مجله دانشگاه علوم پزشکی مازندران
پیاپی 59 (امرداد و شهریور 1386)

Background and Several studies have demonstrated, that atypical antipsychotics attenuate cognitive symptoms of schizophrenia more than first generation of antipsychotics. Because there was no comprehensive and reliable study on evaluating these effects in Iranian population, the research group decided to compare the effects of haloperidol and risperidone, both Iranian drug laboratorie's products, on the cognitive symptoms of patients with schizophrenia. 66 patients with the diagnosis of schizophrenia, according to DSM-IVTR criteria, who were hospitalized in Razi's Psychiatric Center, Tehran, were included in the study. After 2 weeks of wash-out period, patients were randomized in two groups, treated with haloperidol and risperidone, and in 8 week period basic and weekly MMSE were performed for all. Both drugs improved cognitive symptoms of patients, and the course of improvement started in the 2nd week of treatment with no significant statistical difference. The study didnt confirm the preferentiality of risperidone vs. haloperidol on the cognitive symptoms of schizophrenia, which was demonstrated in western articles. Therefore, choosing each drug for treating patients must fulfill on other goals, such as the profile of their side effects.

Background and Tennis elbow is a common complaint. Several treatment strategies, such as corticosteroid injections and physical terapy and braces have been described with no predictable efficacy. The purpose of this study was to evaluate prospectively the result of refractory lateral epicondylitis with autologus blood injections. Twenty two patients with lateral epicondylitis were injected with 2 mL of autologous blood under the extensor carpi radialis brevis. All patients had failed the two previous non surgical treatments including all or combination of physical therapy, splintinge, non steroidal anti-inflammatory medication and prior steroid injection. The patients were evaluated with patient-rated Tennis Elbow Evaluation (PRTEE). The average fallow-up period was 7.3 months (range, 4-10mo). After autologus blood injection, the average pain score decreased from 43.7 to 9.1 (P-value < 0.001). The average functional score decreased from 42.4 to 10.1 (P-value <0.001). On the basis of this study, this minimally invasive treatment advocates refractory Tennis elbow.

Background and This is a study to compare the efficacy and side effects of betaxolol and timolol in lowering the IOP of primary open angle glaucoma or ocular hypertension. This Double-blind randomized cross-over clinical trial was conducted on 29 eyes of 20 patients with primary open angle glaucoma or ocular hypertension. Each patient received timolol 0.5% and betaxolol 0.5% (SINA DAROU) twice daily for four weeks in two phases. Before and between the two courses of treatment there was a wash-out period. At the end of the study the effect of these two drugs on intraocular pressure (lOP), mean arterial blood pressure, pulse rate, and basic tear secretion in addition to ocular symptoms were evaluated and statistically analyzed. The study was performed on 29 eyes of 20 patients with baseline IOP of mmHg. After 4 weeks of treatment, timolol and betaxolol reduced IOP by mmHg and mmHg, respectively (P<0.001) and the difference between the two groups was also significant (P<0.001). Mean arterial blood pressure was reduced with betaxolol and timolol by mmHg (P<0.001), and mmHg (P<0.001), respectively, but the difference between two groups was not statistically significant. Pulse rate was reduced with timolol and betaxolol by beats /min, and beats /min, respectively P>0.05. No significant difference was considered between two groups. Mean reduction in basic tear secretion with timolol and betaxolol was mm/5min and mm/5min, respectively intergroup comparison was also not significant. Patients in 62.1% of the betaxolol group and 27.2% of the timolol group complained about eye burning. The differece between two groups was significant (P<0.01). lacrimation-eye pruritis and bitter tastes was more in betaxolol group. Other symptoms were similar between two groups. Timolol is superior to betaxolol in treatment of early glaucoma or ocular hypertension, but both drugs should be used with caution in patients with cardiovascular compromise.

Background and Vitro cartilage differentiation of mesenchymal stem cells (MSCs) has been noticed in several investigations. In this regard, almost always molecular differentiation of the cells has been examined, while structural and morphological differentiation of them has been ignored. Therefore, the present study examines the structure and ultrastructure of the cartilage differentiated from murine MSCs compared with that of costal cartilage. 2× 105 MSCs isolated from the bone marrow of NMRI mice were pleted by centrifugation and cultured for 21 days in chondrogenic medium. At the end of cultivation period, occurrence of chondrogenic differentiation was confirmed by reverse transcriptase–polymerase chain reaction (RT-PCR) analysis for some cartilage-specific genes. To compare the structure of differentiated tissue with that of natural cartilage, the cartilage was differentiated from MSCs and the cartilage obtained from the same murine rib was prepared for transmission electron microscopy (TEM). Structural studies indicated that similar to the costal cartilage, the cartilage produced from differentiation of perichondrium-like layer was formed. According to the microscopic images, in contrast to costal chondrocytes, the differentiated cells had euchromatic nucleus and their cytoplasm contained plenty of the organelles involved in active cell secretion. Furthermore, intercellular matrix in differentiated cartilage had a fibrillar appearance. Our results indicated that the structure of cartilage produced in micro mass culture system is somewhat different from that of costal cartilage. The cells from differentiated tissue seemed to be more active than those from costal cartilage.

Background and Propofol produces anesthesia with rapid recovery. However, it causes pain or discomfort during injection. The effect of remifentanil in prevention of propofol-induced injection pain was demonstrated in earlier studies. Sufentanil, an opioid analgesic, has not been studied for managing pain on injection of propofol. We have compared the efficacy of remifentanil and sufentanil for the prevention of propofol induced pain. One hundred twenty American Society of Anesthesiologists (ASA) class I-II adults undergoing elective surgery were randomly assigned into four groups of 20 each. Patients received 2 mL (10 mg) sufentanil, 2 mL of remifentanil (10 mg), 2 mL of remifentanil (20 mg), or 2 mL of saline 60 seconds prior to administering 5 mL of propofol 1%. Patients were asked whether they had pain due to propofol injection.Their pain scores were evaluated with the use of the four-point scale of Ambesh. The remifentanil and sufentanil groups significantly showed lower frequency of pain than that in the saline group (p < 0.05). Median pain intensity scores were significantly lower in the group receiving remifentanil 20 mg compared with the sufentanil groups (P < 0.05). The median intensity of propofol-induced pain was statistically similar between the groups receiving sufentanil or remifentanil 10 mg and the placebo groups. Remifentanil 20 mg over 1 min before propofol administration is more effective than sufentanil 10 mg 1 min prior to propofol in reducing the incidence and intensity of injection pain.

Background and Reports of pattern motion between lumbar spine and hip vary for stoop, loading conditions or the pathology present, such as chronic back pain. Therefore, the purpose of this study was to compare the relative contribution of the hip joint and lumbar spine during stoop lifting in subjects with and without a history of low back pain. This clinical trial was performed in Tehran. Fifty subjects were assigned as either a low back pain group or a control group. A Three-Dimensional Optoelectric Motion Analysis System was used to measure the amount of lumbar spine and hip motion during stoop lifting. Each subject performed stoop lifting with and without weight. The data were analyzed using independent t-test and repeated measurement test. These results showed that there were significant differences between patients with low back pain and healthy subjects in the pattern of motion (P<0.05). Individuals with a history of low back pain tended to move from the lumbar spine than those with no history of low back pain. According to the findings, history of backache can affect the change of pattern motion for hip joint and lumbar spine. This change may be a reason for the recurrent incidence of backache.

Background and Beta-thalassemia major (TM), a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. In the present study, the aim was to explore the nature of psychopathology according to age, sex, school performance, severity and complications of the disease in TM patients compared with demographically matched healthy persons. A controlled anterograde cohort study was conducted at the Thalassemia Unit of Boo-Ali Hospital from June 2003 to November 2005 in Sari, Iran. Psychological aspects were evaluated by the Persian version of symptoms checklist-90-revised questionnaire. Information on relevant demographic characteristics, school performance, severity and complications of the disease was collected by one of the investigators who had created the questionnaire. 125 persons with TM completed the questionnaires and were compared with 125 controls and 250 totally. The mean age of the participants was 18.51± 2.0 years and with a range of 15-25 years. 132 (52.8%) were female with equal family status, social and economic status. Patients group reported a significantly lower level of marital status (P<0.01), education level (P<0.0001), school performance (P<0.0001). TM patients were found to have significantly more psychiatric disorders than the control subjects with GSI: 1.16 ± 0.47 vs. 1.01 ± 0.6 (P<0.03), PSD: 54.99 ± 12.59 vs. 46.42 ± 18.76 (P<0.0001), and PSDI 2.02±1.02 vs 2.45 ± 2.22 (P<0.05). We recorded significant changes in the mean scores of somatization (P<0.0001), interpersonal sensitivity (P<0.0001), depression (P<0.003), anxiety (P<0.05) and psychoticism (P<0.03) in the TM patients as compared to the control subjects. These findings show that beta-thalassemia major patients are at risk for psychiatric symptomatology and need appropriate psychiatric consultation.

Background and Cyclophosphamide (CP), an antineoplastic drug, is also widely used in treatment of a variety of diseases such as lymphomas, leukemia, neuroblastoma, ovarian carcinoma, breast cancer and auto-immune diseases. However, its use has toxic effects on different tissues of the body, for example, it causes involution and degeneration of ovarian follicles and toxicity in the ovaries. In contrast, growth hormone (GH) improves the function of most body tissues and research has shown that it leads to the increase in the number and size of the ovarian follicles. The purpose of this study was to study the preventive effects of growth hormone during cyclophposphamide induced toxicity on the ovarian follicles. In this study, 30 New Zealand white rabbits were divided into three groups containing 10 animals in each. Group 1 was the control group and only received placebo. Groups 2 and 3 were administrated 100 mg/kg body weight CP orally daily. Group 3 was also administered growth hormone 0/15 mg/Kg subcutaneously for 49 days (from 7 days before initiation of CP therapy to 14 days after the last administration of CP).The day after last administration of CP, all 30 rabbits were anesthetized by ether and ovariectomized and the number of different types of developing follicles, regressive follicles and degenerations in ovarian tissue was studied. Degeneration of follicles was observed in both groups 2 and 3, but the number of degenerated follicles in group two was more than that in group 3 which had received GH. The number of degenerated areas in ovarian tissue in group 2 was also higher than that in the other two groups. The difference between body weight and the weight of the ovaries in groups 1 and 3 was not significant, but there was a significant decrease in body weight and ovarian weight in group 2 compared with the other two groups. These results suggest that co-administration of GH can improve the function of ovary and preserve the ovary and follicles from CP induced toxicity.

Background and There has not been enough attention towards the domains of development in pediatrics,so there are many deficiencies in monitoring the achievement of developmental milestones in our country. One of the important ways for the improvement of this problem is to use screening method. PEDS questionnaire is one of the screening tools for development. The aim of this study was to investigate about parent's evaluation of developmental status for their children. This was a cross-sectional descriptive study. The population included infants and children under the age of 6 in day care centers of Sari. Sampling method was clustering. The tool for data collection was PEDS questionnaire (Parent's Evaluation of Developmental Status) which consisted of 38 questions about demographic data and medical history of children as well as parent's concern about different developmental domains along with ''Yes'', ''No'' and ''little'' answers. The data were analysed using SPSS11 software. Chi square and Wilcoxon were used. P<0.05 was considered significant. Out of 829 questionnaires, 736 were returned (88.7%). The Sample age was 4.23 ± 1.32 gl. Fifty percent of participants were male. By average, in each developmental domains, 3.2% of parents had major concern and 9.5% had partial concern. The most common domains of concern were communication with others (6.4%), behavior (6.1%), speaking (4.3%), preschool and school education (3.1%), children's understanding (2.5%), the self care (2.1%), the use of fingers (1.4%), the use of legs and arms (1.1%). Parent's concern had a significant relationship with parent's education, residence and history of illness in children (P<0.05). Out of 23.4% of the infants and children who had later returned to the diagnosis center, 80% had behavioral disorder, 87.6% had speech disorder and 16.6% had hearing impairment.. A considerable percentage of parents was concerned about developmental domains of their children, but follow up at referral centers was low. Parent's concern led to the diagnosis of an illness for a child in most cases.

Background and Infectious diseases account for approximately one-half of all deaths in tropical country. In developed country, despite the progress made on the control of disease, incidence of epidemics due to drug resistant microorganisms and unknown diseases spreading microbes pose enormous public health concerns. On the other hand, in spite of improvements in food production hygiene, food safety is increasingly an important health issue. There is, therefore, still a need for new antimicrobial agent to reduce or eliminate foodborne pathogen as well as food spoilage microorganisms. Historically, plants play a major role in primary health-care as therapeutic remedies in developing countries. The screening of plant extracts has been of great interest to scientists for the discovery of new drugs effective in the treatment of infectious disease. Umbelleferea is known to be a potential source for the antimicrobial agents. The present study attempts to investigate the antimicrobial activity of Pycnocycla spinosa as a member of Umbelleferea against selected microorganisms. The plants were collected from Isfahan and different solvent extracts of plants were prepared. Then, the antimicrobial activity of extract was determined, using disk diffusion method. The minimal inhibitory concentration (MIC) was determined by tube dilution method. Results demonstrated that different extracts of plants indicate antimicrobial activity against bucillu subtilis, aspergiluse niger and candida albicans. Generally, the antimicrobial activity of the plant’s fruit extracts is considered medium. Pycnocycla spinosa fruit's extract showed medium antimicrobial activity. Hydroalcoholic extract of the fruit demonstrated higher antimicrobial activity. This may reflect a low concentration of active components in extracts. Further studies are needed to investigate antimicrobial activity of the plant's essential oil and other parts of the plant.

Background and Evaluation of the quality of food proteins has a great importance from of biological and economical perspectives. That is why, biological, microbiological, chemical and integrated methods have been used and introduced for determining the quality of Proteins. Among exsisting methods, NPR, RNPR and TPD have been suggested as appropriate methods to determine the quality of Proteins. Considering the importance of protein quality in foods, especially in low scale families, this study has been conducted to evaluate the aim the protein quality by the use of the mentioned methods in a sample homemade food based on rice (a variety of Mazandaran rice) -lentil mixture in 2007. This experimental study was conducted on wistar rats, aged 21 days under 6 diets in 8 groups including case (home made food), standard (Casein+Methionine) and basal (Protein free) to determine NPR and RNPR and other 3 diets (case, standard and basal) to study TPD. Duration of study for NPR was 14 days. Protein intake and increase in weight were determined to calculate NPR. Duration of study for TPD was 9 days. The amounts of nitrogen intake and fecal nitrogen were determined to calculate TPD. NPR, RNPR and TPD of the group Casein+Methionine with homemade food was analyzed by t- test. NPR values for casein + methionine protein of home-made food were 4.3 ± 0.4 and 3.6 ± 0.6, respectively (P=0.02). TPD values were 92.8 ± 4 and 75.8 ± 5.8 (P<0.0001), for Casein+Methionine and home made food proteins, respectively. Also, RNPR was 83.6 % and homemade food / Casein TPD was 81.6. Findings showed that homemade food TPD and NPR based on rice-lentil mixture is lower than Casein.

Background and Tody, most societies face significant decrease in consuming milk products in children and this process would cause problems in providing the calcium needed by children, particularly since the osteoporosis is definitely connected to a lack of receiving sufficient calcium in children and adolescence age. Therefore, the goal of this study is to study the knowledge and pattern of milk consumption in 7-12 year old children of Sari and their mothers. The research samples consisted 638 male and female student at 7-12 in elementary schools (urban and rural), chosen at random from 16 schools. Necessary data were obtained through separate and different questionnaires on the output of milk consumption and its products through direct interviews. The data of the study were analyzed using t-Test, ANOVA, Duncan follow up, Chi-square and correlation coefficient. In this study, 44% of children and 37.7% of mothers consumed milk and 50.1% of children and 19.4% mothers sometimes consumed milk. 5.5% of children and 19.4% of mothers did not consume milk. Mostly, the reason for non-consuming milk among children and mothers was: not having access to milk (27.9% and 17.7%). The awareness towards the advantages of milk was desirable in 67% children and 48.7% of mothers. It was almost desirable in 21.1% children and 4.5% of mothers and undesirable in 1.4% of children and 1.1% of mothers. The amount of milk consumption for 62% of urban children and 49% of rural children was only one unit, and, in sum, the amount of milk consumption for 59% of boys and 55% of girls was less than the recommended figures. The mean average of criteria deviation in the amount of milk consumption for children showed a significant difference from their educational levels (p=0.001) and insignificant difference from their sex. In addition, the pattern of milk consumption of children had significant relationship with the sex, education level and education of father however, it had significant relationship with the education level of mothers and the jobs of mother and father. Children's knowledge about the advantages of milk had a significant relationship with the education level of mothers, fathers and jobs of mothers (P<0.004) however, it had a insignificant relationship with their sex. In this study, the amount of milk consumption in half of the population subjects of the study was less than the standard recommended amount therefore, to improve children's health status and prevent the destructive effects of osteoporosis in adulthood, there should be necessary actions to increase milk consumption among children.

Background and Wheezing is a common respiratory problem which is related to hypersensitivity of airways, GERD (Gasteroesophageal Reflux Disease) is one of the underlying factors of respiratory diseases and wheezing in infants (different rates). For the patients with refractory wheezing, detection and treatment of underlying disorders is very important. So, in this study, frequency of Gasteroesophageal reflux was detected in infants<2y with refractory wheezing. This is a cross-sectional descriptive study on the patients referred to pediatric clinic during 2003-2005. Infants with refractory wheezing under 2 (Based on HX, PE) were introduced gradually, and patients with the evidence of foreign body aspiration, congenital heart disease, thracheoesophageal fistula and neurological impairement were excluded. Fleuroscopic barium study for detecting GERD was performed for the patients. Data were analyzed using SPSS11 software. During 2 years, 50 patients were studied. Age of the patients was 10.26 ± 5.48 m and 54% of them were male. The most common complaints were wheezing and retraction. Also, 78% of the patients were under dronchodilator treatment, among them 30.8 % responded to the drug. In fleuroscopic study using barium, 60% of the patients demonstrated GERD. Numbers of respiratory attack and admissions significantly were related to GERD. GERD is one the underlying factors of recurrent respiratory symptoms and refractory wheezing in infant below 2 years of age. So, evaluations for the detection of GERD should be performed in this patients.

Background and Treatments of burn pregnant women is a difficult task because the vulnerable fetus is highly dependent on the health of the mother. This study was conducted to determine the epidemiology, etiology, clinical assessment and outcome of pregnant patients between January 1998 and October 2003. A 6-year retrospective descriptive study of burns in pregnant women hospitalized at Mottahary hospital (burn center) in Tehran was performed. A short structured questionnaire was used to collect data. The questionnaire covered demographic information, etiology, clinical manifestations, and outcomes. 74 (5%) of the 1480 women of reproductive age who were admitted for burn treatment during this period were pregnant. The mean age of 74 patients was 22.54 years (SD = 4.78) with a range of 16-35. The majority of the women (50%) were between 20 and 30 weeks of gestational age. The most common cause of burn was kerosene fire 52 (70%). Most of the women 50 (68%) suffered from severe burns with TIBC>40%. 49 (66%) mothers and 50 (67.5%) died as a result of the burn damages. Burn size, TIBC, follow up of clinical manifestations for pregnant women, fetus and performance of proportional treatment protocols were the strongest predictor of mortality for mother and fetus.

Background and Chronic abdominal pain is a common clinical problem in children. Apleys reported the incidence of 10-15% of chronic abdominal pain in school age children, but recent studies reported 20% of that type of pain. The aim of this study was determining the spectrum of clinical manifestations of dyspeptic children and to identify the relation between some clinical symptoms, organic or functional dyspepsia, and long term follow up of functional type. This descriptive case series study was done on 232 children between 4 and 18 years of age complaining about chronic abdominal pain chiefly who had referred to pediatric gastroenterology department of Boo-Ali Hospital of sari in 2005-2006. A checklist composed of patient demographic criteria and pain characteristics was prepared. Physical exam and laboratory tests such as AST, ALT, U/A, U/C, S/E, ESR, CBC were performed for all patients. If there were any alarming signs of organic abdominal pain-persistence or recurrence of symptoms and severe disability despite the use of H-blockers-upper GI endoscopies was indicated. Recorded data were analyzed by SPSS software and Chi- square tests. 102 of 232 patients had dyspepsia 59 were girls (9.2y/o), and 43 were boys (7.5y/o). 65 out of 102 patients had dominant abdominal pain and the rest had flatulence, vomiting and early fullness. 64 of them went under UGI endoscopies. 28 of 64 had mucosal erosion. Because the functional or organic abdominal pain has not unique diagnostic criteria, and the data about pathological change in children are fewer than that of adults we recommend the clinical findings and biochemical change of mucosa for differential diagnosis in children.

Yellow nail syndrome (YNS) is a rare disorder characterized by a triad of yellow discoloration and destructive changes of nails, lymph edema and a variety of pathologies in the respiratory system. This disorder can be associated with and herald the presence of internal diseases. An increased awareness of these conditions may help with the early diagnosis and therapy of the associated disorders. We report a 24 years old whom with yellow nail syndrome whom was admitted at hospital. She also had fever, lymph edema and pulmonary manifestations.

Foregut cysts are various congenital lesions originated from emberyonic foregut. Bronchogenic, enterogenous and neuroenteric cysts are the most frequent forms of foregut cysts. They create different clinical symptoms based on their location. Enterogenous cysts comprise 4-5 percent of posterior mediastinal cysts and include esophageal, gastric and enteric cysts. A 61 year old woman referred to surgical clinic with dysphasia and regurgitation 6 months ago whose illness aggravared over the last 3 months. In physical examination, a lesion was seen in the right site of posterior mediastinum. Surgical excision was done and a ciliated columnar epithelium with two thin muscular layers were reported in pathology. In reality, the distinction between esophageal and bronchogenic cysts is not always clear. Both cysts present in mediastinum and their epithelial tissues are non-specific, however presence or lack of muscle layer in cyst-wall, proximity to gastrointestinal tract or tracheobronchial tree, adaption of clinical symptoms with paraclinic results and observations during surgical procedure can reveal certain diagnosis.

Nosocomial infection is an important prognostic factor in out comes of burned patients. In this descriptive cross. Sectional study, 82 burned patients and related medical equipment were assessed in zareh hospital in 2033-2004. Pseudomonas aeruginosa and staphylococcus areus were found in 69(51.4%) and 31 (23.2%) of 134 clinical specimens respectively. Hence it is mandatory to plan programs for redusing harmful and resistance bacterial infection in this patients.