was to assess the effect of C-band on controlling nausea and vomiting after general anesthesia in abdominal surgery.

This clinical trial study was performed on 174 male patients in the surgery department of Baqiyatallah and Valiasr Naja military hospitals in Tehran. They underwent abdominal surgery and it was their first surgical experience. They were randomly divided into three groups of 58 cases: acupressure (treatment group)، control and placebo groups. The severity of nausea and vomiting (based on visual assessment scale) were recorded by the patients in the related form. The frequency of nausea and vomiting was asked from the patients by the experts who had no information about how the groups were divided and it was recorded in a prepared checklist. Also، it was assessed 8، 16 and 24 hours after operation and then the groups were compared.

Based on our results، C-band caused a decrease in the frequency of nausea in 6 (10. 3%) patients versus 34 (58. 6%) and 33 (56. 8%) patients (p<0. 001) and the severity of nausea (p<0. 007)، and also it caused a decrease in the frequency of vomiting in 2 (3. 4%) patients versus 13 (22. 4%) and 35 (25. 8%) patients (p<0. 008) and the severity of vomiting (p<0. 005) that in compared to control and placebo groups it was more and the difference was significant.

According to the results، it is proposed to use C-band as a non-invasive method to prevent nausea and vomiting after anesthesia.

Osteoporosis is considered the most common disease of the skeleton system، which reduces bone mass، and leads to an increased risk of fracture in the hip، spine and wrist. Different causes like genetic، environmental and hormonal factors، life style and nutrition affect the development of osteoporosis. In recent years، attention is paid to the role of different fatty acids in bone health and osteoporosis. This article reviews the effects of different fatty acids consumption on bone health and osteoporosis in both animals and humans. In order to do this study، literature search was done on PubMed، Google، Iran Medex and SID، analyzing the effect of fatty acids on bone health and osteoporosis. The MeSH keywords used for the search were osteoporosis، bone loss related to menopause and aging، fatty acids، saturated fatty acids، unsaturated fatty acids and conjugated linoleic acid limited to the topics and abstracts in English and Farsi articles published between 1995 to 2012. Three hundred and fifty six results were found in the primary search of the databases. After sifting through the topics and abstracts، eventually 33 articles were selected which were directly related to the effects of various fatty acids on bone health and osteoporosis and its mechanism and used in this article. Reduction of total dietary fat and saturated fatty acid، decreased omega-6 to omega-3 fatty acid ratio and intake of unsaturated fatty acids especially omega-3 from plant sources have been reported to have a positive influence on bone health and lead to a decrease in osteoporotic fractures. A variety of mechanisms may explain the effects of fats on bone health، including changes in calcium absorption، formation of osteoblasts and osteoclasts، prostaglandin synthesis، alterations in cell membrane function and production or inhibition of proinflammatory cytokines. The results showed that different fatty acids via various mechanisms affect bone health، osteoporosis and incidence of bone fracture risk.

Campylobacter jejuni is a common cause of acute diarrhea in humans. As regards there is not exact information about the prevalence and antibiotic resistance of this bacterium in Iran، this study was undertaken to determine the prevalence and antibiotic resistance in campylobacter jejuni strains isolated from 10 years old children admitted to diarrhea in several medical centers in Tehran. This cross-sectional study included 117 diarrheal samples collected from several medical centers in Tehran in 2011. Stool samples were homogenized and cultured in Preston enrichment broth، then were subcultured in Campylobacter specific medium under microaerophilic condition in 42 °C for 48h. The isolates were identified by biochemical tests. Antibiograms were performed by the disc diffusion method. From 117 samples tested، 9 samples (7. 69%) were positive for campylobacter jejuni. Maximum resistance and sensitivity were observed in the cotrimoxazole (5 cases، 55. 55%) and gentamicin (8cases، 88. 88%) respectively. The results of study showed that Campylobacter jejuni is one of the important causes of diarrhoea in children less than 10 years of age and the most resistance of antibiotics was to cotrimoxazole.

Ventriculoperitoneal shunt is the most commonly used technique for management of hydrocephalus، although complications occur occasionally. One of these complications is catheter migration into the intestine، vagina، umbilicus and scrotum. In this article we present a rare case of catheter migration into the scrotum. CASE: A 2-month-old infant underwent surgery for congenital hydrocephalus at the Imam Khomeini hospital of Orumieh، Iran and a ventriculoperitoneal shunt was implanted. Postoperative course was uneventful. Monthly follow up visit revealed no problem regarding to shunt during first 3 months period after operation، but 7 months after surgery parents noticed scrotal swelling in their child. X-ray study disclosed catheter tip in scrotum. Surgery was performed for repositioning of catheter tip and herniorrhaphy. Three days after surgery patient discharged without any complication and during one year follow up period we didn’t notice any problem in the patient. Catheter migration of ventriculoperitoneal shunt into the scrotum is a rare event but prompt surgical obliteration of patent processus vaginalis and catheter repositioning is strongly recommended to avoid shunt malfunction.