مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال شانزدهم شماره 2 (پیاپی 63، تابستان 1387)

Chest X–Ray is one of the most common method of imaging. Cardio Thoracic Ratio ( CTR ) is one of the parameters of Chest X–Ray that is used for determining cardiac enlargement. Echocardiography as compared to Chest X–Ray is expensive and all centers dont have it, but it can determine heart size, valvular diseases, Ejection Fraction, Left Ventricular Hypertrophy (LVH), Pericardial effusion and diastolic dysfunction very well. So, this research was done in order to compare CTR with Echocardiographic findings and precent expensive investigations in the future.

In this cross-sectional analytical study from Sep 2006 to Sep2007, CTR of 172 patients referring to Shohadaye Kargar and Goodarz hospitals was determined from their Chest X–Rays and echocardiography was done later. Data was analyzed with SPSS software and statiscal tests such as Chi-square and Fisher exact tests were used.

The results of this research wereas folows: 1- The mean age for the patients with increased CTR was higher than patients with normal CTR. 2- Left Ventricular Hypertrophy (LVH) and increases of left and right ventricular diameters increased the CTR. 3- There was no statistical relation between sex, pericardial effusion, left and right atrium diameters and CTR. 4- Patients with increased CTR had more valvular heart diseases, systolic and diastolic dysfunction than patients with normal CTR.

Increased CTR is one of the signs of cardiac pathologies and therefore echocardiography is advisable for more evaluation of patients with increased CTR.

Type II Diabetes is one of the most prevalent endocrine diseases in the world that results from a combination of insulin resistance and ß-cell failure. Regarding importance of nutritional factors in management of diabetes, this study was designed to explore the effect of sesame oil on blood glucose and lipid profile in type II diabetic patients at Yazd Diabetes Research Center in 2007.

A quasi-experimental study was conducted on 25 patients with type II diabetes mellitus (age: 51.5±6.28y BMI:27.3±3kg/m2 disease duration:7.08±5.03y Fasting blood glucose level: 181±51.9mg/dl). Subjects received 30 g/day sesame oil for 6 weeks. Sesame oil was supplied to the patients, who were instructed to use it in place of other cooking oils for 42 days. Plasma glucose, glycated hemoglobin (HbA1c), lipid profiles [Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)] were measured at baseline and after 45 days of sesame oil substitution. 24 hours dietary recalls were obtained at the start , middle and end of study. Data was analyzed using analysis of variance with repeated measures and paired t-test.

Following 42 days intake of sesame oil, there were significant decrease in FBS (181±51.93 vs 154±39.65 mg/dl), HbA1c (9.64 ± 2 vs 8.4 ± 1.74 percent), TC (226.68 ± 31.4 vs 199.8 ± 37.87 mg/dl), LDL-c (123.9 ± 34.56 vs 95.53 ± 32.54 mg/dl) compared to pre-treatment values. (P <0.05) . Blood TG level decreased after intake of sesame oil but this difference was not significant (P=0.2).Also, the changes of HDL-c levels were not significant (P=0.1).

Sesame oil consumption results in considerable decrease in blood sugar, HbA1c and blood lipid levels (TC and LDL-C) in type II diabetics. Keywords: Sesame oil, FBS, HbA1c, TC, TG, LDL-c, HDL-c, Type II diabetes.

The extensive use of Lead has led to health problems including CNS, anemia and other occupational poisoning among workers. To determine the blood lead levels in relation to demographic factors, this study was carried out.

In this cross sectional study, 490 workers at Kooshk Lead and Zinc mine were selected and blood samples were taken. The blood lead levels were assessed according to the NIOSH standard using atomic absorption.

The mean, minimum and maximum of blood lead levels were 49, 9 and 116 mg/dl, respectively. The blood lead levels in 45.7 percent of workers was more than permissible limit. The blood lead level was not significantly related to age and history of work. The lowest and highest levels of blood lead were 9 & 116 mg/dl, respectively. In contrast, significant relationship was seen between the location of work and blood lead level. The results showed that in the majority of workers with blood lead levels higher than standard limit, there was a significant relationship between the blood Lead levels and the hemoglobin concentration. The blood lead level in 45% of samples was more than Iranian standards.

The work location was the main factor affecting the blood lead levels. Attention should therefore be focused on the alteration of RBC and Hemoglobin levels during periodic medical examination of workers

Obesity is an emerging major public problem throughout the world. Obesity, over weight and under weight are the most frequent nutritional disorders in children and adolescents in developing countries. The objective of this study was to assess the prevalence of obesity, over weight and under weight in adolescent students in Yazd.

In a cross sectional study, weight and height of 794 guidance school students was collected and BMI [wt (kg)/ht(m2)] determined. The National Health and Nutrition Examination Survey III growth chart which has been adopted by World Health Organization wasused and BMI>95 percentile as obesity, BMI>85 and <95 as over weight and BMI<50 as under weight were defined.

Prevalence of underweight13.9% (male 9.8% , female 18%), over weight 12.9% (male17.2 , female 8.8%) and obesity 6.5% (male 8.8%, female 4.3%) was significant .( P< 0.001)

Prevalence of obesity , overweight and underweight in adolescents of Yazd is of concern and prevalence of underweight is significantly higher in girls as compared to boys .

International study on asthma was conducted to study the prevalence of Asthma symptoms among 13-14 year old children using written and video questionnaires during the early 90's. The aim of the present study (ISAAC) was to evaluate the agreement between the two questionnaires which were self-completed by the children.

This study, which was a part of the third phase of International Study of Asthma and Allergy in Childhood (ISAAC) and performed exactly similar to phase1, was performed by National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in two cities of Iran Rasht and Tehran. All stages of the study were performed in accordance with ISAAC protocol. The present study discusses data related to children of Tehran. A total of 3100 school children aged 13-14 years were questioned about asthma symptoms using written and video questionnaires of ISAAC study. For statistical analysis, initially a descriptive study of the available data was performed. Thereafter, chance corrected agreement between the two questionnaires was evaluated using Cohen’s Kappa co-efficiency.

Of the total of 3100 children, 52.4% were male and 47.6% female, with a mean age of 13.6 years. Although the questions discussed in the two questionnaires were not exactly similar, the results of the video questionnaires showed a statistically significant lower positive response to asthma symptoms as compared to the written version. Kappa co-efficiency ranged between 0.06- 0.21 (mean=0.12), which is considered poor for all variables.

Positive responses to having asthma symptoms were significantly higher using the written questionnaire compared to the video questionnaire. Similar to previous studies, agreement between the two was considered poor for all variables. Although factors such as language, culture, dwelling area, e.t.c. have special effects on results of these questionnaires, results indicate that the two questionnaires should be further studied and validated for this special group of patients in order to reach a better interpretation of prevalence of asthma symptoms.

Rheumatoid arthritis (RA) is the most common autoimmune joint disease. Osteoporosis is a well-known consequence of RA.

The aim of the present study was to determine the interrelationship between radiographic findings and bone mineral density (BMD) in patients with RA.

70 patients with established RA (according to 1987 ACR criteria) were included in a cross-sectional study. BMD at lumbar vertebrae and hip were measured using DEXA machine. Plain radiographs of both hands of all patients were examined and scored according to the Larsen scoring system.

Sixty-five females (92.9%) and five males (7.1%) enrolled in the study. Mean of T-score in these patients was -1.06 in femoral region and -1.56 in lumbar regions. According to lumbar T-score, 50% of patients who were graded in group C Larson score (grade 4, 5) had osteoporosis and 3.33% of patients in this group had osteopenia. A high radiologic Larson score was associated with low BMD at hip and lumbar regions. Age was positively associated with low BMD.

Higher radiologic Larson score was associated with reduced BMD in our RA patients. Because of high prevalence of osteopenia in group B (grade 2, 3 Larson score), we suggest routine bone densitometry in this group and taking into consideration anti-resorptive therapy. However, more studies are required to establish and confirm the results.

Water is an essential nutrient for life. It comprises 75% of total body weight in infants,60% in adult males and 50% in adult females. Decrease in body water is commonly known as dehydration. Acute or chronic dehydration is a common condition in some population groups, especialy the elderly and those who participate in physical activity in warm enviroments. Potential consequences of dehydration include constipation,urinary tract and respiratory infection,urinary stone disease and there might also be an association between a low habitual fluid intake and some carcinomas,cardiovascular disease and diabetes. Many indices have been investigated to establish their role as markers of dehydration status. Body mass changes,blood indices,urine indices and bioelectrical impedance analysis have been used most widely, but current evidence and opinion tend to favour urine indices as the most convenient and sensitive methods.

This cross sectional study was done for estimating the prevalence of dehydration in adult population(students,nurses,officials,workers)in Yazd. These persons were selected randomly. Urine samples of two hundred and thirty persons were obtained at 10-12 AM,and urine specific gravity measured by refractometer (all of the samples)and dip stick (some samples).

According to this study,96.7% of our population had some degree of dehydration.69.7% of them were significantly dehydrated(urine SG>1020) and 4.8% of them were severely dehydrated (urine SG>1030) and the mean specific gravity was 1021±5/65. This study evaluated other factors that could probably indicate hydration status like urine colour, type of drink,frequency of urination and frequency of thirst per day.

High percentage of our population were dehydrated which was not correlated to the type of drink but was correlated to urine colour, frequency of urination and frequency of thirst. So, regular monitoring of urine to keep if clear or light yellow is a simple way to prevent dehydration.

Hearing loss after surgery is reported rarely. Its prevalence rate is different and reported to be between 3-92%. Hearing loss is often subclinical and not diagnosed without audiometry. The aim of this study was to determine rate of hearing changes after spinal anesthesia in patients undergoing surgery with spinal anesthesia.

In this descriptive study, forty male patients scheduled for repair of inguinal hernia under spinal anesthesia were selected by simple sampling method. Before surgery, audiometry was performed for both the ears of the patients. Audiomatery was performed again by the audiometry specialist on day one, five, fifteen and two months after surgery.

Hearing loss was observed in 13 (32.5%) patients. Hearing loss in 12 patients (92%) was in low hearing frequency range and 1 patient (8%) was in mid hearing frequency. Hearing loss in 8 patients (61%) was ipsilateral and in 5 patients (39%) was bilateral. Hearing loss in 9 patients (69%) on 5th day and 2 patients (5/15%) on 15th day resolved spontaneously.

Results of this study conformed that hearing loss after spinal anesthesia is not a serious problem and can resolve spontaneously. It seems that there is relationship between hearing loss and headache.

Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end – stage renal disease . Peritoneal dialysis has different complications This study was conducted in order to evaluate its complications and different survival probabilities of factors in Shahid Rahnemoon hospital .

In this retrospective, historical cohort study, reports of 161 patients on peritoneal dialysis (Shaheed Rahnemoon hospital, dialysis department) from 3.Dec.1997 to 20.May.2007 were evaluated. Required data was gathered and analyzed by specific statistical tests.

The mean age of patients was 49.37 years (2 to 88 years) and most of them (41.6%) included in 40-59 years age group category. Peritonitis, exit site infection and catheter malposition was seen in 41.6% , 6.8% and 9.3% of patients ,respectively.Rate of peritonitis in females was more than males (p=0.002). Diabetes mellitus had no effect on death rate, but hypertension had a protective role.

Peritonitis ,exit site infection and catheter malposition is more prevalent in females, but mortality rate is significantly higher in males.

Estimation of gestational age is an essential component of prenatal care. Gestational age is estimated by Last Menopausal Period, fundal height and ultrasonography. Serial measurment of fundal height and comparison with LMP predicts the G.A more accurately. Since nowadays, ultrasonography is used more frequently during pregnancy, patients have to bear more expenses. But we can use serial measurement of fundal height for determination of G.A. This method is cheap, reliable and easy for assessment of G.A and fetal growth in pregnancies without serious complications. In this study, we compared the accuracy of Fundal Height Measurement And Ultrasonography for estimation of gestational age.

In this cross sectional study we investigated and compared the accuracy of fundal height measurement and ultrasonography in estimation of G.A. A total of 140 pregnant mothers were selected from patients referring to gynecology and obstetrics clinic of Doctor Mojibian and Shahid Sadughi hospitals in Yazd. Gestational age of these patients were estimated two times measurement of fundal height and ultrasonography. Collected data was analyzed with SPSS11.5 program and Pearson correllation statistical test.

This pregnant mothers were identified by some criteria. In these mothers, the G.A was estimated by ultrasonography (BPD,FL) and measurement of fundal height at G.A of 22-25 weeks, 22-25 weeks, and then at G.A of 25 to 28 weeks.

The results showed that measurement of fundal height like sonography has a high a high rate of accuracy for estimation of G.A.

Diabetes is a significant and expensive health problem which had influenced all the ages in almost all the countries. Increasing prevalence of this disease has been caused by continued changes in lifestyle such as unsuitable nutrition, lack of physical activities and fatness which is often related to modern city life, mechanization and industrialization. It is an expensive disease, both for patients and the health and hygienic care systems. This research tried to examine the relationship between lifestyle risk factors and type II diabetes.

This research was a case-control type by random sampling and studying140 diabetes type II patients as case group and 140 healthy people accompanying some other patients as the control group at Tonekabon Shahid Rajaei hospital. People were of both sexes, between 30 and 64 years of age and Tonekabon residents. The questionnaire used included demographic, nutritional, physical activities, stress tolerance and smoking status information. The SPSS 11.5 and excel software were used for statistic calculation and for analysis of data, T and Chi-Square tests were applied.

By analyzing the data collected, there was a meaningful statistical relationship between physical activities, stress residence, nutrition, smoking and the diabetes type II disease (P-value<0.0001). Also, there was no meaningful statistical relationship between diabetes type II disease and factors such as sex, marital status, economical and social status(P-value>0.05).

Results imply that some risk factors important in diabetes type II include unsuitable nutrition such as having too much of sweets and sugar,lack of fruits, vegetables, fish, proteins and also lack of physical activities, stress tolerance and control.

Behcet's disease is a chronic disease with multisystem involvement characterized clinically by oral and genital aphthae, cutaneous lesions and ophthalmologic, neurologic and gastrointestinal manifestation. Nervous system involvement occurs in 5.3 – 30% of patients, mostly in brain stem and basal ganglia. The common manifestations are pyramidal signs, central nervous plegia, pseudobulbar syndrome and cerebellar signs. Tumor-like lesion is a rare CNS involvement.We report a rare case of brain tumor-like lesion. Case : The patient was a 33 year old man with Behcet's disease complaining of urinary incontinency and imbalance beginning one week before admition. Physical examination showed oral ophthae, ataxia and spastic parapelegia. His brain MRI (T2) showed a hyperdense lesion in cerebellum and a space occupying lesion pressing the medulla.The patient was treated with high dose of methyl prednisolone and cyclophosphamide followed by oral corticosteroids. Weakness and plegia resolved. He was discharged in good condition.

Becker's naevus shows itself as a pigmented area of skin which is aquired , persistant and asymmetrical and sometimes shows evidence of increased androgen sensitivity. Colocalization with other developmental anomalies is reported rarely. We report a 20 year old woman who developed an extensive and bilateral Becker naevus since the age of 12 year and had left breast hypoplasia, too.