مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال پانزدهم شماره 1 (پیاپی 58، بهار 1386)

Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two formslow turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors.

This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c) were drawn to measure levels of PTH(parathyroid hormone) ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism.

In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients). 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings.

We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.

Certain painful, invasive procedures are necessary for care, and are commonly performed in both healthly and sick neonates. Current evidence shows that the newborn infant has both physiologic and anatomic capacity to experience pain. Recent research suggests that pain experienced in the neonatal period might have long-term effects later in life. Previous research has shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. This effect is considered to be mediated both by the release of endorphins and by a preabsorptive mechanism related to the sweet taste.

This study was a controlled , randomized and double – blind study on 210 neonates. These newborns were randomly divided into 3 groups A, B and C. Group A received 2 ml of 25% sucrose orally as well as base cream was applied at the site for heel stick, group B received 2 ml of distilled water and application of EMLA cream, while group C received 2 ml of distilled water and base cream. The heart rates of the newborn were recorded by the cardiac monitor before and after heel stick blood sampling and the duration of crying was determined as well. Pain was scored by DAN scale.There were no differences in demographic characteristics of all neonates.

The results showed that the DAN scale was significantly lower in the sucrose group (mean : 3.840) as compared to the EMLA group (mean: 3.366) and the placebo group(5.557), but the difference in the duration of crying was not significantly different in the sucrose group (mean: 10.5 second) and the EMLA group(mean 8.76).

Both sucrose and EMLA are effective in reducing stress associated with heel lancet in newborns, but as sucrose acts faster and is healthier, its usage is proposed in neonates requiring heel sticks for blood sampling.

Omperazole as a very useful drug in peptic ulcer which needs to be converted to active form and its activation requires acidic enviornments. H2 blockers and antacids can prevent this activation by elevation of pH in the gastrointestinal system thus diminishing omperazole effectiveness. In this study, cases of coadministration of omperazsole with H2 blockers and antiacids has been evaluated.

This descriptive study included 1200 prescriptions containing omperazole alone or in combination with other drugs at the Chamran Pharmaceutical Store of Yazd.

In 599 cases, omeprazole was administered with other drugs of which 211 cases (35.3%) was with H2 blockers and116 prescriptions with antiacids. Only in 55 cases (4.6%), both antiacids and H2 blockers were administered in combination with omperazole.

On the basis of previous studies and considering the physiology of acid secretion in parietal cells and pharmacological mechanism of drugs used in the treatment of peptic ulcer, coadministration of antacids and H2 blockers with omperazole decrease its efficacy and must therefore be avoided.

The Clinical and Paraclinical Characteristics of patients with congestive heart failure (CHF) have been described by a number of previous studies, but very little information is available on this issue in Iran. This study aimed to delineate the clinical and paraclinical characteristics of Iranian patients hospitalized with CHF.

During an observational, analytical, descriptive, cross-sectional study, 258 consecutive patients were interviewed and examined at 5 hospitals in Yazd, Iran from January to December 1999.Questionnaire comprised of information regarding etiology, signs, symptoms, paraclinical data, etc. Results were analyzed by SPSS9.01 and EPI6 programs using ANOVA, Chi-Square and T-TEST and reported as Mean ± SD.

The study population had a high mean age (67.59 ± 0.73), 0.8% were less than 35 years old and 70.80% were older than 65 years. Mortality rate due to heart failure was 7.5%. Major causes of CHF were ischemia (65.1%), valvular lesions (5.8%), cardiomyopathy (5%) and hypertensive heart diseases (4.6%). Mean number of hospitalizations per year was 2.2 ± 0.1, while mean hospitalization time was 7.25 ± 3.8 days and mean cost was 1122439 ± 89874.8 rials.

Even though many background and aggravating factors of heart failure are preventable, this disease incurs a lot of expenditure on our country’s health system. Therefore, there is a requirement for programming and research in the fields of education, treatment and prevention of this disease for all members of the community.

The assessment of intravascular volume in severely traumatized patients or patients admitted in ICU is very essential. At present the accurate method for estimating the intravascular volume requirement is by measuring the CVP which is an invasive method. The measurement of IVC diameter by ultrasound has been suggested as an easily available and simple method for measuring the intravascular volume status. The purpose of this study was to compare the results of IVC diameter measurement by ultrasonography and CVP measurement for calculating the intravascular volume in ICU admitted patients.

This was a descriptive and prospective study including 50 patients admitted in ICU with a central venous catheter placed for any reason whatsoever and no signs of increased right atrial pressure. CVP was measured in supine position by CVP manometer. The anterior- posterior IVC diameter was assessed by ultrasonography during inspiration and expiration. Data analysis was performed by SPSS and evaluated statistically with Pearsons regression and linear correlation test.

The mean CVP at inspiration and during expiration was 11.35+ 5.53, 12.20 + 5.65 cmH2O, respectively. The mean of inspiratory and expiratory IVC diameter was 7.71 + 3.5 , 11.37 + 3.28 mm, respectively. There was significant correlation between CVP and IVC diameter both during inspiration (r= 0.64 , p-value= 0.001) and expiration (r=0.495 , p-value=0.001)

The result of this study suggests that IVC diameter measurement by ultrasound can be used as a reliable and non- invasive method for estimating the intravascular volume.

Despite advances in disease prevention and food materials technology, food – borne diseases are still a major problem in both developed and developing countries. Morever, meat plays a key role in transfer of bacteria, especially “Zoonotic” to humans. Therefore, we decided to investigate the outbreak of pathogenic bacteria such as Salmonella,Campylobacter, Yersinia and Aeromonas in red meat and chicken offered as packed and unpacked in areas under the authority of Tehran university of medical sciences .

630 samples including 315 raw chicken meat and 315 raw red meat samples were collected and tested for a period of one year from July, 2004 to August,2005. Samples were collected from shops selling packed meat and chicken as well as shops selling unpacked meat and chicken in different parts of the south of Tehran The methods used for the laboratory investigation were based on Iranian National Standard Procedure No. 2394.

Of the 630 samples of chicken and meat, 183 samples (29 %) were contaminated. 49.2 percent of the contaminated samples were chicken meat and 8.9 percent were red meat. From the total, 71 samples were contaminated with salmonella (11.3 %), 68 samples with Campylobacter (10.8 %), 26 samples with Yersinia entrocolitica (4.1 %) and 18 samples with Aeromonas (2.9 %). In red meat samples, microbial contamination was observed in 4.9 % of packed and 10.3 percent of unpacked samples. Contamination rate of chicken samples was higher including 59.3 % of packed and 45.7 % of unpacked chicken samples. The observed difference between the remitting samples of packed and unpacked chicken was statistically significant. (P< 0.05)

Our results indicated that although the centers selling packed and unpacked red meat from south of Teheran showed different microbial contamination rate, the differences were statistically insignificant. (P> 0.05)

Communicational patterns of the parents can either positively or negatively influence children's personality. Parenting manner has long-term effects on behavior, function, expectations and eventually people's future personality. This study investigates parental interaction patterns in children with attention deficit- hyperactive disorder.

In this study, 50 male children aged 7-12 years were selected in two groups including 1) 25 students with ADHD referring to psychiatry clinics in Isfahan according to the diagnostic scale of DSM- IV and 2) 25 healthy boys selected by random cluster multistage sampling from primary schools in five districts of Isfahan from Septamber 2005 until March 2005. Schaffer and Edgerton parental interaction questionnaire was filled for them.

In "Communication" interaction pattern, the mean score of healthy children was 15.08, while the mean score of ADHD children was 13.42. In "admission" interactional pattern the mean of the first group was 14.76, while the second group was 11.76. In "control" interactional pattern, mean of group one was 13.28 and the second group was 11.76. In "aggression control" interactional pattern, the mean of group one was 13 and the second group was 14.68. In "lack of aggressive attachment" interactional pattern, mean of the first group was 13.36 and the second group was 16.67. The mean scores of parental interactional pattern in healthy children were all higher than ADHD children except for "aggression control" and "lack of aggressive attachment" interactional patterns.

The more the parental "admission" interactional pattern score, the lower the signs of ADHD in children. The signs of severity are lower in cases with more positive parental "control" interactional patterns. If the scores of "lack of aggressive/ attachment" and "aggressive/ control" interactional patterns are higher, ADHD signs are more severe.

Zinc deficiency causes abnormalities in immune response. In chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, impaired immune responses to vaccination have been reported. Therefore, we performed a study to determine the correlation between serum zinc levels and immune response to hepatitis B vaccination in patients on dialysis.

A cross-sectional study including 95 CRF patients on dialysis (70 HD and 25 CAPD), (63 male and 32 female) with three dose regimens of vaccination against HBV was performed.

Four months after vaccination, there were 34 (36%) patients with sufficient HBs Antibody response (HBs Ab≥ 10 mU/mL ) and 61 ( 64% ) patients with insufficient HBs antibody response( HBs Ab< 10mU/mL ). The mean serum zinc level was 23.35±3.87 micmol/L (13.20-33 micmol/L). The mean serum zinc concentration was significantly higher in patients with sufficient HBs antibody level than patients with insufficient HBs antibody levels ( 24.94±4.17 versus 22.15±3.46, P= 0.005 ). In logistic regression analysis, independent variables that correlated with sufficient HBs Ab level ≥ 10 mU/mL included higher mean serum zinc level [OR=1.44 (1.02-2.02), P=0.006 ] and female gender [OR=1.8 (1.01-4.01), P=0.048] . Factors found to be insignificant included type of dialysis, age, diabetes mellitus as a cause of ESRD, serum creatinine and albumin levels.

We conclude that failure to respond to HBV vaccination is significantly related to a low levels of serum zinc. However, clinical trial studies should be performed in order to confirm this finding.

Multiple sclerosis (MS) is a chronic autoimmune disease with unknown etiology affecting the central nervous system. The prevalence of MS is highest where environmental supplies of vitamin D are lowest. Some studies have shown a strong protective effect of vitamin D3 in experimental autoimmune encephalomyelitis (EAE) a model of MS. However, it is not known whether vitamin D3 has a protective effect in EAE. Vitamin D3 may be inhibit EAE by having an effect on TH1 and TH2 immune responses. To address this question, the effect of vitamin D3 on cellular immune responses in C57BL/6 mice with experimental autoimmune encephalomyelitis was investigated.

Male C57BL/6 mice matched in age and weight were placed in two therapeutic groups (n=10 per group) as follows: Vitamin D3-treated EAE mice (5μg/kg/every two days of vitamin D3 given i.p from day -3 until day +19 after disease induction). Non-treated EAE mice (EAE control) received vehicle alone with same schedule. 20 days after immunization, the mononuclear cells (MNCs) of the spleen were isolated from mice and cultured in the presence and absence of MOG35-55 for 96 hours. The supernatant of cultured cells was collected and produced cytokines (IL-10 and IFN-γ) were assayed by ELISA.

The results showed that vitamin D3-treated mice had less severe clinical signs and synptoms of EAE (3.2±0.8) than non-treated EAE induced mice (5.3±0.44), (p=0.001). Also, there was a significant difference regarding the day of onset of disease in the vitamin D3-treated and non treated EAE-induced mice (day 15±1 and day 11±1, respectively). There was no significant difference in IFN-γ production between treated and non-treated mice, but the amount of IL-10 production in the D3-treated mice was higher than the non-treated group (p=0.001).

Considering the role of TH1 in the pathogenesis of EAE and MS, it is suggested that vitamin D3 can reduce or delay the onset of EAE by shifting immune responses to TH2 and IL-10 production. Thus, vitamin D3 as an immune modulatory agent is potentially important for treatment of MS

Vaginits is probably the most common infection in women during their reproductive years, resulting in 5-10 million health-care visits a year, worldwide. Vulvovaginal candidiasis (vvc) is the second-most common form of vaginitis in the United States, which is associated with use of oral contraceptives containing high levels of estrogen and hormonal therapies. Midwives play an important role not only in the assessment and management of vaginal infections, but also in educating women about vaginal health. Recognizing risk factors associated with infections are the key to vaginal health.The aim of this study was to determine the prevalence and risk factors of Candidal vaginitis in women referring to Tabriz health centers.

This was a cross sectional study carried out on 1000 women aged 15-49 years who were selected by multiple random method. A sample of vaginal discharge was taken from the posterior fornix of the cervix and from the vaginal wall using sterile cotton swabs. The mycelium was observed by microscopic examination of a wet mount of the secretions. Another sample was taken for culturing in Agar sabura and transported to the laboratory. In addition, questionnaires with personal and reproductive information were completed. Data was analyzed by using SPSS version 15 and chi-square and, t student statistical tests were used for analysis.

This investigation indicated that prevalence of candidiasis was 25.2%. There was no meaningful statistical relationship between age, marriage age, occupation, education status, body mass index, day of menstruation cycle and abortion history with candidal vaginitis (p>.05),but a statistically significant relationship was observed between number of deliveries, vaginal Ph with candidiasis. Also, there was a reverse statistical relationship between OCP, DMPA methods and candidiasis.

Midwives and other health professionals have an important role to play by giving more information to women about infections and associated risk factors, thus improving their quality of life.

Superovulation produces complications in some patients, so invitro maturation of oocytes is used to decrease or eliminate these complications and improve IVF. Moreover, IVM is used for different aspects of reproductive researches. Slaughterhouse ovaries are the main source of oocytes for IVM and IVF studies. Different media has been introduced and experimented for in vitro maturation of oocytes. Animal's serum at estrus stage contains different hormones and proteins which are essential for oocyte maturation. The aim of this study was to compare three culture media for in vitro maturation (IVM) of bovine oocytes 1)(control)TCM-199, 2)HCG and follicular fluid (FF) and 3) antibiotic.

Rat estrus serum (RSS) or fetal bovine serum (FBS) was added to control medium. Total of 1789 compact cumulus oocyte complexes (COCs) were aspirated from ovaries of slaughtered animals. Oocytes were randomly cultured in mentioned media and incubated in 38.5◦c, 5% CO2 and 95% humidity for 24 hours. The maturation of oocytes was judged according to cumulus cell expansion or randomly orcein stained oocytes and observation of polar bodies.

The results showed that maturation rate was significantly higher in second and third group (90.2%, 78.7%) as compared to the control group (p<0.001). There was no significant difference between second and third groups (90.2 % vs. 86.6%).

RSS is as effective as FBS for IVM of bovine oocytes and can be used as an alternative.

In recent years with introduction of better screening tests, the risk of infection with transfusion-transmitted viruses has been reduced remarkably, although obtaining a zero-risk blood supply still remains international blood transfusion services goal. The routine test for detection of HBV infected blood samples is examination of HBsAg with ELISA method but in occult HBV infection, HBsAg is not detectable by ELISA. Therefore, a more sensitive or complementary test is needed. Some international blood transfusion services have introduced anti-HBc screening as a surrogate test for the presence of HBV infection. The aim of this study was to evaluate the prevalence of occult HBV infection in Isfahanian blood donors and the potential value of anti-HBc testing of donors as a screening test to detect occult HBV infection.

In this descriptive cross-sectional study, 545 blood units were collected (from Isfahan blood center) and tested by HBsAg ELISA kit from April to June 2004 and then all HBsAg negative samples were tested by anti-HBc ELISA kit. To detect occult HBV infection, all HBsAg negative and anti-HBc positive samples were tested by PCR method.

All samples were negative for HBsAg while 43 blood units were anti-HBc positive (8%). These HBsAg negative and anti-HBc positive blood units were tested for HBV DNA of which five units (%11.6) were HBV DNA positive.

Occult HBV infection is a clinical form of HBV infection that cannot be detected by usual method (ELISA) for HBsAg and therefore more sensitive techniques are needed for detection of HBV infection. PCR is a sensitive technique that detects HBV DNA even in a trace mounts. Our results identified that more sensitive and complementary tests such as, PCR and anti-HBc, are essential and helpful to ensure safety of blood units.

Recent molecular studies on Iranian β-thalassemia genes revealed the presence of eight common mutations associated with thalassemia. Although these mutations are frequent, there are other rare and unknown mutations that can create large problems in designing preventive programs. We detected and explained the common mutations in north-western Iran previously and detection of the rare and unknown mutations could be useful in diagnosis and design of future preventive programs.

In this study, 5ml peripheral blood from 20 Azari- β-thalassemia patients whose mutation was not revealed in the previous study was collected and DNA extraction was done by isopropanol and proteinase k method. Initially, samples were examined for the rare mutations: Codon6, Codon16, Codon41/42, Codon36/37, -88 and Codon22 by ARMS – PCR techniques and then the unknown cases were directly sequenced.

According to our results, Codon15(TGG-TGA), Codon16(-C), Codon36/37(-T), IVSII-848(C-A), IVSII-745(C-G), -28(A-C( and Codon25/26(+T) were recognized and added to the spectrom of beta globin gene mutations in Azerbaijan and Iran. Also, we detected four SNP sites: 5’UTR+20(C-T), Codon2 (CAC-CAT) , IVSII-16(C-G) and IVSII-666(T-C) in β-thalassemia genes.

Our results could be useful for developing molecular screening plans and help prenatal diagnosis of beta thalassemia in Azerbaijan , Iran and other neighboring countries.

HTLV-1 , the first known human retrovirus belongs to oncovirus subfamily of retroviruses. The major characteristic of HTLV-1 is its highly restricted geographic prevalence. Northern part of Khorasan is an endemic region of HTLV-1 infection. Epidemiological studies can help in designing preventive programs for HTLV-1 infection. The aim of this study was the establishment of a PCR technique for determination of HTLV-1 infection in paraffin-embedded tissues.

In this experimental laboratory study for establishment of a technique, PCR was initially optimized using Beta-actin primers on various formalin fixed paraffin-embedded tissues from liver, spleen, skin and lymph nodes. The optimized concentration of Mgcl2 was 2mm, primer was 8 pmol. Optimized concentration of DNA was different according to the kind of tissue. HTLV-1 infection was determined by applying tax, pol, env and LTR primers on 50 paraffin-embedded lymph node tissues . The reporoducibility of this technique was shown for skin and lymph node tissues infected with HTLV-1. Resuls: In 50 lymph node tissues, one case with pathologic diagnosis of NHL was positive with all 5 sets of primers (tax, Pol, env and LTR primers) and the other case was positive with only two sets of tax primers but was negative with pol, env and LTR primers. The prevalence of infection was 2% among lymph node specimens. (1 of 50 specimens ) and if the second case is considered, the prevalence would be 4%.

Comparison of the results of this study with another study on blood specimens (seroprevalence2.3%) was not statistically significant thus confirming the results of one another. (P=0.883)

Toluene is an organic solvent that it is one of the byproducts in the coke industry. Exposure to toluene causes central nervous system dysfunction and others disorders. Many workers are exposed to toluene due to leakage from tracks. Therefore the aim of this study was to determine the levels of exposure through environmental and biological monitoring of toluene

Air toluene sampling of air inhaled by 36 coke oven workers was done by using activated charcoal tubes and personal sampling pumps. At the end of the shift, urine samples of workers and control group were collected by urine samplers. Air toluene was determined by GC, urinary hippuric acid by HPLC and urine creatinine level was determined by auto analyzer.

The mean of air toluene and urinary hippuric acid levels in exposed and control samples were 14.34 ppm, 0.33 and 0.28 g/g creatinine. Air toluene and urinary hippuric acid showed a correlation of r = 0.8.

Toluene TWA was lower than the TLV-TWA (p=0.000). Urinary hippuric acid concentration was also lower than the BEI (p=0.008). Difference between exposed and unexposed group was not significant. This study showed that hippuric acid because of its interaction with background factors can not be used as a sensitive biomarker for biomonitoring.

Thymoma is the most common neoplasm of anterior mediastinum with incidence peaks during the fourth, fifth and sixth decades of life. Two-thirds of patients are asymptomatic and identified accidentally by chest x-rays . Of the total, 40-70 % of patients have one or more parathymic syndromes of which Myasthenia Gravis (MG) is the most common and reported in 10-50% . Gullain-Barre Syndrome (GBS) has not been reporterd as a parathymic presentation in present literature. We report a 37 years old woman who presented with GBS after thymoma resection. There is one question: Is there any association between thymoma and GBS or is it a complication of surgery (thymectomy)?