نشریه دانشگاه علوم پزشکی بیرجند
سال پانزدهم شماره 1 (پیاپی 34، بهار 1387)

Since thee beginning of the present century retroviruses have been reported as causative factors that produced transmissible tumors in birds. However, in 1980 Poiesz et al, established, for the first time, a link between a retrovirus and leukemia called Human Lymphotropic Virus Type 1 (HTLV1). Over the course of past 27 years the epidemiology of human T lymphotropic Virus type l has matured. The geographic distribution of the virus has been defined, although some puzzles persist such as the high prevalence in southwestern Japan but low prevalence in neighboring regions of Korea, China and eastern Russia and also a region of high prevalence in Iran. This virus causes two distinct diseases Adult T-cell leukemia / lymphoma and HTLV1 associated myelopathy/ tropical spastic paraparesia. The virus has worldwide spread now, although in some areas it is endemic. Transmission modes of the virus are through sexual contact, breast feeding, injecting infected products, and using infected needles. For the first time in Iran, Tabei et al, reported two Khorasani cases of adult T-cell leukemia/lymphoma with hypercalcemia in 1986 and then Farid and Tabei reported 13 other cases from Khorasan. Now it is confirmed that Mashhad is an endemic area for HTLV1 in the world. This review will discuss the epidemiology, biology, mode of transmission, diseases induced by HTLVI prevention of the disease and treatment of the patient.

Infertility is one of the major problems associated with contusive spinal cord injury (SCI). Sperm qualities such as low viability, low motility, and increase in abnormal morphology are complications arising from infertility following SCI. The purpose of this study was to evaluate testicular changes and spermatic parameters after contusive spinal cord injury in the mice.

In this experimental study, a total of 75 adult NMRI mice were divided into 3 groups: SCI, sham, and control.In the SCI group, following laminectomy without any damage to dura matter, the spinal cord was hit with a 2 gr weight dropped from a distance of 2.5 cms onto the exposed dura matter in the 9th thoracic vertebra while the control group was not exposed to any type of damages or medications. In the sham group, only laminectomy was performed. The epididymal sperms were prepared after one day, one, two, four, and six weeks. The data was analyzed by means of SPSS software using one-way ANOVA statistical test.

The present study demonstrated that SCI is effective on the parameters of sperm. On the first day, none of the parameters were significantly different with those in the control group. In the 1st and 2nd weeks significant reduction in sperm morphology and viability rates was observed in the experimental group (P<0.05) compared to the control group. All parameters of sperm had significant changes in the 4th and 6th weeks compared with the control group (P<0.05). Besides, histological change was observed in the testes tissue, integrity of seminiferous epithelium basal membrane was reduced, and testicular capsule thickness increased.

It was shown that spinal cord injury decreases motility, viability, and changes morphology of the mice sperm.

Nitric oxide (NO) is a substance which protects vessels against atherogenic effects. Previous studies have shown that there is a direct relationship between increasing of permeability of endothelial cells and formation and progression of atherosclerosis. The aim of this study was to evaluate the role of L-Arginine in permeability of aortic endothelial cells and serum lipoprotein level in high-cholesterol fed rats. In this experimental study, 36 male rats were divided into two groups one with a normal and the other with a high-cholesterol diet. Then each group was divided into two sub-groups: Group “a” used L-Arginine 2.25% in water and group”b” used safe drinking water. After eight weeks, the right carotids of the animals were cannulated and 20 mg/kg of Evans Blue was injected into the subjects. Then, the whole aorta of each animal was dissected and put in 2.5ml formamid solution. After 24 hs, absorbance of the solution was measured by means of spectophotometer. Finally, the obtained data was analysed by SPSS software using one-way ANOVA, and Tukey statistical test and P≤0.05 was taken as the significant level. L-Arginine decreased endothelial permeability in aorta in rats feeding on high-cholesterol foods in comparison with the control group. (P<0.005). In addition, L-Arginine reduced the LDL level in the blood serum of rats with a high-cholesterol diet in comparison with the control group (P<0.005). Administration of L-Arginine has a protective effect on the permeability of endothelium of aortic vessels in hypercholesterolemic condition.

Depression is the most common and important psychological disorder among End-Stage Renal Failure cases especially those undergoing hemodialysis so that, it can have negative effects on the quality of life, treatment acceptance and process of illness. Regarding that patients’ participation in self-care activities can help them in their independence and compatibility with their illness and improving of their quality of life (QOL) in all aspects., Therefore, this study was done aiming at determining the effect of self-care education on depression in patients undergoing hemodialysis”. This study was a randomized controlled trial, which was accomplished in the hemodialysis ward of Imam Reza and Hefdeh-e- shahrivar hospitals in Mashhad in 2006. Sixty samples were selected from patients undergoing hemodialysis through convenience and purposeful method and then divided into two (case and control) groups randomly. After need assessment of the patients about self-care, case group education was accomplished by utilizing an educational booklet and holding two sessions (average length of each 45 minutes) with a lapse of one week between them. Depression in both groups before and one month after intervention was measured by CES-D questionnaire. The obtained data was analyzed by statistical tests, paired-T, independent T, x2, Fisher, Mann-Whitney, and general linear model using SPSS software (11.5) and P £ 0.05 was taken as the significant level. Mean age of the patients was 42.3±12.1 years. 62.5% were males, 78.6% were unemployed, 76.8% married, 42.9% were underpaid, and 33.9% had elementary education. There was not a significant difference between the two groups in these variables. Mean depression score before education (23.7±7.1) and after education (17.2±6.7) showed a significant decrease in the case group (P<0.001). Comparison of mean depression between the case (17.2±6.7) and control group (21.8±6) after the study revealed a significant difference, (P=0.01) while there was no significant difference between them before the research (P=0.40). Mean depression rate in the control group before the study (22.2±5.4) and after the study (21.8±6/0) did not show a significant difference (P=0.51). In order to have constant and efficient participation in self-care activities of, patients undergoing hemolysis, they need to receive continuous education regarding self-care and adaptation to disease, so that various physical and mental problems they are facing would be decreased.

Narcotics abuse is associated with major problems in society worldwide. Among addictive substances, opium has been used and abused for centuries. Unfortunately, the lay people-and even a limited number of physicians believe that opium has a number of beneficial effects on cardiovascular diseases. The aim of the present investigation, as a cross-sectional study, was to verify this hypothesis. In this cross-sectional study which was carried out in the cardiovascular research center of Isfahan University of Medical Sciences, 360 smokers addicted to opium were taken as the case group and an equal number of smokers not addicted to opium as the control group. The blood morphine concentration in both groups was measured by ELISA method. The obtained data was analysed by SPSS software, using Student-t test, and ANOVA at the significant level of P≤0.05. The results show a direct correlation between blood morphine concentration and period of addiction. HbA1C, CRP, factor VII, apo B, Lpa, were significantly higher in the case subjects compared with their level in the controls. The levels of hemoglobin glycolysis factors HbA1c, CRP factor VII, LPa, fibrinogen in the cases were significantly higher than the corresponding levels in the controls (P<0.05). HDL and anti-oxidative capacity were also significantly lower in the case group (P<0.05) but FBS w3as insignificantly lower than the controls. The results show that opium has a deleterious effect on new cardiovascular risk factors (Lpa, CRP and apo B). Although it seems to improve a few of them, the effects are of a short duration and are principally not genuine.

Back ground and According to the UNICEF’s Conceptual Model the behavior of those who somehow play a role in taking care of children significantly influences children’s growth as a feedback. Anthropometrical indices such as weight and height for age Z (HAZ and WAZ) are extensively utilized to determine malnutrition and growth rate. In a quasi experimental study, three girls’ junior high schools -randomly selected from the fourth educational district in Shiraz- were assessed with regard to heights, weights, and age utilizing EPI software. After HAZ and WAZ were measured, girls whose HAZ and WAZ were less than (-1) were included in the study. Mothers of these girls were invited to participate in a weekly training program on health, nutrition, and exercise/activity at school. Five months after the beginning of the program, the subjects were weighed, their height re-recorded, and HAZ and WAZ were re-measured. Girls of three similar schools from Educational District No 3(which was economically similar to No 4) were selected as the control group (CG), but mothers of these girls were not trained during this time, and all the relevant indexes were measured both at the beginning and at the end of the period of five months. Finally, the obtained data was analysed by means of linear trend in ratios, statistical paired-t, and independent t at the significant level of P≤0.05. Significant growth (P=0.038) of WAZ, but an insignificant result regarding HAZ (P=0.34) were observed such changes were not significant among the CG. Transferring the girls under study from the area with severe/ moderate malnutrition to the area having slight malnutrition was proved to be significant during the period (P<0.05). Educating parents about health and nutrition resulted in the expected growth indices among 25% of the girls and improvement of growth among all girls suffering from severe malnutrition.

Chronic gastritis is one of the most common gastrointestinal disorders and detection of its etiology especially Helicobacter pylori and risk factors of malignancy (atrophy and intestinal metaplasia) is, to a great extent, based on histological assessment. Therefore, a system which could sustain good reproducibility in reporting observations is very important. Today, the most frequently used system for assessment and grading of chronic gastritis is the Updated Sydney System. The aim of this study was to find out inter-observer agreement on each criterion of this system (i.e reproducibility rate). In this descriptive analytical study, 44 endoscopic gastric biopsy samples (with hematoxylin, eosin, and geimsa stains) were reviewed by two pathologists in turn. Each pathologist graded any of Sydney System criteria including chronic inflammation and H.P density level from 0-3 (absent, mild, moderate and severe) glandular atrophy and intestinal metaplasia from 0-1 (absence and presence). In addition, neutrophilic infiltration (activity of disease) was also graded from 0-3. Finally results of the observation were analaysed by means of McNemar statistical test and K coefficient The most/best inter-observer agreement was found on intestinal metaplasia (K =0.84) representing. Good interobserver agreement was observed on chronic inflammation (K =0.67), H.P density (K=0.62) and neutrophilic infiltration (K=0. 68). For glandular atrophy, agreement was the least (K=0.32) Updated Sydney system is a useful system for the assessment and grading of chronic gastritis. In most cases there was good agreement between the observers. Reproducibility is evaluative differences in grading a specific feature and lack of standardized diagnostic criteria to charactrize its presence and degree.

Postural abnormalities of the scapula and the shoulder regions predisposes individuals to chronic pain. Because of improper position of primary school students, who are growing, the risk of adopting abnormal postures is common. In order to establish appropriate strategies to prevent these impairments, having accurate information about them is necessary. The purpose of this study was to determine the prevalence of postural shoulder impairments in 10-12 year old students in primary schools of Zahedan in 2005. One hundred and fifty-three primary school students ranging between 10 and 12 years were recruited to this study through multiple-stage cluster sampling. In order to measure the symmetry of shoulders a checkered board having 1sq centimeter boxes was used and another one with a red line in the center for protruded shoulders. For the assessment of scapular symmetry, the distance between inferior angles of the scapula to the seventh thoracic vertebra was measured by using Kibler test at 0, 45 and 90 degrees of shoulder abduction. The obtained data was analyzed by means of SPSS software using descriptive statistical tests e.g chi square and Fisher’s exact test. The level of dominant shoulder (89.7%) was higher than that of non - dominant shoulder in right - handed students. Scapular asymmetry was not at “0” (P=0.42) and “90” (P=0.3) degrees of shoulder abduction in dominant shoulders of right-handed students. Rounded shoulder was seen in 56.2% of students. In 61.6% of 10 year old students shoulders were protracted more than normal (P=0.002). No relationship was observed between writing activities at home (P=0.92) and at school (P=0.81) with developing rounded shoulder. It was found that long term standing of primary students at abnormal positions, because of flexibility of musculoskeletal system, leads to developing protracted shoulders. The results also support the effectiveness of instructing students in adopting correct postural position when carrying a bag, and while writing to prevent shoulder postural impairments.

Smoking tobacco products is one of the most important risk factors of noninfectious diseases, especially cardiovascular and cancers. This study was conducted to assess the prevalence of smoking tobacco products and evaluate knowledge and attitude of high school male students about smoking. This descriptive-analytical study was done on Birjand high school male students selected through cluster multi- stage sampling in 2006. A questionnaire which included demographic information and questions about attitude (12), knowledge (17) and practice (4) concerning smoking. The obtained data was statistically analyzed by SPSS software using chi- square test at the significant level (α<0.05). Overall, 1233 cases were studied out of which 3.9% were smokers and 21.3% had experienced cigarette smoking. There was a positive correlation of parent's level of education with prevalence of cigarette smoking and smoking experience. Prevalence of smoking in students whose mothers were employees was more than those with housewife mothers. The difference was statistically significant (P<0.001). Besides, prevalence of smoking was in accord with education level. The most important cause of proneness to smoking was curiosity. 25.5% of the students had very little knowledge about the harms of smoking, 54.7% had moderate knowledge, and 19.8% had favorable knowledge. Attitude regarding the harms of smoking was weak in 5.1%, moderate in 48.3%, and good in 46.6%. Although prevalence of smoking was low compared to other areas of the country, experiencing of smoking was high. Since knowledge and attitude of the students concerning smoking hazards was not satisfactory, implementing educational programmes and social interventions at high school level seems necessary in order to prevent smoking.

Prostate cancer is one of the most prevalent type of cancer and the second cause of death among American men. Its prevalence has a direct relationship with increasing age. The present study was carried out to determine the level of prostate specific antigen (PSA) in Birjandi males aged between 40 and 80 years. In this prospective study, out of 628 healthy Birjandi males, 200 men who did not have any symptoms of prostate cancer were selected from different inner-city areas through cluster sampling during a period of two years (May 2003-June 2005). After the population was approved to have the necessary criteria to be included in the study, their PSA level was measured and its mean in four age groups 40-49, 50-59, 60-69, and 70-79 years was calculated. To rule out prostate cancer cases urinalysis test was done and the subjects underwent DRE (digital rectal examination), and prostate sonography. In order to determine mean difference among the four groups one-way variance analysis test and to determine "PSA" PSA Assay and Tandem-R kits were utilized. Mean and standard deviation of PSA in the 40-49, 50-59, 60-69, and 70-79 year groups was 0.6±0.04, 0.8±0.55, 1±0.09, and 1.4±1.57, respectively. Thus, there was a significant difference between mean level of PSA among the four groups (P<0.05). In a healthy sixty-year old male, e.g., yearly PSA increase is about 32% (0.04 ng/mL per year). Besides, prostate volume has a direct relationship to client's age while PSA density has a weak relationship to age. With respect to the findings of the study, it could be confirmed that PSA level increases in healthy males while they grow older and because of its natural range at any age it can be used as a measure to screen for prostate cancer.

Bacterial infection following major burn injury leads to neutrophile dysfunction and neutropenia which results in serious sepsis. Administration of graolocyte-colon specific factor (G-CSF) is useful for treatment of neutropenia and decreasing the complications of severe infection following burn injuries. A 2- year old boy with major burn injury, despite administration of broad spectrum antibiotics, became neutropenic followed by serious sepsis. After administration of G-CSF, neutropenia was resolved. Finally, after surgical debridement and skin graft, the patient recovered and discharged.

Varicella is an acquired childhood disease and it is a mild and self-limited one, whose complications in older individuals can be life-threatening. These complications usually appear 3 to 4 days after the appearance of varicella exanthems including pain, recurrent fever>38.5 and toxic appearance. Airway complications of varicella are rare. Acute supraglottitis mostly involves 2 to 6 year old children. Its spread is extremely fast and air-way obstruction is due to cellulites of supraglottic structures. Airway examination in a patient with epiglottitis that is a rare complication of varicella infection must be done in controlled condition or in an operating room and by highly- skilled specialists (e.g. surgeons and anesthesiologists). The patient must be admitted to the intensive care unit and be treated with suitable and effective antibiotics and respiratory care. Otherwise, mortality rate will be high. We report a 21 year old patient with post-varicella epiglottits. The patient after 5 days of exanthema, developed sore throat, stridor, dyspnea with sternal and intercostals retraction, tachypnea, fever and tachycardia. Sever epiglottits was seen on nasopharyngoscopy in operation room. Therefore, emergency tracheostomy was done and post direct laryngoscopy epiglottits was established and biopsy was performed. The patient admitted to the intensive care unit treated by broad spectrum antibiotic and discharged after a week with good general condition and a prescription.