مجله دانشگاه علوم پزشکی شهرکرد
سال نهم شماره 1 (پیاپی 33، بهار 1386)

Phytolacca americana is a native plant in several states of USA and mostly its boiled leaves are used as a popular salad (called grandmother salad) in American diet. It grows widely in the coastal areas and forests in northern parts of Iran but is rarely used. In spite of having several medicinal properties, its side effect is digestive toxicity (especially hepatotoxicity). To date, the hepathotoxicity of this plant from northern of Iran has not been studied. Therefore, this study was aimed to investigate the hepatotoxicity of P. americana using Isolated Rat Liver Perfusion (IRLP) system. The albino rats weighted 180-220 g were desighdted into 6 groups. Subsequently, the male rat’s anesthetized using ether, were used for experiments. The inferior vena cava was cannnulated with PE-10 tubing. The portal vein was immediately cannulated with a 23 g catheter. Then the liver was perfused in site by Krebs-Henseleit buffer at 37°C with a rate of 20ml/min for 3hr. After 30-45 min of perfusion, various doses (10, 20, 40, 50, 100 mg/kg) of aqueous and methanol extracts and CHCl3, ETOAC & MEOH fraction (10, 20, 40mg/kg) were added to the buffer and perfused for 2 hr. Samples of perfused fluid were collected every 30min and analyzed for any liver injury by measuring the serum enzymes (ALT, AST). Sections of liver tissue were also examined for pathological changes. The results showed that the activity of aminotransferase enzymes increased significantly and dose-dependently (p<0.01). Also, methanol extract fractionates were increased compared with the control group (p<0.05). The histopathological changes in the liver tissue were dose-dependent and confirmed the previous data. The enzymatic differences between the test groups and the control group showed the most difference at 60 min. The finding showed that the hepatotoxic effect of P. americana is dose dependent. Therefore, decreasing the administrated dose may be effective in prevention of its hepatic side effects.

Determination of preoxygenation before anesthesia is an important factor in prevention of hypoxia and its complications. Regarding the height of Shahrekord from the sea surface (2061 m) and low level of oxygen pressure in this area (600 mg), this study was aimed to determine the onset of desaturation of oxygen following, using of three pre-oxygenation methods in apnostic adult healthy patients. In this clinical single blind study, sixty-six healthy, non-smoker adults undergoing elective surgery were randomly divided into three groups. Following the record of systolic and diastolic blood pressure and heart pulse from the patients, group one were not pre-oxygenated, groups two and three were pre-oxygenated with 50% oxygen and nitrous oxide and 100% oxygen, respectively for three minutes. After induction of the same anesthesia in the 3 groups, the patients were kept in apnostic until their saturated pressure O2 (SpO2) decreased to 91%. Subsequently, their systolic and diastolic blood pressure and heart pulse required to achieve SpO2 of 91% were measured. The data were analyzed using Chi-square and ANOVA tests. Mean age of the patients was 30.5±14.1 in whom 58% of them were male. All of the three groups were sex and age matched (p>0.05). The delay time to achieve SpO2 in group one, group two and group three were 44±16, 114.3±36.8 and 241.6±84, respectively (p<0.001). In all of the 3 groups, the increasing of heart pulse after the intervention was significantly different compared to before that (p<0.001). However, the difference was not significant between the groups. Pre-oxygenation of the patients for 3 min. before induction of anesthesia with normal breathing and with 100% oxygen would significantly increase the time required for oxygen saturation of the patients to 91%.

Papanicolaou (Pap) smear screening is an effective method of detecting cytological changes in cervix before they lead to cervical cancer. To determine the quality of process of Pap smear and comparison of pathologist and cytologist reports about quality of obtained samples and accuracy of diagnosis, this study was performed.

In this cross sectional study which performed during spring and summer 2005, the processing of a total of 160 Pap smears were observed randomly by standard checklist. Also a total of 360 Pap smear samples reported by a cytologist were examined by a pathologist and the Kappa correlation coefficient was compared between the two reports.

The function of midwifes in patient recording was 96.15% good and 3.85% poor. The function for Pap sampling was 88.72% good and 11.28% poor. In the pathologist report, the quantity of specimen, infection cellular changes, inflammation reactive changes, cell abnormality were reported were 308(85.5%), 12(3.3%), 232(64.4%) and 3(0.83%), respectively. There was significant relationship between pathologist and cytologist reports (p<0.05).

According to the result, the quality of processing of Pap smear, the quality of obtained samples and accuracy of diagnosis were acceptable. However, we suggest more supervision and attention about midwifes and cytologists practices.

Patients loss their body heat during the anesthetic period and postoperative shivering is occurred to compensate it. To date, most of the studies about postoperative shivering were done in adults and there are limited data in pediatric patients. The aim of this study was to investigate the incidence of shivering in children and to reveal the causative factors as well as any possible clinical implications. This cross sectional study was performed on 200 pediatric patients with age ranging from 3 months to 14 years. Demographic data, kind of anesthesia, body temperature and recovery temperature were recorded. Data were analyzed using χ2, Spearman and Pierson tests. The incidence of shivering was 7%. Shivering was significantly more in the patients receiving inspirational anesthesia (13.6%) than in the patients receiving intervenes anesthesia (0%) (p<0.05). Shivering was high when body temperature was below 36.4ْC or when recovery temperature was below 26˚C (p<0.05). The incidence of shivering in patients who received pre-medication was lower than that of in patients who received no medication (p<0.05). The incidence of shivering in pediatric patients was related with their body temperature, recovery temperature, pre-medication and method of anesthesia.

Pregnancy and infancy are as diving profits, which are of the most enjoyable times of women. Islams living doctrine recommends some adwises for pregnant women to have healthy generation with good physical, mental and social dimensions. Therefore, the aim of this study was to evaluate the knowledge and attitude of the pregnant women who referred to Iran University of Medical Sciences in 2005 toward Islam’s hygienic instructions during their pregnancy and breast feeding period. In this descriptive-analytical study, a total of 300 pregnant women were selected from parental care unite using multistage sampling. The data was gathered through self-reporting questionnaire which contained some questions about the individuals characteristics, attitude and awareness. Subsequently, using χ2, Pearson correlation and Spearman tests, data were analyzed. The percentage of the knowledge about the Islams healthy instructions during pregnancy was graded: good 20.6%, average 64.7% and poor 14.7%. During breast-feeding, the knowledge was 6.3% good, 77% average and 16.7% poor. There was a positive relationship between the women’s level of education and their knowledge about Islamic trainings. The attitude of the women about the instructions during their pregnancy was positive in 68.3% and negative in 31.7% of them. This attitude during breast feeding was positive in 64% and negative in 36% of the women studied. There was relationship between the knowledge toward the instructions and the level of education during pregnancy and also between this knowledge and the number of pregnancy and the level of education (p<0.01). In addition to moderate knowledge and positive attitude of most of samples and undeniable religious force, on promoting health, recommended that health managers programmed to pregnant women care based on Islamic recommendations and health care workers have more attention in their education training.

The liver diseases are of the most important human kind problems. The discovery of effective medicines on the diseases is the interest of specialists. A wild species of umbelliferus plants, Dorema auchri, is used as vegetable in spring season in southern regions of Iran and is thought that it has medicinal characteristics. In this study, we evaluated the hepatoprotective effects of the crude extract of D. auchri in rats treated with carbon tetrachloride (CCl4).

In an experimental study, thirty rats were divided into five equal groups. The first group served as a control and the other groups treated with CCl4 to create hepatotoxicity. Three groups of hepatotoxic rats (treaded with CCl4) were fed with 200, 400 and 500 mg/day of crude extract of D. auchri. After 45 days, the level of liver damage was measured using aspartate

aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and concentration of total protein, albumin and bilirubin in serum. The data were analyzed using statistical ANOVA test. Intraperitoneal injection of CCl4 increased AST, ALT and ALP activity to 117.85, 468.6, and 134.97 and decreased the concentration of total protein, albumin and bilirubin of serum to 16.8, 20.3, and 880 percent, respectively compared to that of the control group (p<0.001). Consumption of crude extract of D. auchri caused these factors return to the normal level.

Aqueous extract of D. auchri showed hepatoprotective activities against carbon tetrachloride induced liver damage in rats.

Sleep is an important regular and repeated biologic period and leads to refreshment of human life both physically and mentally. One third of human life is spending in sleep and lack of it, endangers human well being. This phenomenon usually is affected by both internal and external factors such as age, sex, drug, disease and surgery. Therefore, the aim of this study was to assess the sleep disorders in congestive heart failure patients in Hajar hospital of Shahrekord in 2003. This descriptive-analytical study was performed on 205 patients with an ejection fraction less than 40%. The sampling was conducted using simple method from September to November, 2003. Data were collected using a questionnaire comprising two parts of questions and expresses, which was filled in by the researchers. Data were analyzed by Chi-square test using SPSS. Prevalence of sleep disorders in congestive heart failure patients was %51. The most prevalent disorder for start sleep stage was disturbing thoughts (62%) and for co-sleep, stage was sleep rising by slight noise (77.1%) and for sleep-raising stage was sleep raising 2-3 hours sooner (57%). The statistical test showed that the more sleep disorder, the less sleep consent (p<0.001). Sleep disorders were more abundant in women (p<0.001). There was no significant correlation between sleep disorder score and age, but with aging, the sleep complications will be increased (p<0.05). Based on our results, the prevalence of sleep disorder in heart failure patients was higher than that of the general population. Regarding the importance of sleep in these patients providing good physical condition for sleep is necessary.

The preeclapsia causes about 5-10 of pregnancies to be complicated and leads to increasing maternal morbidity and mortality rate in both mother and fetus. One of proposed preventions is using of antioxidants during pregnancy. Therefore, the aim of this study was to investigate the effects of vitamins E and C on the pregnancy-related blood pressure as the major sign of the preeclapsia. In this clinical trial study, 150 primigravids, aged 20-35, gestational age 20 weeks, singleton, negative family history of preeclampsia, chronic hypertension or other organic disease, with normal BMI, nonsmokers, moderate socioeconomic level and without molar pregnancy and polyhydramnious, are divided into two equal groups of case and control. The case group received 500 mg vitamin C and 400 IU vitamin E every day. The control group received no vitamin. Using a questionnaire, the data were obtained and analyzed using t, paired t and Fisher exact statistical tests. The preeclampsia rates were 2 (2/6%) and 11 (14/7%) in the case and control groups, respectively (p<0.01). In the case group, the mean of systolic pressure befor and after study were 96.1±9.7 and 109.8±9.5 mmHg, respectiely. In the control group this parameters were 94.6+8.7 and 113.8±8.7 mmHg, respectively (p>0.05). In the case group, the mean of pressure was 60.2±8.3 mmHg before diastolic and 65.5±3.8 at the end of pregnancy and after the intervention. In the control group, this parameter was 59.6±20 and achieved to 72.2±16 at the end of the pregnancy (p<0.01). Our results showed that use of 400 IU vitamin E and 500 mg vitamin C during pregnancy prevented incidence of preeclampsia and reduced mean diastolic pressure, but had no effect on mean systolic pressure. Therefore, it is recommended to use the medications in the high risk-pregnant women.

Headache is one of the most prevalent medical complaints and causes undesirable effects on the human kind feelings and life style. Regarding these complications, the scientific society requires methods to measure them. Therefore, the purpose of this study was to obtain factor structure, validity and reliability of the Headache Disability Inventory (HDI). In an analytical-descriptive study, this inventory was administrated on 100 headache patients referred to a hospital in Shiraz. The patients selected randomly to filled in a questionnaire based on SCL-25. The validity of the inventory was investigated by three different construct validity (factor analysis), concurrent validity and convergent validity. Factor analysis of the inventory was used through varimax rotation based on Skree test. The concurrent validity of the HDI was measured by SCL-25 and in convergent validity, correlation coefficients of emotional and functional subscales with total score was calculated. The reliability coefficients of the inventory were calculated in spilt-half and internal consistency methods. Factor analysis of the inventory showed that two factors labeled emotional and functional which covered 36 percent of the total variance. In concurrent validity, correlation coefficients of the total score, emotional and functional factors of the HDI and SCL-25 were 0.71, 0.51 and 0.55, respectively. In convergent validity, correlation coefficients of emotional and functional subscales with total score were 0.79 and 0.91, and together was 0.48. In reliability, the spilt-half reliability coefficient was 0.77 and Cronbah’s alpha coefficients for total score, emotional factor and functional factor were 0.86, 0.68 and 0.83, respectively. Based on the results, this inventory (questionnaire) has appropriate reliability and validity in Iranian society and is a suitable scale for using in research and clinical situations.

Disasters cause disability, economic burden and death, annually. The casualties following the catastrophes such as earthquake, hurricane, and etc. leads to stress, anxiety, depression, and somatizaten. Post Traumatic Stress Disorder (PTSD) is one of these complications occurred after the unpleasant events. One of these events was happened in a rural region in Chaharmahal and Bakhtyari province, Safilan. Therefore, the aim of this study was to assess the frequency of post disaster psychologic complication in the children of the area and the effect of mental health intervention on them. This is a quasi-experimental study in which all children aged 5-15 years from this region who experienced this event were interviewed. The face to face interview was performed with the parents of the children and the Yoll questionnaire was filled immediately after the event. Subsequently, the psychologic interventions including psychological re-explanation, recognition of social thinking and treatment mechanisms were used for two weeks through 4 seasons. Repeatedly, five months after the event, the same procedures were performed. Results were analyzed with paired t-test, independent t-test and ANOVA. In the first round of measurement, the mean score of PTSD was 61.14±15.03, and in the 2nd time it was 48.19±9.6 (p<0.001). This score in the age groups of 5-10 and 10-15 years was 54.26±13.8 and 65.5±14.3, respectively before the intervention (p<0.05) and was 43±5.7 and 51±10.28, respectively after that (p<0.01). This difference was not sex dependent. Analysis of variance showed that with increasing education, score of PTSD significantly was increased and using Tukey test, it was shown that the difference was significant between the two level of education (p<0.01). The results of this study showed the effect of hygienic interventions and educations in the problem faced. Therefore, use of preventive mechanisms in all 3 preventive levels is essential in the case of this event.

Typhoid fever is a systemic infection caused by Salmonella typhi. The global emergence of multi-drug resistant (especially to ciprofloxacin) strains of this bacterium is of great concern. Therefore, the aim of this study was to compare the efficacy of co-trimoxazole with ciprofloxacin in empirical treatment of typhoid fever in outpatient cases from Ahvaz. In this clinical trial study, which was conducted in Ahvaz, 50 of outpatients were divided randomly into two groups. Group one were treated using ciprofloxacin (7.5mg/kg bid, 7 days) and the second one treated by co-trimoxazole (4.20mg/kg bid, 14 days). A blood sample taken from the patients before, at the end and 3 weeks after the treatment, and tested for S.typhi. The outcome of the treatment was regarded as responded (disconnection of fever and the culture became negative), failure to treatment, and relapse of the infection. These results were analyzed using SPSS11 software using t and Chi- Squared tests. The mean age of the patients in ciprofloxacin and co-trimaxazole groups were 22.4 and 22.1 years, respectively (p>0.05). The responses to the treatment (no fever, negative culture) with ciprofloxacin and co-trimoxazole were 81.81% and 78.57%, failure of treatment with ciprofloxacin and co-trimoxazole were 13.63% and 14.28% and relapse was 4.56% and 7.15%, respectively. This study showed that the effect of co-trimoxazole is similar to that of ciprofloxacin. Therefore, regarding the recent reports indicating increasing resistance of this bacterium to ciprofloxacin and limitation of using of it in children and pregnant women, we recommend co-trimoxazole for treatment of empirical typhoid fever.

The best way to reduce myocardial infarction (MI) is to find its risk factors and prevent or modify them in high-risk populations. This leads to decreasing of its complication and mortality and thus maintenance of productive potential in the societies. Therefore, the aim of this study was to identify MI risk factors in patients referred to Chaharmahal and Bakhtiary province hospitals, 2005.

This case-control study was performed on a total of 247 patients suffering from MI from Chahrmahal and Bakhtiary province during 2005. These patients were assigned as the case and 240 of the other patients as the control group. The patients were compared in the case of predisposing factors to MI. Data were gathered by a questionnaire consisting of four sets of questions: demographic and physiologic variables, Holmes and Rahe Scale, standard activity and standard annual diet. Data were analyzed using regression, Chi-square, Fischer and Odds ratio tests.

Base on the results, there was no significant difference between the two groups in the cases of age, sex, education, job and the place of life. In the case and the control, the frequency of high blood pressure, 40.5%, 29.6% (p<0.001, OR=3.68), total cholesterol level: 42.9% and 19.2% (p<0.001, OR=5.22), Diabetes: 29.1%, 12.1% (p<0.001, OR=3.68), smoking: 60.4%, 39.6% (p<0.01, OR=1.78), stress: 34.4%, 15.4% p<0.01, OR=2.78), and obesity: 15.6%, 5.4% (p<0.001), OR=2.97), respectively. These are recognized as the main risk factors of the disease in this region.

The findings showed that the history of high blood pressure, high cholesterol level, diabetes, smoking, stress and obesity were the main MI risk factors in this area.

It is a fact that most of physician dont beleive that only with stimulation of the breast and encouragement, in a woman is not pregnant and has not had delivery, adequate milk production (lactation) can be induced to feed an adopted child. In this case, we have induced lactation for a 30-years old lady who could never be pregnant as an adopted child. During 2 years fallow up, we have observed that babys growth curve was quite similar to normal pattern. In this period, baby was fed by his adopted mothers milk