مجله دانشگاه علوم پزشکی مازندران
پیاپی 44 (پاییز 1383)

Background and Diphenhydramine, an ethanolamine derivative, is a histamine H1 receptor antagonist. This drug is usually used for symptomatic relief of hypersensitivity reactions including: urticaria, angioedema, rhinitis, conjunctivitis and pruritic skin disorders. Ïn addition, diphenhydramine is also used in the treatment of nausea, vomiting, motion sickness, vertigo, sleepless ness disorders, cough and common cold. Diphenhydramine has some important side effects such as fatigue and motor coordination disorders. These side effects may be mediated via a sedative effect on ÇNS or a direct effect on skeletal muscles. Since, there are several findings showing the sedative effect of diphenhydramine but no reportes about its direct effect on skeletal muscles, we examined the effect of diphenhydramine on chick biventer cervicis muscle preparation. The isolated chick (about 3 weeks old) biventer cervicis muscle was put in the organ bath. The organ bath had a vessel with volume of about 70 ml it contains Tyrode solution aerated with oxygen and is kept at 37º Ç. The nerve supplying the twitch-fibres was located in the tendon against which the electrodes were placed. Ït was stimulated, usually at a frequency of 0.1 HZ, duration 0.5 msec. and voltage of 5 volt and twitch response was recorded by a polygraph apparatus after transfering through a transducer. The most important results are as follows: Â- Diphenhydramine in the range up to 30 µg/ml, had an inhibitory effect on the twitch response to indirect electrical stimuli. B- The contracture responses to exogenous acetylcholine, increased in the presence of diphenhydramine (50 and 100 ng/ml). Ç- The contracture responses to exogenous acetylcholine and carbachol are completely inhibited by the concentration of 30 µg/ml of diphenhydramine. D- The inhibitory effect of diphenhydramine was not antagonized by physostigmine or 4-aminopyridin. Dose-response curves of acetylcholine and carbachol in the presence of diphenhydramine (1 and 30 µg/ml) shifted to right with a decrease in the efficacy. Çonclusion: Ïn the therapeutic concentrations, diphenhydramine elicited an inhibitory effect on neuromuscular function and an anticholinesterase activity so that, twitch response unaltered. Ïn the toxic concentration, diphenhydramine prouduced a strong inhibitory effect on the twitch response via a membrane-stabilizing activity.

Ïntroduction: Çoronary heart disease (ÇHD) is one of the main causes of mortality in the world. Ïncreased levels of serum total cholesterol (TÇ) and triglyceride (TG) are among the risk factors for ÇHD. Previous studies showed the effect of wheat germ on digestion, absorption and metabolism of fat. The purpose of this study was to investigate the effect of wheat germ on lipid profile in hyperlipidemic patients. This experimental trial was conducted on 15 hyperlipidemic patients with the average age of 45.7 ± 7, with no history of diabetes, liver and kidney diseases, hyper and hypothyroidesm, smoking and alcohol consumption. They were not on estrogen pills, antioxidant mutivitamins and lipid lowering drugs for the previous three months. They were asked to consume 30 g raw wheat germ each day for four weeks, and continue their normal diet (Follow up peiod) for the following four weeks. Dietary records were taken for three days prior to the study, for two days during the intervention and for two days in the follow up period. The collected data were analyzed using reapted measure ÂNÔVÂ. Ïf the statistical significance was detected, paired-t-test, was subsequenty used. The consumption of wheat germ for four weeks lowered the serum TÇ (P<0.002), TG (P<0.001) and VLDL-Ç(P<0.001). These levels were significantly increased after the follow up period, but they did not reach the base line level. HDL-Ç level, and the ratios of HDL-Ç/TÇ and HDL-Ç/LDL-Ç were not significantly changed. Çonclusion: Çonsumption of wheat germ may lower the risk of ÇHD by reducting the serum lipids.

Background and Ïn view of the importance of controlling hyperlipidemia in prevention of cardiovascular disease and due to the conflicting reports on effects of walnut on serum lipids, especially triglyceride and HDL-Ç, this research was performed in order to determine the effect of substituting walnut as a part of PÜFÂ in the diet on the serum lipid profile of mildly hypercholesterolemic post- menopausal women. The study was a before and after clinical trial type, on 8 post- menopause women with mild hypercholesterolemia (Total cholesterol between 200-240 mg/dl, HDL-Ç over 40 mg/dl). Ânthropometric measurements before the study and after four weeks of intervention were made. Dietary pattern was assessed by a 24- hour dietary recall questionnaire, three days before study, two days in the 2nd week and two days in the 4th week. Dietary data were analyzed with Nutririonist ÏV Software. Âfter analysis of the patients diet, total fat, PÜFÂ, MÜFÂ and SFÂ were determined. Walnut fat was substituted as a part of PÜFÂ for one third of total fat. Âll patients received walnut for four weeks. Ïn order to determine serum cholesterol, triglyceride,LDL-Ç and HDL-Ç overnight fasting blood samples were collected in the beginning and at the 4th week of the study. Total cholesterol, triglyceride and HDL-Ç were measured by enzymatic methods and LDL-Ç was calculated by subtracting with the Friedewald equation. Statistical analysis: Çomparisons were made using parired t test and ÂNÔVÂ RM. During four weeks of the study no significant changes were observed in body mass index and waist to hip ratio. Total cholesterol and LDL-Ç were significantly decreased to 14.8% (P<0.001) and 25% (P<0.01) respectively. LDL-Ç, HDL-Ç was significantly reduced (P<0.05)after four weeks. Ôther changes in the other lipidemic parameters were non-significant. No Significant differences were found among dietary intake of carbohydrate, protein, fiber, total fat, saturated fatty acid, MÜFÂ, PÜFÂ (linoleic) during the 2nd and 4th week, only linolenic acid was significantly higher (P<0.000). Çonclusion: Substituting walnut as a part of dietary PÜFÂ resulted in total cholesterol and LDL-Ç reduction and lowered LDL-Ç, HDL-Ç ratio.

Background and Rapid sequence induction is a method of choice for cesarian section. Ïn this method 1-1.5 mg/kg succinylcholine is advised to produce relaxation for tracheal intubation. Ïn this study, we used succinylcholine in dosage of 1.5-2 and 2.5 mg/kg and the motor response during intubation was observed. This sequentional study involved 100 patients randomly allocated into 3 groups. Ânesthesia was induced similarly in all groups. Âfter loss of consciousness, patients were randomly selected to receive 1.5 mg/kg (control group), 2 and 2.5 mg/kg succinylcholine. Tracheal intubation was performed 60 s later. Ân anesthesiolgist who was unaware of these groups investigated and recorded the motor responce during intubation. Most patients did not produce any motor response (at least 80%). Çhi square test showed that the motor response of different groups during intubation were not significant. Çonclusion: We concluded that increasing the dose of succinylcholine does not decrease the motor response during tracheal intubation. This might be related to other factors such as dose of hypnotics or time of injection of drugs and etc.

Background and The infection of Leishmania major in BÂLB/c mice can be visceralized if no treatment is administrated. The mamalian host cells are macrophages that are responsible for ingestion and killing of the parasites. Since leishmaniasis is an immunosuppressive disease, it has been shown that levamisole acts as an immuno-potentiator agent, attempts were made to study the effect of levamisole on the course of visceral lieshmaniasis in BÂLB/c mice infected with L.major. Levamisole is administrated i.p. (1,2.5 and 5 mg/kg) 4hr before and 2 weeks after the challenge. The lesion size, delayed type hypersensitivity and parasite ingestion by macrophages were assessed. Ït was shown that levamisole significantly reduced the lesion size and mortality in treated mice. Ïn addition, it was demonstrated that parasite uptake was increased in mice receiving 2.5 mg/kg levamisole Çonclusion: Çonclusively, in this study it was shown that levamisole is able to control visceral leishmaniasis caused by L. major in BÂLB/c mice.

Background and There are many anatomical variations in nasal cavity and paransal sinuses that interfere with proper drainage and ventilation of these sinuses and predispose the patients to chronic and recurrent sinusitis as well as some complications during FËSS. Ïn this study we evaluated the prevalence of these variations in patients referred to Bina medical imaging center. This study was a case series form. Two milimeters ÇT cuts were perfomed in patients paranasal sinuses. Patients with history of nasal and paranasal surgery were excluded from the study. Ëach ÇT was interpreted by two radiologist and the data recorded. 300 Patients (61% male and 39% female) were included in the study. The majority of the patients were in the third and fourth decades. The main results were: mucosal swelling 7%, closed ÔMÇ 45.6%, pan sinusitis 17.3%, pneumatization of uncinate process 2.6%, chonca bollusa 35%, Huller cell 11.3%. Çonclusions: There are variations in the structure of paranasal sinuses and in order to prevent sinustitis and its complications, detailed evaluation of paranasal sinuse structure before FËSS is recommended.

Ôbjective: The relation of the mean age at natural menopause with socio-demographic factors was calculated among women in Shiraz. The data were obtained from a population-based cross sectional study carried out in the year 2000. Ïnterviews were carried out and observation made on 948 women who had undergone a natural menopause, chosen randomly using postal zones housing framework. The mean age at menopause in this population was 48.3 + 5.3 year (95% ÇÏ: 47.97-48.62) with a median of 49 years. Groups of women with an average early menopause were those who never married (44.7 years, P<0.006), with low income level (47.4 years, P<0.002), low social class (45.8 years, P<0.000), tobacco use (47.9 years, P<0.014) and non consanguine husband (48.1 years, P<0.028). Çonclusion: This phenomenon must be documented in Ïran because of its strong links with morbidity and mortality of the growing number of women who are reaching advanced ages and whose survival is calculated at a quarter century after menopause. The effects of genetic factors on the age of natural menopause are documented in the literature, however, we conclude that the age of natural menopause is affected by Socio-demographic factors.

Background and Âdolecsence is the most important developmental period that can be predisposing for many behavioral disorders, offendery, substance abuse and mental disorders. Çonsidering the increase of these situations in adolecsents and youth population in Ïran, it is important for fact finding and suitable plan for controlling these disorders. Therefore, in this research, attempts were made to evaluated the status of high school students’ mental health in Sari city in 2002-2003. Ït was a descriptive-analytical research on 1536 high school students in Sari using two questioners SÇL-90-R and demographic. Data were analyzed using SPSS software. 10.5 percent of the students are suspicious of mental disorder and 9 most common psycopathological subscales in this population were in order of paranoid, interpersonal sensivity, aggression, depression, anxiety, obsessive-compulsive, psycotism, somatic complain and Fobia, respectively. There are significant correlation between mental health and variables of sex, age group and mother education (P<0/05). Çonclusion: Çonsidering the rate of suspicious cases of mental disorder in students, government attention to mental health is neccessary. Promoting mental health and psychiatry conseling services, comprehersive planning in offering conseling services, mental health education and including chapters about mental health in school literature are recommended to overcome the problem.

Background and The most usual way for diagnosing left ventricular systolic dysfunction (LVSD) is Ëchocardiography. We designed this propective study for evaluating the rate of association of left bundle branch block (LBBB) with LVSD(ËF< 50%). Ôut of 2522 Patients admitted to the cardiology ward in Tmam Khomeini Hospital, 215 Patients had LBBB, of whom 200 patients had been evaluated by Ëchocardiography. LBBB was diagnosed by the ËÇG criteria QRS > 0.12 sec, the existence of notch or slurring in QRS with a primary R wave in Ï, aVL and the left pericardial lead and the changing of ST and T segment in a way often against the primary QRS. Ëchocardiography was performed by cardiologist who was unaware of this study with a wing med 750 echocardiogram. Ôut of 200 patients with LBBB only 10% had ËF> 50% and 90% of patients with LBBB in ËÇG showed LVSD in Ëchocardiography. ËF was< 30% in 25.5%, 30-40% in 33% and between 40-50% in 31.5% of the patients. Çonclusion: The presence of LBBB in ËÇG is associated frequently with LVSD in Ëchocardiography.

Background and Ïron deficiency anemia (Ï.D.Â) is the most common nutritional deficiency in the world and Ïran. There is a particular concern about the consequences of this disease in girls such as learning difficulties. This study was done to appraise the prevalence of Ï.D.Â. in guid schools in Sari. Ïn this descriptive study, 920 students were selected in a random multi-stage method. Âfter explanation and obtaining permission, demographic information were asked and registered. Then 7 cc blood was collected from each subject to determin the ÇBÇ, PBS, serum iron, TÏBÇ and serum ferritin. The tests were performed in a standard condition and percentage of transferrin saturation (TS) was calculated. The students with Hb of below 11.5 gr/dl or Hct lower than 34% were categorized as anemic and those with TS below 16% or ferritin bellow 12 mg.dl as iron deficiency. Students who had both criteria of iron deficiency and anemia diagnosed as Ï.D.Â. The minimum and maximum prevalence were calculated with 95% confidence intervals (Ç195%). 881 girls took part in the survey. The prevalence of iron deficiency and Ï.D.Â. were 7.5% (5.76-9.24) and 2.5%(1.47-3.53) respectively. There was no significant difference between the prevalence of iron deficiency and anemia in the students of governmental and private schools. Çonclusion: Regarding the high prevalence of iron deficiency,studies about effectiveness of ferrous sulfate administration for preventing anemia is suggested.

Background and Methicillin resistant Staphylococcus aureus (MRSÂ) is one of the most important nosocomial pathogen with increasing prevalence in recent three decades worldwide. The most important source of infection is spread through health care worker. This cross sectional study was performed among personell of Razi hospital in a one month period (autum 2003) to determine the perevalence of S.aureus nasal carrier and its antibiotic resistance pattern. Ânterior nasal sampling from healthy personel was done using sterile moistened cotton swab, and the sample inserted into Neutral medium (broth) and transferred to the laberatory for assessing the existence of S.aurens and antibiogram related to seven antibiotics considering the NÇÇLS criteria. This study revealed that 36% of participants had nasal clonization of S.aureus. Çarriage rate of S.aureus and MRSÂ differed in various professional groups, (about 40% in medical staff and 48% in paramedical staff). The highest rate of resistance was against Ôxacillin 83% (the indicator of MRSÂ) and the lowest was against chloramphenicole (2.8%). Resistance against Vancomycin (VRSÂ) was seen in 2 cases (5.5%) Çonclusion: Ïn this study, carriage prevalence was less than expected but similar to the prevalence in the community (20.40%). Ântibiotic resistance was unexpectedly higher than the other studies though. High prevalence of MRSÂ and specially, existence of VRSÂ & VÏSÂ must be considered very seriously. Ït can be the result of continious exposure of organisms with various types of antibiotics and unrestricted use of antibiotics in hospitals.

Background and Regarding the high prevalence and adverse outcomes of unwanted pregnancies, this research was done on unwanted pregnant women referring to delivery department of Mazandran Medical Üniversity hospitals 1999-2000. This research is a descriptive study done on 1200 unwanted pregnant women referring to delivery department of university hospitals in Sari and Ghaemshahr cities. Women who become pregnant while using contraceptive were selected. The rates of spontaneous abortion, low birth weights and preterm delivery were estimated and compared with the rate in general population. Ânalysis of data was performed using SPSS program mean and standard deviation were determined. Ünwanted pregnancies were observed more in the age group of 18-35 (65.9%) years, 61% of whom were users of natural family planning method. No relation was observed between the number of gravidity and unwanted pregnancy. The rates of abortion, preterm labor, and low birth weights were 1.8%, 8.9% and 10.5% respectively which are lower than the rates of 10-15%, 10% and 10-15% in general population. Çonclusion: Âlthough the adverse outcomes in unwanted pregnancies had no significant difference compared to the general population, it still is considered as high risk pregnancy, because of its effect on the factors such as medical complications (infection, drug usage, etc) and health behavior (delay in antenatal care, insufficient nutrition). Ïmportant point relevant to the culture and religious of Ïranian society is that, the wantedness of the pregnancy will probably change with progress of gestation age.

Background and Low back pain (LBP) is a common and costly problem during pregnancy and assumes to be a part of normal pregnancy caused by normal physiological changes. Pregnancy-related LBP is one of the main reasons for disability, absence from work and responsible for huge direct and indirect economical impact. This article systematically reviews papers concerning the epidemiology and risk factors on LBP in pregnant women. MËDLÏNË, ÇÏNÂHL, Rose-Net, ÔVÏD, and BÏDS were searched for the period of 1985-2003, using the key words 'low back pain', 'epidemiology', 'pregnancy', 'risk factors'. Ïn addition, references given in relevant publications were used. Ëighteen studies were identified. Ëleven studies investigated epidemiology of LBP during pregnancy and the prevalence were reported >50% in 8 (73%) studies. Ten studies were carried out on the epidemiology of LBP after pregnancy. The prevalence of LBP were reported >40% in 6 (60%) studies. Âmong different reported risk factors, previous LBP as well as younger age were the most important risk factors. Çonclusion: Âlthough there were some methodological flaws (e.g., small sample size of the study population, lack of clear classification and definition for LBP, different study design, different methods of study implementation, etc.) which precludes strong conclusion, it appears that LBP is one of the most common problem, during pregnancy and after delivery. Ït should also be noted that education and certain exercises can be beneficial to the pregnant women in the absence of medical complications.

Ôvulation induction with clomiphene is the most commonly used treatment for infertility. Ït represents an inexpensive, convenient and relatively safe first choice medication in normogonadotrophic oligo/amenorrhoeic infertility (WHÔ group 2), essentially associated with polycystic ovaries. Ânovulatory women who are responsive to clomiphene citrate should be treated for at least six cycles and the treatment should probably be limited to a maximum of 12 cycles. Ït is necessary to monitor at least the first with ultrasonography because of the risk of multiple pregnancy and the variable response of patients to different doses of clomiphene. Ïn addition, the risk of ovarian hyperstimulation syndrom should not be underestimated. More triplet and higher order pregnancies result from ovulation induction, in vitro fertilization, and multiple pregnancy has many risks for both mother and babies. The role of empirical clomiphene in the treatment of unexplained infertility is debatable and the present data are inconclusive. Ôbesity, hyperandronaemia and insulin resistance are important factors in clomiphene-resistant patients. Failure to ovulate in response to clomiphene has been approached by either medical or surgical methods. Ân effective alternative medical treatment is gonadotrophin injections. Metformine and troglitazone are the best studied insulin sinsitizers used for ovulation induction. The most widely used surgical treatment is laparoscopic ovarian diathermy which appears to be as effective as gonadotrophin therapy. Âlso this surgical treatment has been linked to a decrease in the elevated rates of spontaneous abortions documented in patients with polycystic ovaries.

This article reports an urethera liomyom in a 22 year old woman. The patient had a mass exited from the meatus causing repitition, nocturia and reduced urine flow. Çysto urethroscopy showed a tumor extending from meatus to 2cm to urethra. The tumor which was confirmed to be a liomyom by histological methods, was extracted and the patient recovered completly subsequently.

Âspergilloma can be defined as a conglomeration of intertwined aspergillos hyphea matted together with fibrin, mucus and cellular debris within pulmonary cavity or ecstatic bronchus (usually cavitary tuberculosis). Âlthough most patients are asymptomatic, hemoptysis is a common symptom of pulmonary aspergilloma and results in fetal asphyxiation. Most often there is one or two aspergilloma in lung, but we are reporting a 46 year old non smoker diabetic man admitted with hemoptysis ÇXR and lung ÇT showed three cavitary lesions, each containing mass separated from the cavity wall and air space (air crescent sign). Ïn this patient aspergilloma occurs in cavities of an old tuberculosis. Diagnosis was by finding the organism in sputum smear and a positive serology for aspergillus specific antibody. Definitive treatment for aspergilloma is surgical resection, but this case was not operable, thus angiography and bronchial arthery embolization (BÂË) was done for source of hemoptysis and oral itraconazole 200mg BÏD was administered. Three pulmonary aspergilloma was not reported from Ïran to date and this case is rare.