مجله دانشگاه علوم پزشکی مازندران
پیاپی 62 (بهمن و اسفند 1386)

Background and Acute renal colic is a common complaint from patients entering the emergency departments. Although, urethral lithotripsy and extracorporeal shock wave lithotripsy are known to be effective, the role of medical-expulsive therapy for the treatment of this disease has not yet been established. This study assessed the clinical efficacy of addition methylprednisolon acetate in the medical-expulsive therapy of distal ureterolithiasis. Eighty five (85) consecutive patients with a symptomatic distal urethral stone were included in our study and randomized to one of two home treatment groups. Group A patients (n = 45) received tramadol (50mg bid) and hydrochlorothiazide (50 mg daily) for 21 days, and group B patients (n = 40) were treated with a corticosteroid drug (methylprednisolon acetate 40mg intra-muscular on 0, 7 and 14 days after treatment), in addition to tramadol and hydrochlorothiazide. The treatment duration was 21 days. All patients were re-evaluated after 21days with a clinical examination and KUB. The mean stone size was 5.2mm and 5.8mm in groups A and B respectively (P value>0.05). Both groups had a significant difference in expulsion rate (20(44.4%) for group A and 32 (88%) for group B (P value<0.001). Our results suggest that the use of a corticosteroid drug in association with tramadol and hydro-cholorothiazid appeared to induce an increase in the expulsion rate.

Background and Anterior shoulder dislocation is the most common major joint dislocation. In most cases, this dislocation is being relocated in emergency departments. Routinely, pre and post reduction radiographs are performed. This study was done to determine the necessity of radiographs in the emergency department for management of patients with suspected anterior shoulder dislocation. In this case series study, 116 patients suspected of anterior shoulder dislocation were referred to Hazrat Rasoul Akram and Haftome Tir Hospitals emergency departments in Tehran, and were investigated for a one year period. The emergency physicians evaluated and documented the possibility of dislocation or relocation, before obtaining radiographs. Outcome measures were the assessment of joint positions on the x-rays by an orthopedic surgeon. 84 cases (72%) were male and 32 cases (28%) were female. Mean age of the patients was 31.5±8.5 yrs. Thirty (30) patients had recurrent dislocations without traumatic mechanism (group 1) and eighty six (86) patients had no prior dislocation or a blunt mechanism of injury (group 2). The accuracy of the emergency physician’s assessment in dislocations was 100% in group 1 and 98% in group 2. False assessments occurred only in patients with fractures. There is no significant difference between emergency physicians and orthopedic surgeons in the assessment of dislocations and relocations, when the emergency physicians did accuralty diagnose them. Our study showed that the physicians are highly accurate in clinical determination of anterior shoulder dislocation and relocation. Pre-reduction films should be obtained when the mechanism of injury is trauma. Post-reduction films should be obtained in fracture-dislocations or when the physicians are uncertain of correct relocation.

Background and Many studies report that Toxoplasma gondii excreted / secreted antigens (E/SA) appear to be a suitable marker for toxoplasmosis serodiagnosis. Most of these studies have used E/SA, obtained from supernatant of Toxoplasma cell culture, or by incubating tachyzoites in cell free media (RPMI-1640). The present study for the detection of Toxoplasma IgG in human serum was evaluated, using the components of peritoneal fluid of infected mice (as another source of E/SA). Peritoneal fluids of mice infected by interaperitoneal (IP) inoculation of Toxoplasma tachyzoites were collected after 3 days and centrifuged at 750×g for 15 minutes. Then the supernatant was precipitated with ammonium sulphate solution (40% saturated) and used as components encompassing E/SA. Forty (40) none- infected (without anti- toxoplasma antibodies) and thirty- two (32) positive (with IgG to toxoplasma) human serum samples were selected (all sera were first tested by standard method for detection of IgG antibodies anti-T. gondii) then, the sera were tested by ELISA using E/SA. The cut-off point with 95% confidences was found to be 0.78. Moreover, sensitivity and specificity of the method were determined to be 84% and 92%, respectively. The present results indicate that peritoneal exudates from mice infected with T.gondii, may be used as a source of anti-genic material for the detection of Toxoplasma-specific IgG. Furthermore, it may be valuable for the development of new tools in the serodiagnosis of toxoplasmosis.

Background and Coronary artery Stenting is known to improve the outcome for ischemic heart disease. Many clinical studies have been performed to determine the long-term outcome of coronary Stenting and most of them were based on first-generation bare-metal Stents. The aim of this study is to evaluate long-term (24 6.4 month) results of second-generation bare metal stent. From August 2004 to September 2006, one hundred and twenty eight (128) consecutive patients with significant coronary artery stenosis underwent elective angioplasty and stent implantation, using second generation bare metal stent (BMS). Clinical outcome were analyzed after (246.4) months. The Primary end point was based on the incidence of MACE (MI, Death, and Repeat Revascularization). One hundred and forty four (144) bare metal stents were implanted in 134 Vessels. The Mean age was 57 10.4 years, 72% of patients were male and 35.2% were diabetic with 98.4% in- patient hospitalization success rate. Thirteen (10.3%) patients had MACE during the follow-up period (4MI, 3CABG, 2 Deaths and 4R-PCI). Independent Predictor of MACE was Unstable Angina, Prior PCI, Prior CABG, stent diameter and post PCI plavix dose. Our study demonstrated second generation bare metal stent, is superior to the first generation one with a greater survival rate and lower incidence of MACE.

Background and Different studies have shown that caregivers of patients suffering from chronic physical or mental disorder endure a considerable burden. Authors decided to evaluate such burden on two groups of caregivers, (schizophrenic and ESRD patients), since few studies have been carried out regarding this subject in Iran. In an experimental, cross sectional, comparative, two-tier cohort study, 60 caregivers (30 of Schizophrenic and 30 of those suffering from End Stage Renal Disease), were selected as convenient groups. Demographic questionnaires and FBIS were completed for both groups and results were reviewed by SPSS software based on t test. Caregivers of Schizophrenic patients endured a heavier burden in comparison with those suffering from ESRD by a meaningful difference, (0.05%). The results achieved from subgroups also showed that caregivers of both groups bear almost similar economic burden. In subgroup of objective burden, the caregivers of schizophrenic patients endured more burdens in comparison with patients suffering from ESRD, with once again a meaningful difference. Moreover, in subgroup of subjective burden, the caregivers of Schizophrenic patients endured more burdens comparing to patients suffering from ESRD, however the difference was not meaningful. This study revealed that the caregivers of Schizophrenic patients experience more burdens, both objective and subjective, in comparison with patients suffering from ESRD.

Background and Cardiovascular (CVD) disease is the leading cause of death all over the world. Although, most CVD deaths occur from age 65 years and older, it should be noted that one third of deaths occur prematurely. Hypercholesterolemia, oxidized LDL and lipid per oxidation, play a significant role in the pathogenesis of atherosclerosis. It appears that some food additives may decline cardiovascular risk by lowering serum lipids or increase antioxidant activity. This study was designed to determine "the effect of soy protein consumption on serum lipid profiles and lipid per oxidation (serum malondialdehyde levels) in young female adults”. In the present trial, 73 university students were supplemented by 100 grams of soy nuts daily for 4 weeks. Weight, basal metabolic index “BMI”, lipid profile and malondialdehyde concentrations, were measured at the baseline and the end of week 4. Soy protein had no significant effect on weight, BMI, total cholesterol, HDL-cholesterol, LDL-cholesterol, total/HDL-cholesterol ratio and LDL-cholesterol/HDL-cholesterol ratio whereas triglyceride, malondialdehyde concentrations were decreased significantly (P<0.05). These findings indicate beneficial effects of soy protein on some of biochemical indexes of cardiovascular disease. Therefore, soy protein consumption is recommended to prevent cardiovascular diseases.

Background and Blood pressure (BP) is routinely evaluated intermittently during the clinical status for care and treatment. The most common method to measure BP is by using the sphygmomanometer with a stethoscope. This method may be difficult for medical students that will use BP for medical evaluation. The purpose of this study was to compare the accuracy of double stethoscope device for blood pressure monitoring, with standard ausculatory measurements using a mercury sphygmomanometer. In this distinguished report, 65 volunteer participants were studied. Means, standard deviations and Systolic, Diastolic pressure were calculated. The correlation between groups was determined with Pearson correlation. Mean difference in systolic, Diastolic Blood pressure between standard and routine method with double stethoscope method measurements, was not significant (P<0.001) and were in agreement with Pearson correlation between them. This study demonstrates that the double stethoscope device provides an accurate measure of blood pressure that is closely approximates with what is achieved by the indirect auscultator method, using a mercury sphygmomanometer.

Background and Many children younger than 1 year old (about 4/000/000) are dying annually around the world, that three quarters of this mortality is related to neonatal period (4 weeks after birth). Several factors such as environmental conditions, social and genetic factors are causes of decreasing neonatal mortality. The aim of this study was to determine the neonatal survival rate and its related causes in NICU of private and governmental hospitals in Sari. This survival analysis was a descriptive study of 500 neonates who were admitted into NICU of private and governmental hospitals (Booali Sina, Nimeyeh Shaban, Amir-Mazandarani, and ShafaHospitals) in Sari during 2005 to 2007. Data was gathered by using Self-making Informational Form (validity and availability was confirmed by content validity and α- kronbach). Information were obtained by interview with mothers, study of patient's chart, observation of the neonates, or phone interviews, after being discharged from the hospital. Statistical analysis of data was done by using Kaplan-Mayer survival analysis technique, and survival tables. Furthermore, risk factors were determined by logistic regression. Three-hundred twenty six neonates (65.2%) were the first rank of birth. Sixty-three mothers (12.6%) experienced previous neonatal mortality. 217 of mothers (43.4%) were illiterate and 85 (17%) had diplomas or higher education. 119 neonates (23.85) died within 28 days of life. There was a relationship between higher education level of mothers, polyhydraminous (over production of amniotic fluid according to sonography report), and delivery method, neonatal weight at birth, congenital anomalies, and neonatal survival rate. Eighty-seven expired neonates (73.1%) had birth weight lower than 2500gr, and 21 (16.8%) had gestational age lower than 36 weeks. The survival rate was higher among neonates within 21 and 22 days of life. The mortality rate among neonates with 2 to 3 days of life was higher than the other age group. We have not achieved adequate success in comparison with other developed countries in the improvement of neonatal survival rate during low gestational age. On the other hand, the physical and cognitive abilities of neonates were not evaluated in this study. We recommend further studies with more samples for assessment regarding survival rate of the neonates without disability.

Background and Tinnitus is a troublesome disease that may cause several problems, including the following: insomnia decreased concentration and diminished quality of life. This study was designed in order to evaluate depression and anxiety in patients with tinnitus. This study was an experimental survey and carried out with case – control method. There were 50 persons in case and control groups, case group included patients with non-organic tinnitus. The patients in case and control group completed Beck and Spiel Berger questionnaire, in order to evaluate their level of depression and anxiety. Age, sex, marital status and smoking of case and control groups were similar. Case groups included 50 patients in which 20 of those were smokers and their level of depression and anxiety were higher than non smokers and this difference was significant (P=0.03). Level of depression in patients with tinnitus was higher than control group (p=0.03), patients with tinnitus experienced more anxiety than control group. The patients with tinnitus suffered more depression and anxiety in comparison to patients without tinnitus.

Background and For the past years, tubes have been inserted into the stomach via the nose (nasogastric Tube: NGT) for the purpose of evacuating gas and liquid routinely, and for the prevention of nausea, and vomiting. However, there are no evidences regarding its efficacy. The aim of this study was to evaluate the post abdominal surgery complications either NGT inserted or not. In this clinical trial comparative study, 100 consecutive patients who underwent abdominal surgery (elective or urgency) were included in the study. They were divided in two groups: one was inserted NGT before anesthesia and remained until after initiation of bowel movement (control) and another without an incubated (case). Post surgery complications was similar in both groups (P>0.05): nausea (26% vs. 18%), vomiting (4% vs. 6%), fever (10% vs. 6%), bowel movement time (22.8 ± 10.84 vs. 21.84 ± 9.21), pulmonary complications (2% in both), wound infection (4% in both), duration of stay in hospital (2.58 ± 1.62 vs. 2.47 ± 1.6 days) in controls and cases respectively. Only sore throat was significantly more frequent in control group (74% vs. 16%). These results suggest that routine and prophylactic insertion of NGT is not necessary, cannot reduce complications and also leads to patient's discomfort. Therefore, it must be saved in some specific indications.

Manifestations involving the nervous system (neurobrucellosis), is a treatable infection, however it is not well documented. Direct invasion of the central nervous system occurs in fewer than 5% of cases. Acute or chronic meningitis is the most frequent nervous system complication. However, hemiplegia and cranial nerve involvement are rarely encountered. In this report we present a patient with “seventh cranial nerve palsy” and “hemiplegia,” as the manifestations of probable neurobrucellosis. Thus, in endemic area, brucellosis should be ruled out in patients who develop unexplained neurological symptoms such as hemiplegia.

This is a clinical trial regarding the comparative effect of two drugs in COPD patients. The drugs were Salbutamol and Ipratropoim bromide that are being used commonly in the treatment of COPD. Salbotamol is less expensive in Iran and more available than Ipratropim. We chose 16 patients which were referred to Pulmonary Clinic in ImamHospital, Sari. The Pulmonary function test was done for each patient prior and after administering 200 µg salbotamol and 36 µg Atrovent in 0.5 ml within a one and two hour period. Then, comparison was made regarding the results of FVC and FEV1, with paired T- test and SPSS. We found no difference between the effects of these two drugs.