مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال شانزدهم شماره 1 (پیاپی 62، بهار 1387)

HCL is a rare malignant condition that is curable if diagnosed early. HCL can present with reduced blood cells and splenomegaly which maybe misdiagnosed with other conditions. The aim of the present study was to determine the frequency of early clinical and laboratory findings as well as the response rate of patients to the standard treatment regimen of Cladribine.

The study was an uncontrolled clinical trial including 25 HCL patients referring to Oncology Clinics of Shahid Sadoughi (Yazd - Iran) and Shahid Beheshti (Tehran - Iran) between 1999 and 2005. Data was gathered by a pre–designed questionnaire. 21 out of 25 patients were treated with Cladribine and the clinical and laboratory response was assessed.

Of the 25 patients studied, 20 patients (80%) were male and 5 patients (20%) were female. Most of the patients at diagnosis were 55–67 years old and the most common presenting symptom was fatigue and lassitude secondary to anemia. Two patients were asymptomatic and were diagnosed incidentally. Splenomegaly was the main clinical finding which was present in about 80% of the males and all of the females. Accordingly, hairy cells in the peripheral blood smear, leukopenia and anemia were the most common laboratory findings. In contrast to previous results, pancytopenia was found in only 60% of the patients. Response rate was 90% (19 out of 21) of which 61.9% (13 patients) and 28.5% (6 patients) had complete remission (CR) and partial remission (PR), respectively.

According to the results, it can be concluded that HCL should be considered as a possible diagnosis in the context of fatigue, splenomegaly and reduced blood cell count. The results of the present study were similar to other similar international studies.

Occupational exposure to excessive noise is commonly encountered in a large number of industries in Iran. This study evaluated the hearing threshold and hearing loss in Meybod tile factory workers.

This cross-sectional study included 371 tile factoryworkers during summer and autumn of 2005. Current noise exposure was estimated using sound level meter .A specially formatted questionnaire was used. Totoscophc examination and conductive air audiometery were used to assess the hearing loss in each subject .Finally data was analyzed using SPSS version 11.5.

Occupational noise increased mean of hearing threshold at all frequencies which was significant at 3, 4 KHz in both ears (p<0.05).Prevalence of hearing impairment at high and low frequencies were 39.2% and 46.5%.Prevalence of occupational NIHL was 12.9% and the odds of NIHL significantly increased with noise exposure of more than 10 years. The hearing threshold was worse in both ears of workers with tinnitus.

High prevalence of hearing loss and NIHL emphasizes on the necessity of hearing conservational programs in tile factory workers.

Iron deficiency anemia (IDA) is the most common form of anemia and one of the most important health problems. Iron supplementation for high risk groups can prevent IDA and its complications in the community. We need to have a holistic approach to control IDA with minimum cost and complications. Considering the high prevalence rate of IDA in Iran, assessment of the effects of micronutrients in the treatment of IDA is essential. The current study was designed to study the complete iron therapy program in Iran and evaluate the effect of simultaneous administration of vitamin A and C on hemoglobin (Hb) levels.

A triple blind randomized clinical trial was conducted in secondary schools for girls in Shahinshahr city of Iran. 120 students were selected after initial screening for clinical presentation of anemia. They were assigned to three groups. All the cases were administered 50mg elemental iron, 0.5mg folic acid and 11mg elemental zinc. However, group A received placebo, group B received 250mg vitamin C and placebo of vitamin A and group C received 250mg vitamin C and 100000 IU vitamin A. The hemoglobin levels were measured on day one and eight weeks later. Data was analyzed using software SPSS version 11.5 and statistical test used was one way ANOVA test.

There were statistical significant differences between the final Hemoglobin levels of the three groups (P<0.001). Hb increase in group C was significantly higher as compared to the control group (P<0.012). There was a difference between the Hb levels of group B and C, but this difference was not significant.

The findings showed that simultaneous supplementation of iron, folic acid and zinc with vitamin A and C is very effective for increasing hemoglobin levels. Further investigations are needed to confirm this hypothesis for treatment of IDA.

Cholestasis is impairment of normal bile excretion into the duodenum and classified as mechanical and non mechanical cholestasis. Mechanical Cholestasis presents with increase in bile duct diameter or obstruction in bile duct in an ERCP. Cholestasis leads to different complications. One of these complications is mucosal peptic erosion leading to gastrointestinal bleeding, perforation and even obstruction due to stricture. We therefore carried out this study to assess the relative frequency of peptic ulcer and erosion in patients with different type of cholestasis.

In a case control study, 170 patients with mechanical cholestasis on the basis of physical examination, liver function tests, radiologic and serologic assay were candidates for ERCP as final therapeutic and diagnostic test. Collected data was registered in questionnaire and evaluated by the Fisher Test. Later, sonography (common bile duct diameter) in the two groups: mechanical (85 patients) and non mechanical (85 patients) and endoscopy was done for exact survey and location of mucosal erosions.

Frequency of mucosal peptic erosions in mechanical cholestatic groups was42.6% ( 36 patients ) and significantly more than frequency of mucosal peptic erosion in non mechanical cholestatic groups (15 patients, 17.6%) (P=0.02). 51 patients (30%) of the total patients with cholestasis had mucosal erosion. From these patients, 25 patients had peptic ulcer [frequency of duodenal ulcer was 17 patients (68%) and gastric ulcer was 8 patients (32%) ](P=0.01). There was significant difference in prevalence of duodenal ulcer in patients with mechanical (12 cases, 70.6%) and non mechanical (5 cases, 29.4%) cholestasis(P=0.01). There was a significant difference between prevalence of duodenal ulcer (12 cases, 70.6%) and gastric ulcer(5 cases, 29.4%) in patients with mechanical cholestasis (P=0.01) but this was not so in patients with non mechanical cholestasis.

According to present study, prevalence of duodenal and gastric mucosal lesions in different types of cholestasis is greater than the general population and prevalence of duodenal mucosal lesions in mechanical cholestasis is more than non mechanical Cholestasis.

Aim of the study was to determine the efficacy of minor lateral tarsorrhaphy in conjunction with levator muscle recession in thyroid ophthalmopathic patients with severe lid retraction in order to correct the temporal flare in these patients

In a before-after clinical trial study, 22 eyelids of 12 patients with severe lid retraction underwent surgery by this method and the lid height in a 6 months follow up was evaluated. Lid height before and after operation were measured on basis of Margin Reflex distance (MRD1) and recorded in a special form for analysis. All of these patients were in the silent phase of disease and if a strabismus or orbital surgery was indicated, it was performed before the study.

After a six months follow-up, mean MRD1 decreased in the right eye from 7.76±0.55 to 4.86±0.32 mm and in the left eye from 7.81±0.64 to 4.75±0.35mm (p<0.0001). In all patients, satisfactory response was achieved and corneal surface discomfort was relieved. No serious complication was seen.

Minor lateral tarsorrhaphy in conjunction with levator recession procedure in thyroid ophthalmic patients can have satisfactory results and result in correction of temporal flare.

One of the main complications of hemodialysis in patients with chronic renal failure is hypoxemia which is related to several factors including the type of filter. The aim of this study was to evaluate the hypoxemia levels in patients undergoing hemodialysis with focus on the type of filter.

In a crossover clinical trial, 29 patients from emodialysis ward of Fatemieh hospital were enrolled in the study. The patients were randomly divided in two groups (allocation). First group was hemodialyzed using Polysulfone filters while the second group was hemodialyzed by Hemoph an filters for one month. After a period of 24 hours washout, filter was changed and hemodialysis was done for another month. Arterial blood O2 saturation at different times, before and after hemodialysis was determined and amount of decrement was measured and compared in both groups.

Mean decrease in the arterial blood O2 saturation during 5, 30, 60 and 120 minutes after initiation of hemodialysis was higher in Hemophan filter than Polysulfone filter (p<0.001). In both groups, peak of decreasing levels were 30 and 60 minutes after initiation of hemodialysis.

As use of polysulfone filters causes lesser decrease in arterial blood oxygen saturation, it is recommended in igh risk, especially cardiopulmonary disease patients

Hypercholesterolemia is a metabolic disorder that ultimately results in arterial sclerosis and complications like hypertension and coronary arterial diseases. Various drugs have been used for the treatment of this condition and many studies are underway for introducing new drugs. Chitosan and Salvadora Persica are two such drugs. Chitosan is produced by deacetylation of chitin which is present mainly in the exoskeleton of crustaceans. The aim of this invitro study was to study the effects of these two drugs on blood lipid levels.

In this Interventional Laboratory Trial, 30 mature vistar rats weighing 200-250 grams were selected and after a period of two weeks in order to allow them to adapt to their surroundings, they were allotted randomly to 6 groups. The rats were then fed for a period of 15 days with normal or fatty diet, with or without the drugs. Chitosan in pure powder form and persica in the form of hydro alcoholic salvadora persica stem extract were added to the diet of the respective study groups. At the end of this period, blood samples were taken in order to measure cholesterol, triglyceride, HDL and LDL levels. Data was analyzed statistically using SPSS software program and Scheffe, ANOVA and Descriptive statistical tests.

Both chitosan and persica decreased cholesterol and LDL levels in the groups ingesting fatty diet (P< 0.05) and the mean decrease was not statistically different for the two drugs. (P > 0.05). The two drugs had no effect on triglyceride and HDL levels. (P > 0.05) Both chitosan and persica had no effect on blood lipid levels of subjects on normal diet whose cholesterol levels were normal (P > 0.05).

Persica and chitosan have similar effects on reduction of cholesterol and LDL levels in cases of hypercholesterolemia, but have no effect on triglyceride and HDL levels.

In modern societies, shift work is an essential component of daily life. Since the beginning of research in shift work, researchers have been engaged in the identification of factors predicting adjustment and adaptation to shift work. The concept of adaptation and tolerance refers mainly to the biological response in terms of circadian rhythms and performance efficiency as well as sleep duration and quality. Since some of the shift workers show higher level of adaptation in comparison with the others, the individual sensitivity may be a good predictor. The present study was undertaken to specify whether changes in cortisol rythmicity are associated with chronotype, quality of sleep and adaptation to shift work.

This study was cross-sectional. Blood samples were drawn from 57 shift workers. Three sample were drawn from each subject (at the beginning of their night shift, at the end of their night shift and at the beginning of their morning shift). The samples were immediately centrifuged and the plasma was removed and stored at -25 0c until assay. Cortisol was measured by radioimmunoassay using LKV Mili gama counter and Immunotech-IM1841 kit. Also, all subjects completed questionnaires for the acquisition of chronotype, quality of sleep and adaptation to shift work.

The mean age, work experience and BMI of the sample was 33.5+6.2years, 6.2+2.5 years and 24.1+2.8, respectively. 89.5 percent of subjects were married. The mean cortisol level at the beginning of night shift, the end of night shift and the beginning of morning shift was 6.95 Mg/dl,18.31Mg/dl and 19.1Mg/dl, respectively. 83.9 percent of subjects had morning chronotype and 16.1 percent had evening chronotype. The mean cortisol level at the beginning of morning shift and at the beginning and end of night shift for morning and evening subjects were (19.5, 16.5),(6.5,7.7)and(17.1,18.4)Mg/dl. 46 percent of subjects reported good sleep at the morning shift, while others reported moderate and weak sleep. Also, at the night shift, only 21.4 percent showed good sleep.

Although there was a difference between the mean cortisol levels of morning and evening active subjects, but because of small sample size of evening active subjects, statistical analysis showed no significant difference between them. The mean cortisol level at the beginning of morning shift was related to the quality of sleep directly. There was a significant difference between the mean cortisol level at the end of night shift and morning shift sleep score (P=0.035). Also spearman analysis revealed a significant correlation between morning shift sleep score and value of beginning night shift cortisol reduction per end of night shift. There was a correlation between mean cortisol level at the end of night shift and adaptation score. Results showed that as the adaptation score increased, the differences between mean cortisol level at the beginning and the end of their night shift decreased.

Ferric sulfate pulpotomy is a safe and effective method of the pulpotomy of primary teeth. But the results of different studies indicate low success rate of ferric sulfate pulpotomy in comparison to Formocresol pulpotomy and a portion of these failures may be related to stimulating and harmful effects of zinc oxide Eugenol paste. The aim of this study was to determine and compare the clinical and radiographic success rate of ferric sulfate pulpotomy of primary molars with zinc oxide eugenol and zinc polycarboxylate cements in order to determine the more suitable pulp capping material for ferric sulfate pulpotomy.

In this randomized trial study, 140 primary molar teeth in children between3-5 years old, with the treatment plan of pulpotomy were randomly allotted to one of two groups ferric sulfate pulpotomy with zinc oxide eugenol and zinc polycarboxylate cements. After treatment, pulpotomized teeth were double blindly evaluated clinically and radiographically and Fisher's exact test was used for analysis of data.

Clinical success rate in one year evaluation in two groups of zinc oxide eugenol and Zinc polycarboxylate was 98.1% and 93.9%, respectively that was not significantly different. (P=0.34). In one year evaluation, radiographic success rate was 96.30% in zinc oxide eugenol group and 91.8% in zinc polycarboxylate group but this difference was also not significant(P=0.42).

In ferric sulfate pulpotomy, it is not preferable to use zinc polycarboxylate cements as a subbase instead of zinc oxide eugenol cement.

Many post-surgical wound infections in hospitals cause morbidity and morality of patients and these are usually transmitted via hands of surgical personnel. The aim of the present study was to detect and antibiogram the bacterial agents following scrubbing of hands of surgical personnel before operation.

Hands of 134 personnels of operation room were swabbed following scrubbing with antiseptic Betadine solution. Swab samples were inoculated on selective and differential media such as blood ager, McConky and manitol salt agar(MSA). Following incubation of media at 37c° for 24hr, bacterial species were identified using differential related tests. The isolated species were than antibiogramed and the results together with other data was analysed by SPSS software program.

Of the total of 134 cases, 81(60.4%) were male and 53(39.6%) female. The mean scrub time for each person was (206.1+/-103.2) seconds 6 to 60 seconds base change. Increasing time of scrub was significantly correlated with decreasing rate of bacteria (P=0.003), (R=-0.254). Contamination was present in 129(96.3%) cases following scrubbing. Maximum contamination was observed in nails (92.5%). Average number of bacteria for each individual was between 0 and 159. 62.6% of isolated bacteria were non- staphylococci and 7.7% were S. aureus. Vancomycin and ceftizoxim were the most sensitive, while penicillin was the least sensitive antibiotic.

Results revealed that hand contamination was more than the expected standard level. Therefore, regarding the critical task of surgical personnel, training of all operation room staff is highly recommended to minimize the rate of contamination.

From maturity to menopause, women are worried about pregnancy. Abstinence from sex or use of pregnancy prevention methods are choices for them. As abstinence is impossible, the only remaining choice is use of pregnancy prevention methods. Effective control of pregnancy is really essential for the health of mother and infant and also control of unplanned increase in population. Regarding the importance of continuance rate of pregnancy prevention methods (OCP, IUD, Condom &DMPA) & the reasons for their disruption, this study was carried out with the aim of determining the continuance rate and reasons for discontinuance of pregnancy prevention methods in Yazd women.

This was a cross-sectional study. Six urban health care centers of Yazd were selected as study clusters and information of 15-49 year old women using the pregnancy prevention methods (OCP, IUD, Condom& injection) was collected via a questionnaire. The data collected was analyzed by Coplan- Mayer statistic method and variance analysis test.

Pregnancy prevention methods were most prevalent in the 25-34 years old age group (57%). Mean duration of pregnancy prevention method usage was 27.98 months using Caplan-mayer method with a median of 24 months. 86.3% for 6 months, 72.8% for 12 months, 62.5% for 18 months, 47.9% for 24 months, 39.9% for 30 months and 37% for 37 months had used four certain methods of pregnancy prevention (OCP, IUD, Condom and Injection). The reasons of discontinuance were disease (15.6%) for OCPS, bleeding (27%) for IUD, unwanted pregnancy (21%) for Condoms and also disease (75%) for Injection method.

According to the results, not only education programs regarding family planning before starting each pregnancy prevention method to women is recommended, but a complete incentive consultation about these methods is essential. This educational & consultation programs should be implemented initially for women using OCP method.

The proportion of older adults in the population continues to grow in the developing countries. In addition, persons at or over the age of 60 years have decreased quality of life in geriartrics because of several factors, such as low physical activity and impairment in mobility. This study was performed to assess the effect of group-based exercise program on physical functional independency in order to finally increase the quality of life in older adults.

This quasi-experimental study was conducted in old women and men in 2005-2007. In this study, 50 elderly men and women were randomly divided into two groups experimental (25) and control (25).Group-based exercise program was administrated to the individuals of experimental group for 8 weeks (3 time a week) and subsequently using SF-36 questionnaire, the level of quality of life was measured in the two groups at the beginning and the end of the study. The data was analyzed using manvitni , chi-square and nonparametric tests.

Using group-based exercise program, increase in mean level of quality of life in different dimensions physical functional, role functional, pain, general health, emotional well-being, social functional , emotional functional and mental health was statistically significant(p<0.01),whereas in the control group ,these parameters, were unchanged(p>0.01).

Our study results showed that use of a regular and prolonged exercise program can increase the level of quality of life in older adults in different dimensions.

Tracheobronchopathia Osteochondroplastica (TO) is a rare disorder of large airways with unknown etiology which is characterized by cartilaginous and bony nodules lining the mucosa of the trachea and major bronchi. Generally, it is benign and asymptomatic, but it may present with cough, exertional dyspnea and wheezing. It could therefore be mistaken with asthma and chronic obstructive pulmonary disease . The diagnosis is usually made on bronchoscopy and confirmed on histology .We describe two cases of TO with characteristic bronchoscopic and histological findings. The first one had exertional dyspnea and hoarseness for more than 3 years and the second one had exertional dyspnea for more than 10 years .In both of the cases, fiber optic bronchoscopy was performed which revealed numerous white,hard,irregular nodules on trachea and main bronchi. The pathologic diagnosis of bronchoscopic biopsy was TO.