Journal of Studies in Medical Sciences
Volume:19 Issue: 4, 2008

Atherosclerosis and coronary artery disease are the leading causes of death in developed and also developing countries. Reactive species, especially those derived from oxygen, are mediators of vascular and tissue damage in various diseases including coronary artery disease. Determination of this reactive species by direct method is expensive, but we can determine the product of this reactive species indirectly i.e. MDA. MDA level is determined by thiobarbituric acid reactive substances (TBARS) and HPLC methods. The main purpose of this study was to compare and evaluate HPLC and TBARS methods for determination of serum MDA in a group of patients with coronary artery disease in comparison to control subjects.

Study populations were 47 controls and 53 patients with coronary artery disease. Blood samples were collected after an overnight fasting, and sera were separated by centrifugation. For MDA determination, first serum protein was precipitated by trichloroacetic acid, and separated by centrifugation, and supernatant was reacted with thiobarbituric acid solution in 950C for 50 minutes. For determination of TBARS, TBA-MDA adduct measured spectrophotometrically by reading of absorbance directly at 532 nm, and for determination of MDA, 20 µL of each reacted sample was injected to a C8 revesephase column of HPLC, separated isocratically, and quantitated by visible detector at 532 nm.

The recovery of HPLC and TBARS methods were 92.05 - 105.2 and 84.7 - 102 respectively. The precision of HPLC method was 4-6.17 while in TBARS method it was 7.27 - 12.22%. The detection limit of HPLC and TBARS method were 0.05 µM and 0.1 µM respectively. Serum levels of MDA which determined by TBARS method was higher than those determined by HPLC in the same samples (P value <0.002). There were significant correlations between the results of TBARS and HPLC method for serum MDA in all subjects. (r2 = 0.325, P value = 0.02).

However, HPLC is a sensitive and accurate method for determination of MDA, but it is time consuming and very expensive. So in improved and optimized conditions, the results of TBARS could be acceptable, and this method is suitable for routine laboratory use, and larger sample size epidemiological studies. According to our results and previous findings, serum levels of MDA in patient with coronary artery disease were higher than the control group, so it is an independent risk factor or a marker for cardiovascular diseases.

It is necessary to terminate pregnancy for fetal or maternal indications in some second trimester pregnancies. The cervix is usually unripe in 2nd trimester, so pre-induction ripening is mandatory. The aim of this study is to compare the efficacy of extra-amniotic saline infusion with prostaglandin E2 suppository in pre-induction cervical ripening in 2nd trimester pregnancies. In this study, women (n= 80) with indications of termination of pregnancy (range 14-28 weeks) and bishop scores of 3 and lower were assigned randomly to receive extra-amniotic saline infusion (2ML/ min) or prostaglandin suppository (6mg).We induced uterine contractions using intravenous oxytocin only when contractions had not commenced by 6 hours after extra-amniotic saline infusion and 4 hours after prostaglandin. We assessed ripening efficacy, success and failure of therapy, mean time of induction, and complications of two methods. Statistical analysis was done based on the data. The mean pre-ripening bishop score was l.2±0.53 in group 1 (extra-amniotic saline infusion) and 1.68±0.66 in group 2 (prostaglandin). The mean post- ripening BSC was 4.5±2.14 in group I and 3 ± 1.6 in group 2, which was significant. There were 20 (%50) fetus expulsion in group 1 and 8 (20%) in group 2. The mean time for induction was 17.27 ± 8.38 hours in group 1 and 20.9 ±6.17 hours in group 2, which was statistically significant. One patient in group 1 had vaginal bleeding because of warfarin use. Three patients had nausea in group 2. There were no other complications in both methods. Cervical ripening by extra-amniotic saline infusion is faster and more effective than 6 mg prostaglandin E2 suppository, resulting in a higher rate of fetus expulsion in 2nd trimester.

Yarrow (Achillea. millefolium) has been used as a spice and medicinal plant in many ancient cultures from olden times. Today, biochemical investigations have shown different bioactive components responsible to medicinal and therapeutic properties of yarrow, in particular the antimicrobial effect of it. The aim of this study is in vitro assessment of potential of inhibitory function of aqueous and alcoholic extract of yarrow on some pathogenic microorganism: s taphylococcus aureus, escherchia coli, pseudomonas aeruginosa. The yarrow plants were used in this investigation, produced in around of Urmia. The extracts were used in five dilutions (10%, 20%, 30%, 40%, 70% and neat). Also microorganisms were used in this examination were staphylococcus aureus (ATCC25923), escherchia coli (ATCC25922), pseudomonas aeruginosa (ATCC27853). The agar disk diffusion test was used as microbiological examination. According to the results of this investigation, minimum inhibition concentration was approximate 30% and also the most sensitive organism to both extracts of yarrow was staphylococcus aureus and the least sensitive organism to these extracts was pseudomonas aeruginosa (P<0.05). With attention to our findings and other related reports in this field, it could be concluded that aqueous and alcoholic extract of yarrow have considerable antimicrobial effect on some pathogenic bacteria. Therefore, before application of these extracts as antimicrobial agent, it must be evaluated in vivo and clinically.

Nosocomial infection is an important concern in intensive care units (ICUs) and associated with an increase in mortality, length of stay, and costs of hospitalization. Unfortunately incidence rate of these infections in our country are more than the rates in developed countries. Theoretically one of the most important reasons for this problem is poor quality of nursing care. The aim of this study is improving quality of cares and evaluation of its effects on incidence of nosocomial infections in MICU. This is an action research conducted in four steps and lasted one year. At first we collected baseline data of nosocomial infections. In the second step, we designed an action plan to make necessary changes in nursing cares delivered to patients, stundardized nurse-patient ratio, and educated the staff. In third step, we carried out the action plan and finally in the fourth step we compared the results of final stage with baseline data. 64 patients at first stage and 86 patients later in the third step were selected as subjects using purposive sampling approach. In order to control the unwanted variables, we focused on 11 diagnostic groups and the age of more than 16. Furthermore, we controlled severity of disease in each diagnostic group using APACHE II in the first and the third steps. Multiple data gathering methods were used including questionnaires, Lab tests results, field and especialists note. A descriptive analysis using SPSS 12 was performed. Continuous variables were expressed as means ± SD. Associations between frequencies were assessed with the Fisher’s exact test. Statistical significance was defined as p<0.05. Results showed that implementaing standard nursing care plan led to improve almost all aspects of the critical care outcomes. There was a dramatic reduction in rates of nosocomial infections. Rate of VAP, UTI, and pneumonia decreased from 17.18%, 9.37%, and 1.85%, to 3.48%, 3.48%, and 0%, respectively. This study highlights the importance of implementing standards on reducing nosocomial infections rate in MICUs.

Previous studies have revealed that induction of two kidneys, one clip Goldblatt hypertension induction in rats eliminates hypertensive response after inactivating of the central nucleus of the amygdala. The present study investigated the possibility of alteration in local renin angiotensin system activity in central nucleus of the amygdala after hypertension induction and evaluation of cardiovascular response to angiotensin I microinjection into central nucleus of the amygdala in wistar rats. 130 Wistar rats were studied in this investigation. Clamps were placed on the left renal arteries to induce two kidneys, one clip Goldblatt hypertension. A similar surgery procedure without clipping was done in sham group. The rats were studied eight weeks after surgery. The mean arterial blood pressure and heart rate were measured directly with indwelling arterial cannula under urethane anesthesia. Rats received bilateral cannulation of the central nucleus of the amygdala for angiotensin I microinjection. After bilateral microinjection of consecutive doses of angiotensin I (0.5µL- 10µM, 10 nM and 10 pM), saline and pretreatment of losartan (10 µ M), saralasin (1nM) or captopril (10 µ M) before Angiotensin I injection into central nucleus of the amygdala, mean arterial blood pressure and heart rate were measured and compared between groups. Bilateral microinjection of consecutive doses of angiotensin I into central nucleus of the amygdala significantly increased mean arterial blood pressure and heart rate in hypertensive group in comparison to normotensive one (P<0.001). After pretreatment of saralasin and losartan the effects of 10nM angiotensin I microinjection into central nucleus of the amygdala of all groups were inhibited. Captopril inhibits effects of angiotensin I in normotensive animals but does not in hypertensive ones. These results are functionally demonstration of cardiovascular effects of angiotensin I microinjection into central nucleus of the amygdala and those effects have increased after 2K1C hypertension induction. This process may contribute in Goldblatt hypertension pathogenesis. Increased angiotensin II receptors or accelerated proteolytic process of angiotensin I to angiotensin II may alter angiotensin I microinjection into central nucleus of the amygdala outcome.

Menstrual migraine was described as one sided headache associated with nausea and vomiting, occurring monthly during the menstrual flow. Menstrual headaches are generally of a longer duration more debilitating and more resistant to treatment than other migraines. The target population was the medical female students of Tabriz University from April 2005 to April 2006. In this study 300 female students, 18 to 26 years old (50 medicine students, 50 dentistry student, 50 pharmacology students, 50 untiring student, 50 obstetric students, and 50 nursing student), were studied. The survey was done using questionnaires that were field up by students. This was a cross-sectional descriptive analytic study. All of the interviewers (100%) completed the questionnaires: the prevalence of pure menstrual headache was 27.3% a positive family history headache was found among 62.9% of students who had menstrual headache 20% of native students and 34.2% of in native students had experienced menstrual headache. The prevalence rate of migraine was 30.5% and tension-type headache was 69.5%. 47.6% of students had attacks occurring 2 days before onset of menstruation and 41.6% had 3 days after the menstrual period. The results of this study were compatible with other studies and this study shows that menstrual headache is highly prevalent among medical students at this university - specially medicine students.

Impacted distal ureteral stone have always been controversial on the choice of treatment. This study aims to evaluate the effect of tamsulosin (non selective alpha 1-blocker) in medical expulsion therapy of distal ureteral stones. 96 patients with UVJ or distal ureteral stones (size between 3-6 mm) were randomly divided into two groups. Group 1 (46 patients – the control group) received only indomethacin (100 mg /PRN). Group 2 (50 patients) received indomethacin and tamsulosin (0.4 mg daily). All patients were questioned about the episodes of ureteral colic, dose of Indomethacin, rate and time of spontaneous passage of stones. Patients were followed for 28 days. 30 of 46 patients (62.5%) in the control group and 41of 50 patients (82%) in tamsulosin group had spontaneous stone passage during 28 days. The expulsion rate were not significantly different between 2 groups (P>0.05). Stone expulsion time was 8.03±4.7 days in control group and 5.07±3.7days in tamsulosin group. This difference was statistically significant (P<0.05). The control group had more ureteral colic episodes and more indomethacin use rather than tamsulosin group. This difference was statistically significant (P=0.05). Tamsulosin decreases the duration of stones passage, severity of pain and use of analgesics in conservative management of distal ureteral stones, but doesn’t increase the frequency of spontaneous passage of the distal ureteral calculi significantly.

BK virus nephropathy is recognized as a cause of graft loss in renal transplant patients. The disorder may be related to the introduction of new, potent immunosuppressive regimens. We sought to assess the prevalence, outcome, and clinical characteristics of BK virus nephropathy. We retrospectively analyzed 160 specimens from episode biopsies. BK virus nephropathy was diagnosed by light microscopic examination and positive immunohistochemical staining. Among 160 patients, 21 (13.1%) were diagnosed as BK virus nephropathy. The mean interval between biopsy and transplantation was 13.6 +/- 10.67 months. There were no significant differences between BK virus nephropathy patients and non-BKVN patients with respect to age, sex, interval between diagnosis and transplantation, cyclosporine blood level, and azathioprine versus mycophenolate mofetil immunosuppression. Graft loss occurred in 57.1% of BK virus nephropathy versus 12.2% of non- BK virus nephropathy subjects (P =. 005). There was a significant difference between antilymphocyte globulin (ALG) - and non-ALG-treated groups with respect to the incidence of BKVN (6.6% in non-ALG versus 19% in ALG groups P <. 01). BKVN was diagnosed by immunohistochemistry in 61% of specimens with acute rejection according to light microscopic evaluation. This is the first report of BKVN in Iranian renal allograft recipients. In our hospital, the prevalence of BKVN was higher than that previously reported for non-Iranian recipients. BKVN had a negative impact on graft survival.

Diabetes is one of the chronic and non-communicable diseases with increasing prevalence. Retinopathy mostly appears in diabetic type I. Diabetic retinopathy is one of its complications leading to low vision and blindness. Determining effective factors can help us in early diagnosis and controlling the progression of diabetic retinopathy. This study is a cross-sectional one being done on 116 patients (diabetic type I). Their diagnoses age was under 30 years. They referred to optical clinic of Farabi hospital. The samples were randomly selected the presence and severity of any diabetic retinopathy was examined in both eyes separately and classified into four classes as follows: none mild severe and moderate and proliferative. Finally covariate variables were collected for each patient considering the clinical visits, patient self report or patient's hospital records. Retinopathy severity for the left eye was: normal (45.6%), mild (30.2%), severe and moderate (15.51%) and proliferative (8.6%) and for the right eye was: normal (%42.24), mild (31.03%), severe and moderate (17.24%) and proliferative (9.48%). The retinopathy severity correlation between two eyes was statistically significant (P<0.0001, r =0.701). Analysis of effective causes showed that the variables such as: diseases long duration, age of diagnosis, DHTN, sex, BMI, dose of insulin per day, proteinuria and macular edema had significant relation with diseases severity and pulse rate, residence, refractive error and intra-ocular pressure have not significant relation with diseases severity. This study shows that poor control, being a durable disease, being male, DHTN, BMI, dose of insulin, proteinuria, macular edema in diabetic type 1 are effective factors on retinopathy. Controlling the systematic factors, effective variables and systematic clinical visits by specialists in internal medicine and eye physicians are helpful for predicting retinopathy incidence and recurrence.

The shoulder is the most commonly dislocated joint in the body. Ninety-five percent of shoulder dislocations are anterior. Bilateral simultaneous dislocation of the shoulder is a rare entity. They are mostly posterior following seizure. Bilateral anterior dislocation after trauma however, is still rarer, mainly as the mechanism necessary to produce such injury is unusual. Only 8 cases are reported in the literature, out of these only 2 are not associated with fractures. We report a rare case of bilateral traumatic anterior shoulder dislocation and discuss the mechanism of injury.

We report an unusual non-Hodgkin lymphoma metastasis of the penis. Review of the literature revealed less than 200 cases of metastatic lesions to the penis, excluding primary neoplasms from skin, urethra and blood. The most common neoplastic metastases to the penis in order of frequency were from the bladder, prostate, rectum and rectosigmoid areas, and kidney in the cases, respectively. The incidence of other primary tumor sites that metastasize to the penis is extremely rare.

Alkaptonuria is a rare autosomal recessive disorder characterized by deficiency of homogentisic acid oxidase. This deficiency leads to accumulation of homogentisic acid in tissues and its urinary excretion and resulting in characteristic features like ochronosis, darkening of urine, and arthropathy. We describe a case of alkaptonuric ochronosis in a 62 year old man, who had alkaptonuria, degenerative arthropathy of hip and knees, spinal abnormalities similar to ankylosing spondylitis and renal calculi.Total replacement of hip joint was done. Total replacement of hip joint was done.