Journal of Kermanshah University of Medical Sciences
Volume:11 Issue: 3, 2007

Different energy substrates and nutrients can greatly influence oocyte nuclear and cytoplasmic maturation. Effect of glucose on in-vitro oocyte maturation and subsequent early embryonic development is controversial. The objective of the present study was to verify the effect of various concentrations of glucose on cumulus-oocyte complexes maturation, fertilization and early embryonic development using a bovine model. Ovaries were collected from the local abattoir and brought into laboratory. Cumulus-oocyte complexes (n=1170) were aspirated from follicles, randomly divided into 4 groups (3 treatment/experimental & 1 control), and cultured in an organ culture dish containing 1 ml maturation medium, in treatment groups, chemically defined medium, supplemented with 1.0, 1.5 or 3.0 mg/ml D-glucose respectively, at 38.5 degrees on the Celsius scales in an atmosphere of 5% CO2 and 95% air with high humidity for 24 hours. Following maturation, 394 oocytes were fixed randomly for 24h, for maturation rates; and 776 oocytes were inseminated with frozen-thawed bull semen for fertilization rates and early embryonic development, 387 oocytes (presumptive zygotes) fixed randomly for fertilization rates, and 389 oocytes (presumptive zygotes) were cultured for development with similar medium to blastocyst stage (day 8). The samples were examined by streomicroscope and the results were analysed by X2 test. The oocytes maturation rates were higher (P<0.001) in the medium contained glucose compared to the control group (82%, 79% and 80% vs. 55% respectively). Although fertilization rates of oocytes were not different among groups, (57%, 54% and 50% vs. 49% respectively), the rates of blastocyst formation in the treatment group were significantly higher (p<0.01) than the control (30%, 33% and 32% vs.14%). These results confirm that the presence of glucose, in the maturation medium, is important for oocyte maturation and the subsequent embryonic development.

Patients with peripheral nerve injury make up five percent of referrals to medical centers owing to accidents. Since peripheral nerve injury can lead to functional defect, therefore, there are many factors that should be considered for obtaining the best result of managements, e.g. degree of nerve injury, age, kind of nerve injury and date of surgery being out of our control. It is more than likely the best result of management could be obtained through the best technique of surgery_ substitution of old techniques for the most modern one, Microsurgery. In this study, we have tried to report the result of management of 69 patients with peripheral nerve injury undergone microsurgery technique. In this survey, 69 patients with an average age of 2.5 to 59 have been studied within 7 years. The patients were suffering from 82 traumas leading to upper extremity peripheral nerve injury. All nerve injuries, have been repaired via "end to end coaptation microsurgery technique" in form of perineuronal, fasicular, group fasicular nerve repair, or mix of the three methods, using 9-0, 10-0 Nylon string for most patients.All the patients were followed up through physical history, physical exam like Semmes-Weinstein Monofilament, Two -Point Discrimination, Moberg pick-up test, and performing EMG and NCV tests 35 months after microsurgery. 83% of patients were male. About half, underwent operation less than one week after accident. Sensory and functional recoveries were evaluated by using a modified British scale. We considered sensory recovery “good” for grades S3+ and S4 observed in 56 injured nerves, and functional recovery “good” for grades M3 and M4 in 48 injured nerves. Having used microsurgery technique for peripheral nerve injury repair, only 20 percent of injured nerves had a complete sensory and functional recovery contributed to some variable factors such as delay to the repair of nerve, degree of nerve injury and age of patients.

Although isoniazid is the most efficient in killing the tuberculosis bacilli, resistance to this drug also develops most readily. Mutations in katG, inhA and ahpC are responsible for isoniazid resistance in a large proportion of tuberculosis cases. The frequency of these mutations varies with population samples, however. This study provided the first molecular characterization of Isoniazid-resistance in M. Tuberculosis strains that is widely applicable for rapid drug resistance detection. The study was a descriptive and analytical and the presence of mutations in specific regions of the katG, inhA and ahpC genes was analyzed in 32 M. tuberculosis Isoniazid-resistant strains in Isfahan and Tehran. To determine the mutations in codon 315 of katG, PCR-RFLP technique was performed. In this way, 355 bp PCR products were digested by MspI and MspA1I. Mutations in inhA and ahpC genes were detected by sequencing. The frequency of mutations in the katG 315(Ser→Thr), inhA and ahpC were detected in 71.9%, 18.9% and 6.2% of the 32 Isoniazid resistant isolates, respectively. Mutation was not found in one of the isolates. The PCR-RFLP with MspI, being able to detect katG Ser315Thr substitution, can identify more Isoniazid-resistant strains with mutations at codon 315 in the katG. Elucidation of the molecular basis of Isoniazid resistance in M. tuberculosis has led to the development of different genotypic approaches for the rapid detection of Isoniazid resistance in clinical isolates. The results also suggest that the detection of the Ser315Thr in the katG gene may be used as a rapid screening method for identifying Isoniazid-resistant clinical M.tuberculosis isolates recovered from Isfahan and Tehran tuberculosis centers.

Upper gastrointestinal bleeding is a medical emergency. Patients over 60 years constitute about 30%-40% of upper gastrointestinal bleeding. Traditionally, bleeding in elderly, compared to younger patients, has been accompanied by high mortality and need for more surgery. In recent years, new insights to management of gastrointestinal bleeding with use of proton pump inhibitors and I.C.U ward admission has been emerged. This study was conducted to evaluate the efficacy of these new strategies in the natural course of bleeding in patients over and under the age 60. The study was a descriptive and cross-sectional type conducted in 200 patients_100 consecutive patients aged over 60 and 100 others under 60_ admitted with a diagnosis of upper gastrointestinal bleeding at Taleghani and Imam hospitals affiliated of Kermanshah University between 1999-2000. Diagnostic endoscopy was performed about 72 hours after admission. Older patients with co-morbid diseases and those having high risk endoscopic stigmata of recent hemorrhage (active bleeding and visible vessel) were admitted in intensive care unit/ICU, proton pump inhibitor (Omeprazole) 40 mg twice daily was given to patients. Information collected included history of associated diseases, vital signs, laboratory data, endoscopic findings and length of hospitalization days, amount of blood required, number of surgery and mortality rates. Statistical analysis was carried out by SPSS software version 11.5, for qualitative variables x², and for quantitative variables student t-test (P value, equal or less than 0.05) was used and considered as significant. Mean age of patients over 60 was 70.48±0.66 and under 60 was 37/±1.27 (p=0.0008). 73% of patients over 60 and 80% of patients under 60 were male. History of taking NSAIDs was more among patients over 60 years of age (p=0.003), but they showed less dyspepsia (p=0.05). Cardiovascular (p=0.0008) and arthritis (p=0.05) were more among patients under 60 years of age. Endoscopy findings included more duodenal ulcers in younger patients (p=0.0096)) and gastric ulcers among older ones (p=0.009). Hospitalization in the two groups was not different with regard to mean duration of hospital stay: 3.8±0.19 days in patients over 60 vs 3.77±0.21 in patients under 60 (p=0.19), mean number of blood units transfused: 4.52±0.30 units in patients over 60 vs 4.49±0.36 units in patients under 60 (p=0.64), number of surgery (3 patients in each group) or mortality (2 patients in each group). According to this study, with application of modern therapeutic management in gastrointestinal bleeding in recent decade, the duration of hospital stay, in the old and young patients has became the same. We conclude that use of proton pump inhibitors and I.C.U admission for elderly patients or those with high risk endoscopic stigmata of recent hemorrhage to be done routinely in medical centers.

Trauma is one of the major causes of morbidity and mortality in different countries. Road accidents are the main causes of death due to trauma. The injury resulted from traffic accident is one of the neglected problems of public health whose follow-up is necessary. The purpose of this survey is to study the epidemiology of injuries and their causes in traumatic patients admitted in Poursina hospital in Rasht. This study was conducted by Guilan Trauma Research Center in the second half of the year 2005. Methods and Materials: This is a cross sectional study carried out on 1141 traumatic patients between September 2005 and March 2006. Data collected prospectively using a form including demographic data, mechanism of trauma, location of accident, way of transportation, part of the body injured, (based on AIS) and severity of the head injury based on GCS. In 1141 patients with trauma, the ratio of male to female was 3.6/1. The mean age of male and female was 31.3±17.25 and 36.69±19.31, respectively. About 50% of patients were 20-44 years old. The most common causes of injuries were traffic accidents (74.4%) and then falling (14.98%). 47% of the traffic casualties were motorcyclist. Head and neck were the most injured part of body (80.8%), then limb and pelvis (25.41%). About 11% of patients suffered from severe head injury. Most of the injuries occurred in Rasht. Only 3% of patients were transported by emergency ambulance. Finally, 59 patients died. To improve the quality of care in traumatic patients, we suggest public training program promotion, improving the situation of diagnostic and therapeutic procedures along with improvement in hospital transport system.

With regard to the mediastinum importance as a central region of thorax and its physiologic traffic of vital structures,the knowledge of mediastinal masses is necessary. This survey was conducted to determine the prevalence of different kinds of mediastinal tumors in patients who underwent surgical procedures at Taleghani hospital between 2002 and 2006. Methods & Materials: This is a descriptive sectional study that was done on the patients files and we used an information form containing variable factors such as kind of mass, place of mass, age, sex, metastasis, clinical signs. After gathering of information, data was analyzed by statistical soft ware. Among 318 nontraumatic thoracotomies performed in this period, 89 cases were mediastinal masses and most frequent masses were thymic (25.8%) and lymphoma (15.7%). Anterior mediastinum was the most common site affected 66.9% of patients. The average age was 28.2 years and 42% of patients were female. The most significant clinical signs were: Weight loss (60.5%), cough (42%), dyspnea (42 %), and chest pain (39.5 %). Metastasis occurred in 33.3% of patients and the most frequent sites were lung and pleural. The frequency of myasthenia gravis in thymoma was 73.7%. Patients with myasthenia gravies with normal thymus and thymectomy were excluded from the study. There was little difference between our statistical results and other studies (mass types frequencies and mediastinal compartments most involved by each type of this masses). The only exception was the high prevalence of tuberculosis lymphadenopathy in our study. Knowing of common location of mediastinal masses prevents unnecessary aggressive surgical procedures because masses like tuberculosis lymphadenopathy and lymphoma only needs tissue diagnosis and the definite treatments for such diseases are antibiotic and chemoradiation respectively.

Cryptorchidism is one of the most common congenital anomalies at birth. Cryptorchidism is an abnormally positioned testis. The undescended testis can be located anywhere between the abdominal cavity and just outside the anatomical scrotum. This study was conducted to determine some etiologic factors in cryptorchidism. In an analytical cross-sectional study, we examined 1100 male alive neonates born in the Neonatal Ward of Fatima Hospital in Hamadan. Gestational age and weight, positive family history, maternal pre-eclampsia, laterality, bilaterality and other genital organ abnormalities were recorded by physical examination and interview with mothers and then statistical analysis were done. Prevalence of cryptorchidism at birth was 3.82% (1.9% in full-term birth and 14.5% in preterm birth). In 75% of cases, cryptorchidism was unilateral (63% right side, 37% left side), and 25% was bilateral. Association of cryptorchidism with hypospadiasis was 28.6%, with Hydrocele 14.3% and with Chordee 7.7%. Prevalence of cryptorchidism at neonates with low birth weight (<2500gr) was 14% and in neonates with normal birth weight (>=2500gr) was 2.1%. Maternal occupational exposure and maternal history of pre-eclampsia were two main high-risk factors associated with cryptorchidism. Prevalence of cryptorchidism at neonates with maternal history of pre-eclampsia was 22.4%. Prevalence of cryptorchidism at birth was 3.82%. Preterm birth, low birth weight, maternal pre-eclampsia and maternal occupational exposures were the important risk factors for cryptorchidism.

To determine the prevalence of placental abruption, due to its maternal & fetal known adverse outcomes, the present survey was carried out on pregnant women referred to the obstetric center of Kermanshah University of Medical Science (Motazedi hospital) in 2001_2002. This study was a descriptive one, having surveyed all the inpatient pregnant women with a definite diagnosis of placental abruption. The instruments for gathering data was a checklist containing 32 items about demographic (Age, Job, Education) and gestational (the Age of Pregnancy, Pariety, PROM and Gestational Hypertension) characteristics. In this study, placental abruption was observed in 300 cases out of 14433 with the prevalence of 2.08%. This study shows a significant prevalence of placental abruption in the first and second delivery. 44% of deliveries were preterm and the age of pregnancy was under 37 weeks and 51% of them involved in still birth /dead fetus. According to the findings of the research, the frequency of placental abruption was more than those of the other research, perhaps it is due to the difference in the frequency of the predisposing factors of this problem among other societies. For later studies, it is highly recommended to consider the predisposing factors for placental abruption.

conditions, such as condom interruption and its role in prevention of unwanted pregnancy, recognition of Knowledge, Attitude and Practice of different social groups in each region about emergency contraception is necessary. The purpose of this study was to determine the Knowledge, Attitude and Practice of women referred to health centers of Shahrekord. In this descriptive and analytical study, we used a customized questionnaire for data collection, including two parts “individual information" and "specialized questions". Sampling was carried out as sectional, based on the people covered by the health care centers. 400 women who referred to health care centers using condoms, coitus interruptus and rhytmic methods for contraception, were selected. For analysis of data, we used SPSS software, t test, pearson correlation test, and P<0.05 was considered significant. The Mean age was 30.12±6.24 years. The majority of women were educated and the mean marriage age was 21.37± 3.89 years. The Mean of knowledge score about emergency contraception was 3.95±2.68 out of 8. In these conditions 22.5 % of women had inadequate knowledge, 55.5 % had moderate and 22 % had adequate knowledge. The attitude of women about emergency contraception was positive and their practice was inadequate. There was a significant correlation between age and job and the score of their knowledge (P<0.001). A significant correlation was considered between the level of education and the score of their knowledge (P<0.01). The women with adequate knowledge, had better practice than those who had not the adequate knowledge (P<0.001). With regard to the inadequacy of the knowledge and the practice of the women and their positive attitudes towards emergency contraception, we suggest the health care providers to educate the women about contraception, especially emergency contraception to increase the knowledge and the improvement of practice

Antitubercular drugs can induce hepatic toxicity and it has still remained as a problem in treatment of tuberculosis (TB). In this study, we defined the prevalence of antitubercular drug induced hepatitis in the patients hospitalized for TB in Kermanshah Sina hospital during the period 1994 to 2004, and also a number of probable risk factors for drug hepatitis in these cases. In this cross-sectional study, 723 patients admitted for active tuberculosis infection or drug-induced hepatitis from a data chart was retrospectively studied. Statistical tests for analyzing the results were "chi-square" and "fischer exact test" for qualitative variables, "Z test" for comparing proportion of drug hepatitis in the age groups and "T,F tests" for comparing the mean and variance of patients with or without drug hepatitis, respectively. The level of significance was considered as 0.05. 37 patients out of 723 admitted for TB developed drug hepatitis (5.1%) that was not significantly related to sex, type of TB (pulmonary/extra pulmonary) and HBV, HCV, HIV infection. Drug hepatitis developed in a mean of 12.4±3.3 days after beginning of antitubercular drugs. The mean age of patients developed drug hepatitis was higher than the patients without drug hepatitis (P=0.025). In the age group over 64 years old, drug hepatitis was significantly higher than the other patients (P=0.020). It is recommended that in patients with tuberculosis, clinical and laboratory follow-up for drug hepatitis, especially in the early course of treatment and in the old patients, to be considered.

In the 6-billion-population world 2000, approximately 10 million cancers were diagnosed, among which there were an estimated 6.2 million cancer deaths. Whereas the universality of cancer incidence and mortality is established, the burden of cancer by type or organ site is distributed unequally between developing and industrialized nations. We want to collect some information from the patients with solid tumors who were referred to Kermanshah hospitals during the period 2000 to 2004. This descriptive and cross-sectional study was performed on 734 patients with solid tumors who were referred to Kermanshah hospitals during 2000 up to spring of 2004. We gathered data via census method and analyzed them by chi-square, fisher exact in SPSS version 13. Patients with cancers aged 57.37±16.45 years that 61% were males. The most common locations of tumors in patients were: Gastrointestinal (n=206; 29%); Genito-urinary (n=200; 28%); skin (n=77; 10%); breast (n=72; 10%); head & neck (n=69; 9%); cardiopulmonary (n=60; 8%); hematopoietic system (n=24; 3%); musculoskeletal (n=16; 2%) and CNS (n=10; 1%). The most common pathologic type of tumors was: epithelial tumors (n=626; 85%); mesenchymal (n=55; 8%); melanocytic tumors (n=20; 3%); mixed (n=18; 2%), and teratocarcinoma (n=15; 2%). 31% of epithelial tumors involved genito-urinary tract and less than 2% involved hematopoietic system. The mean age of patients with epithelial tumors was 58.7±15.3 years. Suitable information of different types of cancers in particular geographic areas can help define medical programs for treatment and screening of high-risk groups.