مجله مطالعات علوم پزشکی
سال بیستم شماره 1 (بهار 1388)

Pregnancy is a sensitive period of life in women; sexual and coital relationships can change because of physical and psychological changes during this period. This study was done to determine sexual behavior and some of its related factors in pregnant women. In this descriptive-analytical study, sexual behaviors and some related prevalent factors during pregnancy were studied in 350 pregnant women through two randomly stratified selection stages. Data gathering were done using a questionnaire. Chi-squared test was used to analyze the data. A p-value <0.05 was considered significant. A majority of pregnant women reported a diminished libido (58.6%) and a declined frequency of sexual intercourse (61.1%) during pregnancy. The Main reasons for the decrease were mentioned the fear of trauma to the fetus and infection. There were significant differences between sexual intercourse, sexual satisfaction, sexual desire and orgasm with fear of trauma to the fetus with (p=0.02), (p=0.008), (p<0.001), (p<0.001) respectively. Considering the importance of sexual health during pregnancy, consultation services and attendance of experts in sexual behaviors during pregnancy in healthcare centers is mandatory

Infertility affects approximately 10-15% of couples. The major causes of infertility include ovulatory dysfunction, tubal and peritoneal pathology, uterine pathology and male factors. Unexplained infertility is 10-15% of cases of infertility. Ovarian stimulation combined with IUI is treatment of couples with male factor infertility and unexplained infertility. Once limited to just clomiphene citrate for ovulation induction but now includes a wide variety of agents. Although its use is still extremely limited, the aromatase inhibitor letrozol may be another potential option for ovulation induction an ovulatory women. The aim of this study is to compare the effectiveness of letrozol and clomiphene for ovulation induction in patients with unexplained and borderline male factor infertility. In this study 206 patients with unexplained infertility and borderline male factor infertility were recruited.The patients were randomized into two groups, being treated with clomiphen and another groups treated with letrozol. HMG injected due to growth follicle. HCG was used to trigger ovulation. IUI was performed in patients, 36-40 hours after administration of HCG. Transvaginal sonography determined endometrial thickness and number of mature follicle on the day of use HCG. Pregnancy Rate, multiple pregnancy and rate abortion were detrmined in both groups. The mean number of gonadotropin ampules used in both groups were: c.c groups 2.18±1.86 vs. letrozol group 2.94±3.3, p<0.05. Different endometrial thickness was found between the two groups (c.c groups 8.23±1.08 mm, letrozol group 7.86±1.03mm, p<0.05. Total number of mature follicles during stimulating were: 2.10±1.04 in C.C group v.s 1.86±1.03 in letrozol group, p>0.05. Pregnancy rate per cycle was 37 (36.3%) in the letrozol group and 20 (19.2%) in the clomiphene group, p< 0. 05. Multiple pregnancy occurred in the letrozol group 3 (8.1%) and in the clomiphene group 3(15%), p>0/05. Abortion rate per cycle was 11(29/73%) in the letrozol and 5 (25%) in the clomiphene group, P<0/05. Superovulation with letrozol in patients with unexplained infertility and borderline male factor infertility was associated with a significantly higher Pregnancy rate is encouraging for the development of these agents as first-line ovulation induction agents.

Brucellosis is a widespread, economically devastating and highly infectious zoonosis. Mass immunization has become a favorite strategy to control of disease. in, this study, we tried to estimate marginal effectiveness of livestock immunization program in West-Azerbayjan province. Epidemiological data about of brucellosis was gathered through literature review, expert opinion, existing resources of data and synthesis by modeling of other data and transmission of disease pattern. In a state transition model different stages of disease and intervention in three scenario (cover of immunization with 50%, 80% and 0%)were simulated and estimate the economic benefit and cost –effectiveness through the control of brucellosis by mass vaccination of livestock. In a scenario of cover with 50% reduction of brucellosis transmission between animals achieved to vaccination, estimated intervention costs were 102270000000R(Iranian Rials) & the overall disease cost reduction due intervention was 269124000000 R (Iranian Rials) and benefit-cost ratio is 322%. In a scenario of cover with 80%, estimated intervention costs were 163710000000R (Iranian Rials) & the overall disease cost reduction due intervention was 322125000000 R (Iranian Rials). Our study showed that effectiveness of immunization against brucellosis is quite significant. Calculation using basic estimates of cost of intervention program implies that this intervention is possibly very cost-effective and if with other interventions, such as control and limitation of livestock mobility, the eradication of disease is available aims.

m ortality rate of newborns accounts for 18.3 per 1000 live birth that comprised 69% of IMR and 56% of under 5 mortality in Iran. A comparison of statistical trend between infant and newborn mortality rate from 1988 to 2001 revealed a considerable decrease in IMR but slightly decrease in NMR. In a series of studies it has been proposed that training neonatal’s mothers is effective in prevention of neonatal mortality rate. t his study has been carried out for assessing the knowledge of mothers in different fields of neonatal care and role of some associated factors in r asht. In this cross-sectional study, from target population of mothers with hospitalized infants in Rasht, a sample was chosen with convenient s ampling method. Then a questionnaire consisting of questions regarding to the different field of neonatal care was completed by mothers at the presence of researchers. Finally the score were given to the correct or wrong answers and then the knowledge score of each mother was calculated. Data were analyzed using SPSS 11. T- Test and ANOVA were used for analyzing the relationship. P value less than 0.05 was considered significant. 450 mothers with mean age of 26.56 were studies. The mean score of knowledge relating to the icterus infants, umbilical cord and general care of infants were 54.88%, 25.11%, and 46.09% respectively. 16.7% of mothers had poor knowledge, 71.3% moderate and 12% had good knowledge. Mother’s age of 18-35 years living in town, higher level of education, having a job and mothers with more than 3 pregnancies had significantly higher level of knowledge. The result shows that knowledge levels of 71.3% of mothers are moderate. So it is imperative to provide comprehensive training in the field of newborn and infant care for mothers.

Different factors such as hypoxia, nutrient deficiency and metabolic disorders (diabetes mellitus) are known to disturb wound healing process. Previous studies have shown that systemic and local administration of estrogens promote tissue repair through alteration of inflammatory responses, down regulating of macrophage migration inhibitory factor (MMIF) and particularly release of growth factors. Estrogens have potent effects on angiogenesis by stimulating the endothelial cell migration and proliferation. The aim of the current study was to evaluate the effects of systemic administration of estradiol on the process of wound healing in excisional wounds of diabetic rat. Forty four male Sprague Dawley rats (N) were divided into four groups (2 normal and 2 diabetic groups). Diabetes was induced by Streptozotocin (STZ) administration (38mg/kg, IV). In one normal and one diabetic group estradiol valerate (200ųg/kg, IM.) was injected 24 hours before wounding. Control groups received same volume of vehicle (season oil). The rats received four full thickness excisional (6 mm in diameter) wounds (n) in paravertebral region on the back. Wound size was monitored and measured at days 1, 4, 8 of wounding. The surface area and the rate of size reduction were determined accordingly. To digitalize the wound size, wound images were scanned imported to a PC and analyzed by ScnImage software. Repaired tissue was harvested on day 10, post wounding. Also wound-healing qualities were evaluated by microscopic examination of the section prepared from harvested tissues. Administration of estradiol significantly increased the rate of wound size reduction, both in normal (P<0.05) and diabetic rats (P<0.05) compared with their control groups. Histological evaluation showed that angiogenesis and cell population was positively affected by estradiol in normal and diabetic repaired tissue. Systemic administration of estradiol 24 hours before wounding improved the wound healing in normal and diabetic wounds.

Hearing loss is the most common inherited sensory disorder affecting approximately one child in every 1000 births. At least 50% of hearing loss is inherited and about half of the genetic hearing loss is autosomal recessive non-syndromic. Several hundred genes have been identified being responsible both for syndromic and non-syndromic deafness. DFNB1 due to mutation of GJB2 gene is the most frequent autosomal recessive non-syndromic hearing loss. Although many mutations have been found in GJB2, a single mutation, i.e. 35delG is responsible for the majority of cases in different populations. The identification of GJB2 mutations in a population would provide a diagnostic tool for a common genetic form of deafness and can be used in prenatal diagnosis and also would be helpful in the risk assessment for family members of the proband. The aim of this study was to determine the rate of 35delG mutation of GJB2 gene in non-syndromic prelingual hearing loss in West Azerbaijan population. 103 cases from 81 families with autosomal recessive non-syndromic hearing loss were screened for 35delG mutation in the GJB2 gene. 3-5 ml of whole blood was taken for genomic DNA extraction. The mutation was screened using a semi-nested PCR method. RFLP analysis with EcoNI carried out on the PCR product and subsequently visualized on a 2% agarose gel. Homozygote 35delG mutation was detected in 5 patients. Sixty-nine out of 103 (67%) studied cases were sporadic, and 33% were familial. Four out of five cases with 35delG mutation were offsprings of consanguineous union. 206 chromosomes from 103 patients with autosomal recessive non-syndromic hearing loss were studied and 35delG mutation was found in 10 chromosomes (5 patients were homozygote). The frequency of 35delG mutation was 4.85%. Based on the results of this study it can be concluded that the other genes or mutations could result in autosomal recessive non-syndromic hearing loss in West Azerbaijani population

Drug abuse and dependence have been focused by many physicians until now. Many approaches were used for cessation of withdrawal syndrome but pharmaceutical agents were used widely. Magnetic fields were used for treatment or decreasing some disorders such as pain. Some studies have shown that magnetic fields can affect behavioral and physiological functions. It has been used in alternative medicine for a long time. Adult male mice were divided in two: a control group (n=6) and a magnetic field treated group (n=8). All mice were dependent to morphine by standard intraperitoneal injection procedure. The treated groups were taken in the magnetic field for 2 hours (0.07 mTpeak, 10 Hz) by being placed in a special cage. Morphine withdrawal syndrome precipitated by naloxone induction subcutaneously. Withdrawal syndrome signs registered every minute for 45 min for each mouse observationally. The studied signs included: restlessness, urination, defecation, diarrhea, jumping, ejaculation, shivering, and wet-dog shake. The treated mice with magnetic field did not show shivering and ejaculation but all of the control group showed signs of study. Diarrhea and defecation were seen in less number of the treated mice. The latency of beginning of urination and defecation were greater than the control group significantly but in the jumping and wet-dog shake there were no time difference for beginning of the behavior between two groups. Morphine withdrawal syndrome signs are major factors to drug relapse and craving. The prevalence and initiation of these behaviors are very complex and integrative. Much therapeutics tries to decrease or abolish the signs but it seems that some different mechanisms are involved for such behaviors. Magnetic field can decrease some signs, so it hypothesizes that it may be used to challenge of drug dependence treatment.

Various congenital, malignant and benign acquired diseases may cause disorders in structure and normal function of bladder and therefore making its repair essential. Natural and synthetic alternative materials have been used to increase bladder volume. The aim of the present study was to change an incontinent high pressure low volume bladder into a continent low pressure high volume bladder and therefore providing a precious model for experimental medical studies. In the an experimental pilot study, using of fresh goat’s amniotic membrane (G.A.M.) as an organic material for bladder grafting in dogs, for the purpose of bladder augmentation were used in six healthy dogs, a piece of cranial wall of bladder, approximately 4-cm2 in diameter was resected and replaced with fresh G.A.M. For the purpose assessment of, microscopic pathologic parameters were studied. Pathology findings were: the regeneration of transitional epithelium and proliferation of granulation tissue, No degenerative changes at the junction of the bladder and graft, was seen. The results indicate that fresh G.A.M act as a proper scaffold with least disadvantages, for repairing bladder defects in dogs.

Shivering is a common problem after general anesthesia. This condition increases the oxygen consumption. Therefore prevention of shivering is important particularly in elderly and patients with ischemic heart disease. Dexamethasone decreases the gradient between core and skin temperature and modifies the inflammatory response. The goal of this study was to determine the efficacy of dexamethasone on postoperative shivering. In a prospective double–blind clinical trial 100 ASA I and II patients aged 20-50yr scheduled for elective cholecyctectomy under general anesthesia were randomly assigned to receive either dexamethasone 0.15 mg/ kg or placebo after induction of anesthesia. All patients received same medication and standard monitoring during maintenance of anesthesia. Rates of shivering analysis were preformed by using Chi Square tests. The incidence of shivering was significantly lower in dexamethasone group than placebo group. (18.7% vs. 36% and p=0.009). There was no significantly difference regarding severity of shivering among two groups. Dexamethasone is an effective drug for prevention of postoperative shivering and its use is recommended.

Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in adults and diabetic women. It is also associated with neuropathic bladders, bladder outlet obstruction, in-dwelling urinary catheters, chronic urinary tract infections and immunosuppression.This report is a 71 year-old man that was presented with frequency, dysuria, fever and abdominal pain. We diagnosed emphysematous cystitis, during the work up. E-coli was isolated. He was empirically treated with ceftriaxon and based on the sensitivities of culture; he was treated at home using ciprofloxacin.

Renal involvement is one of the most serious sequela of Henoch-Schönlein purpura. The presence of proteinuria (nephritic range) and hematuria is also associated with progression to renal insufficiency. In fifty percent of patients who display a combination of nephritis-nephrotic symptoms, end-stage disease develops. Pharmacologic treatments are controversial, and more research needs to be done to clarify therapeutic regimens.A five years old child with clacic signs and symptoms of Henoch-Schönlein purpura and sever renal involvement (combination of nephritis-nephrotic syndrome) was treated succesfuly by Mycophenolate mofetil. This case was resistant to methyl prednisolon and cyclophosphamid pulse.Mycophenolate mofetil is an immunosuppressive agent which is used in many autoimmune disorders such as lupus nephritis, vasculitis, necrotizing glomerulonephritis, corticosteroid resistant glomerunephritis and IgA nephropathy, but there are no enough data on the use of mycophenolate mofeti in complications of Henoch-Sch nlein diseases. Herein, we report successful use of Mycophenolate mofetil in a case with severe Henoch Schönlein- nephritis resistant to both methylprednisolone and cyclophosphamid pulse.