مجله دانشگاه علوم پزشکی مازندران
پیاپی 49 (آذر و دی 1384)

Background and Human visceral leishmaniasis (HVL) is endemic in several foci in IRAN, such as Ardebil and Fars provinces (in North western and southern parts of IRAN) and in some regions as sporadic. Visceral leishmaniasis in Iran is Mediterranean type and the causative agent is Leishmania infantum and its main reservoir is dog. In this study direct agglutination test (DAT) was compared with indirect fluorescent antibody test (IFAT) for the diagnosis of visceral leishmaniasis in patients suspected of kala-azar. A total of 70 serum samples were collected from suspected kala-azar patients mainly in the kala-azar endemic areas. The Leishmania infantum antigens (MHO/TN/80/IPTi) were prepared in Department of parasitology, School of Medicine, Isfahan University of Medical Sciences. The principal phases of the procedure from making DAT antigen were mass production of promastigotes of leishmania in the RPMI1640 + fetal bovine serum, Trypsiniznation of parasites, staining with Comassie Blue and fixing with formaldehyde. The human serum samples were tested by DAT, as well as, by IFAT, with the L.infantum antigen prepared in our laboratory. The sero positive rate (SPR) with DAT in titers of ≥ 1:3200 was 91.4% and with IFAT in titers of ≥ 1:80 was 94.3%. Geometric means of reciprocal titers (GMRT) were 6309 for DAT and 692 for IFAT. Therefore, as the titers of ≥1:3200 are usually considered positive in DAT, the titers of ≥1:80 were regarded as position in IFAT. The coincidence of the two tests was 92%. These results showed that a simple local laboratory with one or two trained technicians is quite sufficient for DAT, sero-diagnosis and serological surveys of kala-azar in an endemic area. According to the results of this study, it seems that in Kala azar endemic areas, the clinical symptoms of Visceral leishmaniasis, particularly among the children with DAT antibody titers ≥1:3200 is a good indication for specific treatment of Kala-azar.

Background and Several adverse effects were reported for oral sildenafil. In this research after formulation of sildenafil topical gel, the effect of gel was compared with sildenafil tablet in a double-blind placebo-controled clinical trial. After choosing the solvent system, several formulations were prepared and the most suitable gel was chosen for clinical trial. The study was a controlled randomized (block-random sampling), double blind, prospective, placebo-controlled trial. 94 patients, with clinically diagnosed erectile dysfunction were recruited. This includes men with ED of organic, psychogenic, and mixed causes. Patients were divided into two categories of age under and over 50. Six blocks were considered for including patients based on the nature of ED and age. All of the patients with ED from July 2003 to May 2004 diagnosed by one urologist were included in the study. The cases received 1% topical gel of sildenafil and placebo tablet, and the control group received sildenafil tablet (100 mg) and gel base (without drug) as placebo. The tablets were taken one hour before sexual action and the topical gel was used in 0.5g(approximately)on the glans of penis and were massaged for 5min, before the sexual activity. In the case group that topical gel of sildenafil was administered, 5 patients (12.5%) had complete erection, 5 patients had moderate erection and erection was not observed in 30 (75%) of them. In control group, that sildenafil tablet was administered, these results were 28 (70%), 6 (15%) and 6 (15%) respectively. The onset of erection in case group (in-patients with complete erection) was 7.4 ± 3.6 min, but this time was 37.8 ± 14.9 min in control group. Four cases of mild headache were observed in-patients who administered topical gel of sildenafil. This was pain treated before 4 min. Two cases of severe headache were observed in-patients who were administered sildenafil tablet. The disorder on visual function was observed in one patient in control group. One case of severe dyspepsia was observed in this group too. Sildenafil delivery using transdermal formulation can be enhanced by several synthetic or natural percutaneous absorption enhancers, and appears to be a promising approach for the treatment of erectile dysfunction.

Background and Head lice infestation caused by Pediculus capitis and its treatment is a worldwide and historical concern. This study has been done with cooperation with the health’s deputy of medical sciences university in different cities of Hamadan province in 2000-2001. Screening was done in 120 girl’s elementary schools during which 7291 students were examined for head lice infestation. About 13.5% (975) of the girls were detected with head lice. The infested girls were divided into three treatment groups with three kinds of shampooes containing pediculicide and one control group with ordinary shampoo (placebo). In a randomized evaluator, blind clinical trial to compare pediculicidal and ovicidal effects of shampooes against head lice, the participants assigned to groups to use the shampooes based on manufacture’s instructions and followed up three weeks after treatment. Statistical analyses were done by X2 test and line logarithmic procedure. The results show that cure rates (no live adult and nymph of lice were seen on physical re-examination of scalp(, at the end of the first week were 29,36, 34 and 15 percent for d-phenothrin 0.2%, lindane 1%, permethrin1% and placebo respectively. These cure rates for treatment shampooes showed significant differences when compared to placebo (0.0010.05). but at the end of the third week, the cure rates for the three mentioned shampooes were 88, 88 and 87 percent and also there is no statisticall differences in their efficacy. It should be noted that the results of ordinary shampoo is just for the first week after usage. Line logarithmic analysis of results shows that efficacy of different pediculicide shampoo (p value=0.58) in different times (p value=0.25) have no difference. but the cure rate of cases varied three weeks after treatment. (p value<0.0001). This shows the residual effect of pediculicides on new hatched nymphs. According to the results obtained, economical viewpoint, and popular acceptance, lindane %1 shampoo is advocated as the first choice for treatment of head lice infestion if its usage is done under manufacture’s instruction and with caution combine with physical removal of nits with fine-toothed comb. Finally, educative campaign of parents and school personnel is reinforced.

Background and Hypospadias is a common congenital anomaly of urogenital system. In spite of different techniques for treatment of hypospadias and complications such as fistula after operation, most surgeons are keen of doing operations with the least complications and best results. TIP urethroplasty has been introduced for hypospadias repair in recent years and is becoming popular for its low complications, simplicity of operation and very good cosmetic results. In this study we evaluate 66 patients with all forms of hypospadias that were operated using this technique. This study is based on medical records of 66 boys with age between 8 month to 13 years with mean of 2.96+/-2.31 that were operated from March 1997 to May 2004 with TIP urethroplasty The patients were followed up after operation and complications such as infection, fistula and stenosis were looked for. The mean duration of follow up was 3 months. All patients had primary hypospadias and there was no case of secondary operation. For evaluation of data we used frequency, mean and standard deviation. 57(86.4%) pateints had distal and 9(13.6%) pateints had midshaft and proximal hypospadias. In all patients the cosmetic result of glans and neo-meatus was very good and like healthy boys. Urination was normal in all boys and there was no incidence of urinary retention. We did not see any complications in 59(89.4%) patients. 7(10.6%) had fistula that 5 were in distal group and 2 were in mid and proximal groups. We did not have any wound infection or dehiscence of repair. TIP urethroplasty is a simple and quick way to rapair hypospadias. Complications of this operation was low in our study and the only complication was fistula by the rate of 10.6% that was acceptable compared to other reports. Other complications such as infectious, stricture, or dehiscence were not seen.

Background and The low amount of blood sugar in neonates is an important and prevalent problem which needs serious attention because of its cerebral complications. High birth weight is one of the risk factors for hypoglycemia. There is no general agreement about how to approach the high birth weight neonates who do not have the symptoms of hypoglycemia but are at a high risk of it. In some centers the neonates blood sugar is checked before beginning the breast feeding and treatment but it imposes risk of opening the vein, hospitalization and also cost of care. So in this study the effects of breast feeding on blood sugar in high birth weight neonates have been studied. This study is a before/ after clinical trial on high birth weight neonates (BW>3800 gr) who were born in Imam and Razi University hospitals. Each neonate was its own control and the intervention was breast feeding. Simple sampling method was used to recruit the subjects and the exclusion criteria were neonates with symptomatic hypoglycemia, blood sugar less than 30mg/dl and absence of breast feeding in the first 2 hours after birth. After measuring the blood sugar, breast feeding was done and then 0.5 and 2 hours after that, the blood sugar was measured again and compared with the first amount (before breast feeding). A total of 94 neonates with birth weight of 4120+234 and 39.6+1 weeks of gestational age were studied. Most of the neonates were at the first and second parity (38.2% & 40.4%) and given birth through caesarian section (63.8%). History of hypertension in 7.2% and gestational diabetes in 6.4% were positive. Blood sugar at birth was 52. 25+ 15.5 mg/dl and blood sugar of 0.5 and 2 hours after breast feeding were 56. 89+ 14. 45 mg/dl and 68+ 14.5 mg/dl respectively. The differences between the blood sugar at birth and after 0.5 and 2 hours of breast feeding were significant (P<0.05). Birth weight and the commencing time of breast feeding were the factors significantly related to neonates blood sugar. Breast feeding increases the blood sugar in high birth weight neonates and decreases the chance of being in hypoglycemic group and this effect in Neonates with near normal birth weight, early onset of breast feeding and longer length of time after beginning the breast feeding is much more significant.

Background and Penile fracture is the rupture of the corpus cavernousum due to trauma to the erect penis, which has various background etiologies in different countries according to their habits. The aim of this study was to determine and evaluate the frequency, etiologies and complications of penile fracture in our geographic area. This analytical-cross sectional study was performed via census sampling among men referred to Sh. Beheshti Hospital of Babol Medical University during 1995 to 2004. Data were analyzed by Chi-Square, Fisher`s exact and T-test using SPSS release 12. 84 patients with penile fracture (mean age of 18.1 years) were studied. The frequency was higher in single patients (78%) than married ones. The most important complaint of patients with penile fracture was penile pain (36%), hematoma (30%), and penile swelling (12%). Background factors were manipulation of erect penis (74%), sexual intercourse (18%) trauma to erect pennies (8%). Urethral ruptures were seen in 8% of all patients with feacture. There were significant differences between urethral rupture and background etiologies (P=0.000) and marrital status (p=0.000) as 90% of the cases were single patient, referred to hospital due to manipulation of erect pennies (P=0.000). High frequency of penile manipulation among young boys in the study area in comparison with other studies results in penile fracture but subsequent urethral rupture was uncommon among men. Better and earlier diagnosis of penile fracture is related to determination of background etologies in the patients.

Background and Infertility is a common problem in all connunities. Between 8 to 12 percent of couples around the world have difficulties conceiving a child. Cultural, Socioeconomic and environmental factors play major roles in the etiology of infertility. The objective of this study was to estimate and analyse the causes of infertility in patients attending the infertility clinic. The medical records of 657 infertile couples attending Imam infertility clinic, Sari, Iran from October 2002 to October 2004 were reviewed. The evaluation protocol include menstrual obstetric and sexual history, sex hormone profile, tubal patency and semen analysis. The mean duration of infertility of couples was 5.7 years. The mean age of male and female partners were 33 and 29 years respectively. About 23.5% of the couples had secondary infertility. The etiology of infertility revealed a female factor in 37.6%, a male factor in 31.1%, combined factors in 17.2% and undetermined causes in 14.2% of the cases. Anovulation and semen factor were the most common identifiable etiologic factors in female and male partners repectively. The etiology of infertility revealed a simi lar spectrum of causes as found in other studies. However, ovulatory failure was higher comparing to some other studies.

Background and Despite the vital effects of zinc on infant growth, the low zinc store of mothers especially in poor communities may lead to low content of zinc in their newborns. In the first 6 months of life, the young infant has a relatively high zinc requirement to support the very rapid growth of early infancy and growth retarding continues to be highly prevalent among children in low-Income countries. In this study we evaluated the effect of zinc supplementation on the infant growth and development. In a randomized double blind controlled field trial, 500 lactating women were identified and enrolled into the study within 2 week of delivery. They were enrolled only if they intended to exclusively breast feed for 6 to 12 months. Height (Ht), head circumference HC, weight and development milestone were evaluated monthly to 12 months. Data were analyzed using spss 10 software. WT. HT. and HC in infants of trial group were significantly higher than control group (p<0.05). Development milestone in trial group was seen earlier than in control group (p<0.05). There were negative correlations between birth WT and increasing WT in each month in trial and control groups. the objective of the present study was to determine the effects of maternal zinc intake on infant growth and development. Further researches is needed, to evaluate the zinc supplementation for lactating women or infant.

Background and The purpose of this study was to assess the effects of left lateral position compared with lithotomy position in the second stage of labour on nulliparous women perineal trauma. In this clinical, randomised trial 100 primiparous women with singleton fetus and vertex presentation had vaginal delivery at two hospitals of Nishbour, Iran in 2001. Data were obtained from iterviewing and observation in the first and second stage of labor and pelvic muscle strength scale. Data were analized using t-test, χ², ManwithneyU, Fisher test and Loglinear analysis in SPSS 9 software. Incidence of episiotomy was 7.8% in left lateral group and 30.6% in lithotomy group (p=0.004). Ocurrance of laceration was 63.8% in left lateral positon and 79.4% in lithotomy position. Fetal position and pelvic muscle strength factors were significantly associated with episiotomy and maternal bearing down efforts was significantly associated with laceration. Left lateral position in the second stage of labor decreased perineal trauma. This position is a safe method for primiparous delivery and recommended for protecting of perineum.

Background and As radiography units of hospitals are normaly expensive and ever evolving, keeping them up to national and international standard are important. The purpose of this study was to study the conditions of radiology units and compare them with the ICRU NCRP and ICRP standards. Different variables have been considered to evaluate the conditions of diagnostic radiology unit. Referring to the latest standard, questionnaire was designed composing of there sections about a: space provided, b: personal data and protective device for patients and staff C: and radiology instrument and dark room devices. Detective dosimeter and thermometer were used too. The collected data were compared with the standards in order to qualitatively evaluate the instruments. Data were collected through observation, interviewing and questionnaire. Results show that the situations of the radiology units are 50% of international standard. The results showed that, none of the dark rooms are standard, and are not equipped with proper alarming signal. In 63% of these units there was no filing system on staff protection against radiation. The observed defects in radiography room, protective barrier and rays leakage were 60%, 51% and 47% respectively. Considering the obtained data, periodic supervisions are necessary in order to obtain high quality images.

History, clinical findings, procedures undertaken, and patients response to treatment are written in clinical records, hence their contents are indicators of physicians’ evaluation. If clinical records are provided precisely, clear and systematized, they indicate the clinical thinking of the staff and facilitate patients diagnosis process. These records have an important role in coordinating professional staff involved in patient care. Since the physicians and medical students are involved more in medical records documentation than the other hospital staff, thus, a study on their knowledge, attitude and practice towards the principles of medical records documentation is undertaken. This is a descriptive study, which is done about the rate of knowledge, attitude and practice of 207 Medical students of Mazandaran University of Medical Sciences in university hospitals. Descriptive and inferential statistical analytic methods were used for the collected data. For comparison of the hospitals, regarding observing designed principals in the completion of medical files, according to the filled questionnaires the minimum and maximum score designated as 1-5 which is very poor to excellent. Then the mean score was calculated and considered for the comparison of hospitals. For the determination of the relationship between knowledge, attitude, and practice, β Kendall’s Tau Test was used. The majority of the participants had low knowledge (77.8%) about medical records documentation. Most of them did not have good attitude (54.1) about completion of medical records and significance and value of medical records documentation in treatment, education, and research. Results indicate that incompletion of medical records at the university affiliated hospitals are due to lack of awareness of the students towards the method of medical records documentation. In addition, not considering the completion of records in evaluation of the students can affect their practice.

Background and Considering the role of folic acid in preventing congenital malformation and other problems it is rutinely prescribed in Iran. In this study, knowledge and practice of Mazandaran health and therapeutic staff about folic acid were assessed in 2004. This is a descriptive study on 400 health and therapeutic staff about folic acid. Data were collected via questionair check list. The subjects were divided into three categories of good, medium and weak in terms of their knowledge and practice about folic acid. Correlation between awareness and clinical practice about folic acid and demographic characteristics were analyzed using X2 test. Awareness of 64.8% of the subjects about folic acid was medium and only 20.1% of those had good awareness. Subjects with higher knowledge consulted more with childbearing age women during prequency. 81% of the subjects were aware of the relation between neural tube defects and folic acid deficiency. 4.47% of the subjects were aware of the relation between low birth weight and folic acid deficiency. Also 64% of subjects consulted pregnant women for folat intake. There was no correlation between gender and history of occupation with awareness and clinical practice about folic acid. Health and therapeutic staff were aware of the link between folat intake and neural tube defect, but less aware of other aspects of folat metabolism. Considering the beneficial effects of folic acid in prenuting cardiovascular diseases and cancer and also its importance to childbearing women, we recommend education at programs for the staff.

Background and In Iran, wheat is one of the main cereals for human consumption. Wheat grains containing zearalenone can cause genital problems and reproductive disorders in domestic animals. In human, episodes of breast enlargement in young boys and sexual precocity have been reported. This toxin may therefore have a role in hormonal balance and mammary cancer in regions with high zearalenone ingestion. In this study the incidence of zearalenone in wheat samples from Mazandaran warehouses were investigated. A total of 118 wheat samples (1 kg each) were randomly collected from all 12 warehouses of Mazandaran province. Competitive microtitre plate enzyme immunoassay for the quantitative determination of zearalenone was used according the manufacturer instructions (Riedel-de Haen Sigma-Aldrich Laborchemikalien GmbH). Zearalenone was found in 81% of samples and 64.4% of samples contained >200 μg/kg of this toxin. The minimum levels of zearalenone were 29 μg/kg. All of the warehouses were positive for the presence of zearalenone. 50-100% of samples in each of the warehouses had >200 μg/kg contamination of zearalenone Our results showed a high percentage and levels of contamination of wheat samples with zearalenone. With regard to proposed standards given by the Standard Administration of Iran, under which the content of zearalenone should not exceed 200 ppb in food products, 64.4% of samples meet these criteria.

Background and Hospital wastes pose a serious public health problem. This is primarily caused by the way individual components of the waste is handled. One acceptable method for managing the medical waste is incineration but uncontrolled incinerators can cause emission of pollutants to atmosphere. The objective of this study was to evaluate pollutants emission from hospital waste incinerators in Hamadan. In this investigation, samples were collected from Emam, Syna, Fatemieh, Mobasher Kashani hospital incinerators to determine the level of lead, mercury, cadmium, benzene, toluene. Xylene, carbon monoxide, sulphour dioxide and particulate. Collected samples were analysed using gas chromatograph, atomic absorbtion, spectrometer and smoke meter in the laboratory or by SO2 and CO meter as a direct method in the field. Results show that Mobasher hospital has maximum concentration of metals fume such as lead, mercury, cadmium (1113, 540, 3340 mg/m3, respectively). Mean concentration of sulphour dioxide was 127 ppm and for suspended particulate concentration was 639 mg/m3. In Syna hospital, the concentration of aromatic hydrocarbons including benzene, toluene, xylene and carbon monoxide were maximum (77.46, 108.64, 33.6 mg/m3 and 1041 ppm respectively). It can be concluded that hospital atmospheric pollutants are higher than EPA standards, at least with P<0.05 which can be due to inopportune opening door of combustion chamber, input of excess air mass, low temperature, unmixed solid waste and unsuitable design of the incinerator, and leak or unsuitable pollution control device.

Background and Previous studies indicate an important genetic factor in the etiology of β-Thalassemia and bipolar mood disorder. There has been several case reports implicating a possible association between the two conditions. But the results of a cross sectional study was not reconfirming. Regarding different patterns of mutations in different geographical areas, this study was performed to evaluate the genetic association between these two conditions in Mazandaran province in which β–Thalassemia is prevalent. This case-control study was conducted on 110 patients with bipolar I disorder and 118 persons without any history of mood disorders in them and their family. Hemoglobin electrophoresis was performed in all cases and controls that showed microcytosis in their CBC. Hemoglobin A2 between 3.4 to 7 was considered for diagnosis of β-Thalassemia minor. 8.18% of cases and 4.24% of controls were diagnosed to be heterzygote for β-Thalassemia, the difference was not statistically significant. The reported genetic relationship between Bipolar disorders and heterozygous β-Thalassemia probably has been a “false association”. However, as there are different mutations for minor thalassemia in different populations, the authors are aware of low external validity of this study, and suggest farther studies on different populations.

Background and Low birth weight (LBW birthweight 2500 g. or below) is a public health problem, because it is associated with increased risk of morbidity and mortality. This prospective study was conducted during March 2002 - 2003, to determine the incidence of low birth weight infants and associated risk factors in neonates born at Shahid Rajaee Hospital in Tonekabone, Iran. For every LBW case, maternal age, sex, gestational age, parity, route of delivery and spacing between pregnancies of low birth weight were analyzed. For control, the first baby born before and immediately after the LBW baby who weighed more than 2500 g. at birth were analyzed. The results revealed that the incidence of low birth weight was 4.2 % which is lower than population of other cities and only 0.34% (7 cases) of newborns weighted 1500 g. or less. The higher incidence of low birth weight was found in the primigravid (P=0.042), in cesarean section (P=0.025) and close spacing of pregnancy (P=0.033). Maternal age and sex of baby had no significant effect on the incidence of low birth weight. There were more premature deliveries in cases than controls (P=0.000). According to present findings, LBW incidence of albeit in Tonekabon in comparison with other cities throught the country is at acceptable level, prevention of premature delivery and conduction of health education programs for high risk groups, especially primigravid can lower the rates.

Foreign body ingestion is common and a frightening experience to the patients and their relatives. A great variety of objects that are capable of penetrating the wall of the gut are swallowed, usually accidentally, but sometimes intentionally by the mentally deranged. Our patient was a 27 year old man admitted to emergency. After laparatomy we removed 10 sharp metal objects from GI. This is a rare presentation and type of foreign body ingestion that we reviewed.

Coronary heart diseases (CHD) are the main cause of mortality in hemodialysis patients. Lipid profile abnormality in hemodialysis patients including hypertriglyceridemia, normal total cholesterol, modest decline in HDL rise in LDL are effected by omega 3 speculative. The purpose of this study was to investigate the effects of omega 3 fatty acid on lipid profile in hemodialysis patients. this clinical trial was performed on 16 hemodialysis patients with hypertriglyceridemia. They were asked to consume 2 gr pearl omega 3 each day for 3 months. Lipid profile was obtained by enzymatic method before and after treatment with omega 3 and the data were analysed. Consumtion of omega 3 for 3 months lowered the serum triglyceride (p<0.05). HDL increased but there was no change in total cholesterol and LDL. Consumtion of omega 3 lowered the risk of CHD in hemodialysis patients by reducing the serum triglyceride.