مجله دانشگاه علوم پزشکی رفسنجان
سال پنجم شماره 4 (پیاپی 21، زمستان 1385)

Use of joint sound signals for diagnosis of knee joint disorders has been greatly welcomed since it is a non-invasive and inexpensive technique. In vibroarthrography (VAG), joint sound signals can be detected using a contact sensor over the skin surface of the joint during movements. This study aimed to investigate the capability of this method in diagnosis of knee osteoarthritis (OA). In this study which was the evaluatin of a diagonstic test, forty-four knees from 22 healthy and OA-diagnosed subjects were included in this study. A miniature potentiometer was placed on the patellar, medial and lateral sides of the knees and their VAG signals were recorded in a non-weight bearing (NWB) flexion/extension task. The average root mean square (RMS) of the signals were calculated and compared between the healthy and OA knees. The findings of this study revealed more physiologic signals in healthy knees. OA-diagnosed knees showed less physiologic signals with some spikes among them. There was no significant difference between these two groups in terms of the total average RMS of the VAG signals. However, a noticeable difference was noted between the right and left OA knees. The left OA knees did not show significantly different RMS in the medial and lateral sites, however this finding was significantly different on the patellar site compared to the left healthy knees (p=0.03). Based on these findings, the VAG technique might be considered as a non-invasive method in diagnosis of OA changes of the knees. It was also concluded that use of potentiometer on the patella is possibly helpful in diagnosis of only left knee osteoarthritis.

Detection of microalbuminuria is an important laboratory test for evaluation of diabetic complications. A reliable method for determination of urine albumin is critical in this process. In the present study, we set-up and evaluated an electroimmunoassay (EIA) method for measearing the amount of albumin in urine. The reliability of Clinitek-100 Instrument was evaluated for screening of microalbuminuria as well. In this study which was the evaluation of a diagnostic test, anti human albumin antiserum was prepared following the immunization of rabbit and the EIA method was set-up for albumin determination. The ratio of albumin to creatinine, as the index of albumin excretion rate, were calculated for 61 urine samples of diabetic patients. Finally, the reliability of EIA and clinitek-100 for detection of microalbuminuria were evaluated. An enzyme-linked immunosorbent assay (ELISA) was used as a reference method for determination of urine albumin and for detection of microalbuminuria as well. The detection limit for EIA method was 2 mg/L, with analytical range of 2-200 mg/L. The intra-assay coefficient variation (C.V) of various albumin concentrations were 3.34 to 5.57%, whereas the regression coefficient was 0.996 (r=0.996). The sensitivity and specificity of EIA-test for detection of microalbuminuria were 95% and 83%, respectively. The sensitivity and specificity of Clinitek-100 for microalbuminuria detection were 67% and 94%, respectively. The EIA is a precise and specific method for determination of urine albumin and detection of microalbuminuria, but it is time consuming and unsuitable for single test reports. Clinitek-100 is specific and fast for delection of microalbuminuria. This method is suitable for single reports, but its negative results in test are controversial. We suggest that more care be taken for the clinitek-100 results and the negative results should be re-examined by other sensitive methods.

The pH of umbilical cord blood is a useful parameter for health status assessment of neonates. They may be premanently and irreversibly affected by acidemia. Some studies have shown that neonatal acidemia is related to the mode of delivery. Based on these considerations, the aim of this study was to investigate the relationship between mode of delivery and acidemia and to find the possible effects of acidemia on amniotic fluid and Apgar score. In this longitudinal study, 200 neonates born by normal vaginal delivery and the same number born by elective cesarian (C-section) were included. These two groups were assessed in terms of the pH of umbilical cord blood, Apgar score at 1st and 5th minutes, and meconial amniotic fluid. By definition, acidemia was considered in neonates when their blood pH fell below 7.1. The rate of acidemia in the neonates born by C-section was significantly higher than the other group (36% vs 20.5% respectively, p<0.05). Acidemia in the C-section group was associated with low Apgar score at 1st and 5th minutes and also with meconial amniotic fluid. Based on our findings, acidemia in neonates born by C-section may cause a low Apgar score associated with fetal distress. These results provide further evidence of the negative effects of C-section on neonatal health. So it could be of great value to recommend C-section only for justifiable indications.

There are many reports about the antimicrobial and the antifungal effects of Myrtal extract. This comparative and experimental study was carried out to investigate the effects of Myrtus communis extract on 3 species, Trichophyton mentagrophytes, Microsporum canis and Microsporum gypseum versus clotrimazole in guinea pigs. in this experimental study, ninthy three guinea pigs (450g body weight) were divided into 27 groups and inoculated with T. mentagrophytes, M. canis and M. gypseum. After the appearance of infection's symptoms, the infected animals in different groups, were treated with the 1%, 2% and 5% of gel, ointment or, the methanolic extract solution of Myrtus communis. One precent Clotrimazole was used for the positive control groups. Guinea pigs which were contaminated with M.canis did not show any signs of recovery after treatment with ointment in contrast to the solution and the gel (p<0.01). The best results of improvement were observed in the cases infected with T. mentagrophytes but not against M. gypseum. There were no significant differences among myrtal concentrations against T. mentagrophytes. Overall, evaluating the results indicated that the effects of myrtal extracts on the anthropophilic and geophilic dermatophytes on the animal models were much better than 1% clotrimazole, although the animal model is very resistant to this ointment.

Patients with diarrhea are susceptible to zinc deficiency. Zinc deficiency can cause growth retardation, delay in sexual maturity, behavior disorders, persistent diarrhea and abnormalities of immune system, susceptibility to respiratory and gastrointestinal infections and impairment of taste and smell perception. The aim of this study was to evaluate of the effect of oral zinc supplementation on the treatment of acute watery diarrhea. This study was a randomized double-blind placebo controlled clinical trial that was carried out in 139 children, aged 1 to 4 years, with acute watery diarrhea referred to two out-patient pediatric clinics in Yazd. Participants were randomly divided into two groups, zinc group (ZG) and placebo group (PG). The former group received zinc sulphate 2 mg/kg qd orally for 10 days and the latter group were treated with saline-dextrose solution (1/3:2/3). Duration and frequency of the diarrhea episodes were recorded in each group. Data were analyzed using Chi-square and Student t-test. The mean frequency of diarrhea at the first visit in ZG and PG groups were 4.6±1.7 and 4.2±1.5, respectively (p=0.1). At forty-eight to 72 h post-intervention, these values were 2.32±1.43 and 3.84±1.34 for girls (p=0.001), and 2.21±1.49 and 3.9±1.8 (p=0.001), for boys respectively. In general, after five days intervention, 45 patients (43%) were recovered, that 24 (53%) of them were from ZG. However, 10 days after the intervention the recovery rate in the ZG was markedly higher than the control group. At the end of the intervention, 80 (77%) patients, with 50 cases (66%) belonging to the ZG completely recovered. This study showed that oral zinc supplementation (2mg/kg qd) in children with acute watery diarrhea reduces the duration and severity of diarrhea.

The need for a standard instrument to assess pain in cancer patients is universally accepted. The aim of this study was to assess the psychometric properties of the Persian version of the Brief Pain Inventory (BPI) on a sample of Iranian Cancer patients. This cross-sectional study was conducted in Kerman on a sample of 211 cancer patients. At first the questionnaire was translated and back translated through standard methods. The face validity of the inventory was examined on 15 individuals with diverse educational levels to assess the comprehensibility and acceptability by the patients. The construct validity of the instrument was assessed by both exploratory and confirmatory factor analysis. The internal consistency was analyzed by Cronbach’s alpha coefficient and item scale correlation. The response rate was 96%. Nearly 52% were female. The Persian version was compatible with the original version. The Kaiser’s measure of sampling adequacy (MSA) before factor extraction of the questionnaire was 0.87, which indicated an acceptable factorability of the statements. The construct validity of the questionnaire was confirmed by exploratory and confirmatory factor analysis. The measures of internal consistency were in an acceptable level. Cronbach`s alpha for the whole questionnaire (11 items) was 0.87 and it was 0.87 and 0.89 for the intensity and reactive dimensions, respectively. The Persian version of BPI was a reliable and valid measure to assess pain in cancer patients.

Cholinergic neurons of nucleus basalis magnocellularis (NBM) have a key role in learning and memory process. It has been shown that these neurons are degenerated in patients with Alzheimer disease (AD). On the other hand, using the cholinomimetic agents and acetylcholinesterase inhibitors improve cognition in these patients. Some studies have shown that the frontal cortex receives some cholinergic projections from NBM. In the present study, the effect of intrafrontal cortex administration of physostigmine (acetylcholinesterase inhibitor) was investigated on active avoidance learning on the animal model of AD. In this experimental study, NBM was lesioned electricaly in Wistar male rats, (250-300g body weight) for making the animal model of AD. Because the frontal cortex receives cholinergic projections from NBM, different doses of physostigmine (2.5, 5, 7.5 µg/µl) were injected bilaterally into the frontal cortex of lesioned rats 20 minutes before active avoidance learning (8 sessions, 30 steps in each session) in Y-maze. The results showned that active avoidance learning was decreased significantly in NBM-lesioned group. Also intrafrontal cortex injection of phsostigmine (2.5, 5, and 7.5 µg/µl) significantly severed NBM lesion-induced learning deficiency. The findings of this study suggest that the cholinergic projection of NBM to frontal cortex in lesioned animals has a negative role on this type of learning. It seems that other neurotransmitter systems such as glutamate and other afferent projections from different brain areas to frontal cortex probably are involved in this phenomenon.

Cholinergic neurons of nucleus basalis magnocellularis (NBM) have a key role in learning and memory process. It has been shown that these neurons are degenerated in patients with Alzheimer disease (AD). On the other hand, using the cholinomimetic agents and acetylcholinesterase inhibitors improve cognition in these patients. Some studies have shown that the frontal cortex receives some cholinergic projections from NBM. In the present study, the effect of intrafrontal cortex administration of physostigmine (acetylcholinesterase inhibitor) was investigated on active avoidance learning on the animal model of AD. In this experimental study, NBM was lesioned electricaly in Wistar male rats, (250-300g body weight) for making the animal model of AD. Because the frontal cortex receives cholinergic projections from NBM, different doses of physostigmine (2.5, 5, 7.5 µg/µl) were injected bilaterally into the frontal cortex of lesioned rats 20 minutes before active avoidance learning (8 sessions, 30 steps in each session) in Y-maze. The results showned that active avoidance learning was decreased significantly in NBM-lesioned group. Also intrafrontal cortex injection of phsostigmine (2.5, 5, and 7.5 µg/µl) significantly severed NBM lesion-induced learning deficiency. The findings of this study suggest that the cholinergic projection of NBM to frontal cortex in lesioned animals has a negative role on this type of learning. It seems that other neurotransmitter systems such as glutamate and other afferent projections from different brain areas to frontal cortex probably are involved in this phenomenon.

Soft tissue involvements are the most common types of rheumatic diseases. The prevalence of periarthritis in a study in the USA was 20-30% of all rheumatic diseases. The aim of this study was to estimate the prevalence, type, topography and treatment in these disorders. This cross-sectional descriptive study was done on 1600 files of patients that were visited in rheumatology center of Shariati Hospital between 1996-2002. The samples were selected randomly and systematically and the data were extracted. The prevalence of periarthritis was estimated 16.25% (260 cases). Most of the cases with periarthritis were found in the age group of 40-50 years (26.6%) and the mean of age was 46.48±13.86. About 78.5% of patients were female and 21.5% were male. The most common forms of periarthritis were tendonitis and bursitis (64.6%) and the second rate was neurovascular (23.6%). The most frequent disease was carpal tunnel syndrome 21.9% and shoulder capsulitis (13.5%). Right upper limb and wrist (26.2%) were the most frequent sites of involvement and the rate of bilateral carpal tunnel was 42%. The rheumatic disease, as background, were found in 17.3% of patients. Bilateral carpal tunnel syndrome was the most frequent type of bilateral periarthritis which was statisticaly significant (p<0.001). As the results showed periarthritis diseases are very common, specially carpal tunnel syndrome and shoulder capsulitis. The future studies need to evaluate the response to treatment, job and trauma must be considered because of their importance in etiology. This study can be considered as a basis study for future reserches.

Previous studies have suggested that activation of the glucocorticoid receptors may have a modulatory effect on fear and anxiety. Therefore, the aim of this study was to determine the role of glucocorticoid hormones on modulation of anxiety in elevated plus-maze model in mice. In this experimental study, 60 male mice (25-30 g) were included. They were randomely divided into test and control groups. The test group received different doses of dexamethasone, as an agonist of glucocorticoid receptors, at 0.1, 0.3, 1, 2 and 10 mg/kg, Subcutaneausly, and the control group received the same volume of 2% ethanol in normal saline 30 minutes before the evaluation of their behavior. Twenty five minutes after the injection, the mice were put in a black box for 5 minutes to induce their activity and stress. The animals were then individually transferred to a standard elevated pluse-maze in regulated time and the percentage of time spent in the open arms and the ratio of open arm entries to total entries in 5 mins was measured. Results indicated that dexamethasone with the doses 0.3 and 1mg/kg, significantly reduced anxiety in mice (p<0.01). However, this effect was not observed at 0.1 and 2mg/kg. Our findings also showed that denamechasone at the dose of 10 mg/kg increased anxiety behavior in mice (p<0.01). The findings of this study indicated that glucocorticoids have important role in modulation of anxiety related behavior in a dose dependent manner using an elevated plus maze model in mice.

Normal sexual differentiation occurs in the 6th embryonic week and in a normal embryonic life. Both wolffian and mullerian ducts are present until the onset of sexual differentiation. Normal sexual differentiation is directed by the sex-determining region of the Y chromosome (SRY). Secretion of mullerian inhibiting substance (MIS) by sertoli cells results in regression of the mullerian duct in males. Any disruption of orderly steps in sexual differentiation may be reflected clinically as variants of the intersexes syndromes. One of the rarest forms of these syndromes is Persistent Mullerian Duct Syndrome (PMDS). This syndrome is caused by lack of regression and development of mullerian system and formation of female genital tract including uterus, fallopian tubes and two thirds of upper part of vaginal in male. While bilateral cryptorchidism, inguinal hernia and infertility are usually associated with this syndrome, external genital organs are normal. The diagnosis is usually made in the first years of life. Case Report: The presented case, a 71-year-old man, admitted to the surgical ward of Ali-ebn-Abitalib Hospital in Rafsanjan was diagnosed with a large right inguinal hernia. Physical examination of external genital tract was normal. The findings at operation were as follows: the uterus was attached to spermatic cord in the internal ring. Hysterectomy was done. Orchiectomy was also performed due to severe adhesion of the uterus to spermatic cord and rupture of the spermatic vessels. Pathologic examination of the resected tissues confirmed the diagnosis of PMDS. This syndrome is typically diagnosed by cryptorchidism and inguinal hernia during early years of life. Infertility is also a common finding in this syndrome. Although, there are a number of diagnostic procedures including sonography for detection of PMDS, this syndrome is almost recognised through operations casual. Rarity of PMDS and also unusual findings regarding this case including old age, the absence of infertility and cryptorchidism were the reasons for reporting this case.