مجله دانشکده پزشکی اصفهان
پیاپی 420 (هفته چهارم فروردین 1396)

Junction obstruction in the ureter is a high-prevalence disorder and its standard treatment is dismembered method. This study aimed to evaluate laparoscopic transposition of lower-pole kidney crossing vessels in patients with ureteropelvic junction obstruction, before and after surgery, in a 5-years follow-up study.
In this cross-sectional study, 24 patients with lower pole crossing vessels underwent laparoscopic surgery of transposition of crossing vessel were enrolled. For patients, diethylene triamine pentacaetic acid (DTPA) scan was performed before, and 1 and 6 month after the surgery and they were followed yearly for 5 years.
Findings: Twenty four patients with a mean age of 28.04 ± 12.99 years (58.3% male) and 3.29 ± 0.69 days of stay in hospital, suffering from stenosis of ureteropelvic junction were enrolled. Mean blood loss was 151.99 ± 7.48 ml. In all the patients, kidney function improved after the surgery (the Moffitt surgery: 100%).
Laparoscopic transposition of aberrant vessels has a success rate of a hundred percent in improving the renal function and it also has the lowest rate of complications and hemorrhage. Further studies with control groups are recommended to compare the results of this method with older methods, especially in people under the age of 2 years.

One of the markers of coagulopathy incidence in critical patients is acidosis that leads to increasing mortality and morbidity rates in patients hospitalized in intensive care unit (ICU). The aim of this study was determining the relationship between acidosis and coagulopathy in patients admitted to the intensive care units.
In a cross-sectional study done in intensive care units of therapeutic and educative centers in Isfahan city, Iran, 120 critical patients were enrolled. The criteria of acidosis and coagulopathy were examined during 14 days and the relationship between intensity of that was determined.
Findings: Of 120 patients, 15 suffered from severe acidosis; 2 of them (13.3%) had moderate and 13 (86.8%) had severe coagulopathy. 20 patients suffered from moderate acidosis that 9 (45.0%) had mild and 9 (45.0%) had moderate coagulopathy. 23 patients suffered from mild acidosis that 16 (69.6%) had mild, 2 (8.7%) had moderate, and 5 (21.7%) had sever coagulopathy. In addition, of 62 of patients without acidosis, 38 (61.3%) had mild and 8 (12.9%) had moderate coagulopathy. There was a significant relationship between the intensity of acidosis and the intensity of coagulopathy (P The intensity of acidosis and the intensity of coagulopathy had significant relationship. Total factors of acidosis and coagulopathy had a positive role in patient's outcomes. So, in patients with acidosis, specially sever intensity, total activity must be done to prevent coagulopathy.

The relationship of the number of daily meals and snacks with gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries. We aimed to find this relationship in a large sample of Iranian adults.
In this cross-sectional study, 4669 individuals fulfilled a questionnaire about their number of daily meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks and participants were categorized into 4 categories: Findings: The prevalence of GERD in study population was 23.7%. After adjustment of all potential confounders, women who consumed 1-2 or 3-5 snacks per day, compared to those who never used snack, had a 41% (OR:0.59; 95% CI: 0.42-0.84) and 51% (OR: 0.49; 95% CI: 0.32-0.75) reduced risk of having GERD, respectively. Women who consumed 6-7 or ≥ 8 snacks and meals per day had a 38% (OR: 0.62; 95% CI: 0.41-0.96) and 43% (OR: 0.57; 95% CI: 0.34-0.95) risk reduction for GERD, in comparison with those who ate We found an inverse significant relationship between the meal frequency and GERD symptoms in Iranian women, but not in men. Prospective studies are required to confirm this association in Middle-Eastern populations.

Oral candidiasis is one of the most important and common opportunistic fungal infections especially in patients with leukemia, and other kind of cancers. This study aimed to isolate and determine the frequency of common species of Candida in children and adolescents with leukemia in Isfahan province, Iran, in order to provide some ways for prevention and using short-term treatment for them.
In this study, 72 oral samples were obtained from the mouth lesions of the children and adolescents with leukemia hospitalized in Seyed al Shohada hospital in Isfahan city. Two wet sterile swabs were used for sampling, one for direct exam and the second for culturing on CHROMagar candida, and Sabouraud Dextrose agar with chloramphenicol. For more accurate determination of the species, molecular methods such as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using Msp1 enzyme were done.
Findings: Out of 72 patients with oral lesions, 21 patients (29.2%) had oral candidiasis The frequency of candida species were as 17 cases of Candida albicans (81.0%), 2 cases of Candida glabrata (9.5%), and 1 case of Candida krusei (4.8%) and 1 case of Candida kefyr (4.8%).
This study showed that Candida albicans is the most common identified species. Considering that chemotherapy makes the patients susceptible to fungal infections such as candidiasis, early detection of these agents can be useful to control the infection and have a short-term treatment process.

This study aimed to compare the effects of pantoprazole and ranitidine on serum magnesium level in pediatric patients admitted in pediatric intensive care unit (PICU).
In this clinical trial study, 70 patients admitted in pediatric intensive care unit divided into two groups of 35 patients. To prevent gastrointestinal complications, intravenous pantoprazole and ranitidine was prescribed in first and second group, respectively. The serum magnesium level was checked daily for seven days and compared. Data were analyzed using SPSS software.
Findings: During the study, 18 patients (51.4%) in pantoprazole group and 21 patients (60%) in ranitidine group showed hypomagnesemia; but the difference between the two groups was not significant (P = 0.47). According to t-test, comparing the daily mean serum magnesium levels did not show significant difference between the groups.
The prevalence of hypomagnesemia in both groups was high, but there was no difference between intravenous use of ranitidine or pantoprazole to prevent hypomagnesemia in critically ill pediatric patients.

Logbook is raised as one of the valuable clinical evaluation tools to monitor the achievement of educational goals. This study was done to determine the efficacy of present logbooks in clinical wards from medical student's viewpoint in Birjand University of Medical Sciences, Iran.
This analytical-descriptive study was conducted on 233 medical students in clerkship and internship stages in fall 2016. Data collection instrument was a researcher-made questionnaire including 4 demographic questions, 10 viewpoint questions with a 4-point Likert scale and 2 practice questions; validity and reliability of the questionnaire were confirmed. Questionnaires were completed by all the students in clinical wards using self-administered method. Data was analyzed via SPSS using descriptive and analytical tests.
Findings: Mean age of the students was 24.02 ± 1.45 years. Their mean knowledge score was 0.70 ± 0.69 from 2, mean viewpoint score was 22.62 ± 7.60 from 40, and mean practice score was 2.61 ± 0.92 from 4. Only 24.5 percent said that logbook complement in learning of clinical skills is highly and very highly useful. 70.8 percent expressed that existing logbooks need to be revised. Pearson's test showed significant correlation between mean knowledge score and viewpoint (P = 0.010) and practice (P = 0.030). Kruskal-Wallis test indicated significant difference in mean practice score based on different clinical wards (P = 0.030).
Findings showed that existing logbooks in clinical wards was not efficacious in learning clinical wards skills. Therefore, regarding to logbook role in students learning process, it seems essential to conduct educational workshops for faculty members and students to enhance the knowledge and necessary skills, to design careful implementation, and to revise content of logbooks.

Ritalin is a methylphenidate and a stimulant of the nervous system. Its Pharmacological effects are similar to amphetamines. Ritalin is used in hyperactive children and in some cases of brain trauma usually in the form of tablets. It has been the most effective and common drug for treatment of attention-deficit hyperactivity disorder (ADHD) for years. Ritalin has a high potential for abuse, particularly in some students use it to increase focus in order to success in exams. Use of high-dose Ritalin via intravenous and inhalation or intranasal administration can cause many complications similar to cocaine and amphetamine. These complications include violent behavior, hallucinations, hyperexcitability, irritability, panic, and psychosis. In some animal models, structural damage to the nervous system and other organs has been reported. So, distribution and usage of Ritalin should accurately be controlled and monitored to prevent its abuse.