مجله دانشگاه علوم پزشکی شهرکرد
سال یازدهم شماره 2 (پیاپی 42، تابستان 1388)

Diabetes is a multi-factorial and metabolic disease, which is diagnosed by chronic hyperglycemia. Although a few epidemiological researches have focused on the genetic of the type 2 diabetes in Iran, but it is not clear that which of the parents are more important to transmit the disease to their children, mothers or fathers? This study was performed in Chaharmahal va Bakhteyari province in Iran to answer to this question. This survey was a cross – sectional epidemiological study on all diabetic patients in Chaharmahal va Bakhteyari province in 2008. A two-stage random sampling method was used to select 254 diabetic patients. Data was collected by interview and analyzed by stata9 software, using Chi-square test. From the total number of the type 2 diabetic patients, 59% were female. The average age of the patients was 54.8±8.6 years and the average duration of the disease was 7.4±5.8 years. A positive history of the disease was seen in the family of 116 patients (45.7%), for example 61.4% of the patients had a family history in their mothers, 19.8% in their fathers, 62.9% in their sisters, 18.1% in their brothers, 40.5% in their daughters and finally 18.1% in their sons. Positive family history was higher in mothers than fathers. This was seen more in sisters and daughters compared to the brothers and sons (P<0.001). Our findings showed that the chance of having diabetes from the mothers is higher than from the fathers. It means that type 2 diabetes can be inherited from the mothers more than the fathers.

A specific event is not stressor for all persons. It is perception that determines an event is stressor or not. Headache causes that peoples have problems to evaluate events. In this study, we aimed to evaluate the effect of group therapy on perception of stressors in recurrent headache patients. In this semi-experimental study on female students of Shiraz University, 20 students diagnosed as having headache were selected as case group. Control group was consisted of 32 normal students with same sex and age as case group. Both groups (case and control) were asked to fill a Daily Minor Hassles Questionnaire. They were compared for two variables, perception of the unpleasant stressors and the frequency of unpleasant stressors. In second part of the research, patients in the case group were asked to participate in a 90 minute session per week for 9 weeks. They were compared in three conditions of pre-test, mid-test and post-test. Data were analyzed using independent t-student and paired t-test. Our results showed a significant difference between headache (case) group and normal (control) group in perception of the unpleasant stressors and the frequency of unpleasant stressors (P<0.05). We also found that cognitive-behavioral group therapy throughout the therapeutic sessions decreased perception of the unpleasant stressors and the frequency of unpleasant stressors in headache patients. Cognitive-behavioral group therapy decreases perception of the unpleasant stressors and the frequency of unpleasant stressors in patients with recurrent headache.

Brain trauma is one of the most important causes of morbidity and mortality, especially in the urban and industrial societies. Risk factors that increase the mortality of the patients are aging, other organs trauma and cardiac arrhythmia. Some of the ECG abnormalities following traumatic brain Injury are tachy-arrhythmia, brady-arrhythmia, increased QTc interval and changes in ST segment. Traumatic brain patients also show subarachnoid hemorrhage (SAH) and increased QTc intervals. Our aim in this study is to evaluate QTc interval changes in patients with moderate to severe brain injury. This retrospective study was performed on 200 patients with moderate to severe head injury, who were admitted in Al-Zahra and Kashani hospitals, in Isfahan city, Iran between years 2004-2006. QTc interval (based on Bazett formula) and level of consciousness (based on Glasgow coma scale) were obtained from the patients files. Data were analyzed using student t-test and Chi-square test. The most common injury in the patients was intracranial hemorrhage (ICH). Our study did not show any correlation between age and level of consciousness with QTc interval (P>0.05). The most common cause of mortality in our patients was subarachnoid hemorrhage (SAH). There was no significant correlation between causes of injury and patients mortality (P>0.05). Evaluating QTc intervals from the files of the patients who were died showed that they had longer QTc interval compared to the alive patients’ (P<0.01). QTc interval was longer in women compared to men (P<0.05). A direct correlation was seen between decreased level of consciousness and QTc interval elongation (P<0.001). Our findings show that QTc interval can be used as a good index for mortality in the patients with moderate to severe brain injury. QTc interval prolongation has correlation with severity of consciousness loss and mortality.

One of the main problems with intravenous injection is high prevalence of phlebitis. The duration of staying the patients in the hospital and mortality have been significantly reduced in the hospitals with less side effects of intravenous injection. The aim of this study was to evaluate the effect of 2% nitroglycerin ointment application on the phlebitis intensity, induced by intravenous catheter.

This is a single-blind clinical trial study in which 300 hospitalized patients Ghaem hospital in Mashhad city, Iran were selected by purposive-sampling method. Patients were randomly divided into two experimental (150 patients) and control (150 patients) group. In experimental groups, after intravenous insertion of catheter, we applied 2% nitroglycerin ointment (0.5 inch) in the distal part of the catheter and in control group, we did not use nitroglycerin ointment. The catheter areas were evaluated for phlebitis every 12 hours after catheter insertion in both groups. In experimental group, replacement of nitroglycerin ointment was repeated after 24, 36, 48, 60 and 72 hours. Data were statistically analyzed using student-t test, Chi-square analysis and Fisher test.

The phlebitis intensity in experimental group was less than control group (P<0.001). According to the MADOX criteria, the degree of 0 (for no phlebitis) and 1 of phlebitis intensity was significantly more in the experimental group compared to the control group (P<0.05). On the other hand, the degree of 2 of phlebitis was significantly more in control group than the experimental group (P<0.05).

The results of this study suggest that the local application of 2% nitroglycerin ointment can reduce the phlebitis intensity, induced by intravenous catheter.

Pre-eclampsia is one of major causes of maternal morbidity and mortality, IUGR (Intra uterine growth retardation), preterm birth and mortality in newborns. According to Immune mal-adaptation hypothesis, using contraceptive methods or short period of unprotected cohabitations may be risk factors of pre-eclampsia. The aim of this study was to determine the possible association between these factors and pre-eclampsia. This study was performed on 300 pregnant women who were admitted in the delivery ward of the Tamin Ejtemaee hospital in Shahrekord, Iran. They were matched for age categories and interviewed for filling the questionnaires. Data analysis was done by SPSS 14, using student t-test, odds ratio or X2, tests. Majority of the participants, both in the case & control groups, were primi-gravida and only 20% had a history of one or more abortions. A significant positive association was seen between the total duration of cohabitation (marital duration) and the risk of pre-eclampsia (P<0.001). This correlation remained significant even after elimination of number of delivery. There was no significant relationship between using contraceptive methods and pre-eclampsia. The results of this study have challenged the immune mal-adaptation hypothesis in some aspects and it seems that there may be another explanation for the role of long cohabitation as a risk factor in pre-eclampsia, which requires further researches.

The relationship between the number of platelet and the outcome of trauma is not clearly known. The purpose of this study was to determine the relationship between the number of platelet and the outcome of trauma in traumatic patients (Abdomen and chest) referred to hospital and mortality and morbidity rates after trauma. This descriptive-analytical study was performed on 300 patients with torso trauma admitted in Al-Zahra hospital in Isfahan, Iran, in 2005. Injury Severity Score (ISS), complete Blood Count (CBC) and platelet count were measured from all the patients at their arriving to the hospital. We also evaluated the patients for the duration of hospitalization, need to stay in ICU, duration of ICU care, thrombo-embolic events, such as deep vein thrombosis (DVT) and respiratory emboli and finally for the outcome of the trauma (death or recovery). Data were analyzed using student t-test, Chi-square and regression. The mean age of patients was 32±17.51 years, from those 78% were men. We found a direct significant relationship between the duration of hospitalization and platelet count and ISS (P<0.05). Mean platelet count was 203000±57233 in those patients who died after hospitalization and it was 233208±72345 in those patients who were recovered (P>0.05). Our findings suggest that platelet counting in traumatic patients at the beginning of their hospitalization is a good predicting factor to estimate the duration of the hospitalization.

One of the main routes in which bacterial resistance is transmitted is through food products. Antibiotic products are widely used in the nature to control diseases. It has been shown that these products can be transmitted to human through meat, milk, fruit, fruit juices and water and consequently they can cause antibiotic resistance problems. The aim of this study was to compare antimicrobial resistance of staphylococcus strains isolated from orange and apple juices and those strains isolated from clinical samples. This descriptive- analytical study was performed on 111 staphylococcus bacteria which were isolated from fruit juices or from patients referring to the educational hospitals in Shahrekord, Iran. Antibiotic susceptibility test was performed by disc diffusion method. The bacteria were classified by antibiotyping. Data were analyzed using Fishers exact test. The results of antibiotyping showed that 111 staphylococcus isolates were distributed in 36 patterns from which 10 isolates (53%) were Staphylococcus aureus belonged to 4 patterns. From the total staphylococcus isolates, 62 isolates (67%), were Staphylococcus epidermidis which were belonged to 11 patterns. These patterns were observed the same in fruit juices and clinical samples (P>0.05). The rest of isolates (39 isolates) were belonged to 21 patterns. The results of our study showed that most of the staphylococcus isolates were resistant to one or more antibiotics. On the other hand, 65% of isolated samples showed the same antibiotic resistance pattern in fruit juices and clinical samples. It is possible that food products, including fruit juices have role in transmitting bacterial resistance. Therefore, it is necessary to restrict the use of antibiotics and to control the production, transportation and maintenance of fruit juices.

Atherosclerosis is a chronic autoimmune inflammatory disease that remains the most common cause of death in the globe. This affects the vascular wall and leads to coronary artery diseases. Several studies have evaluated the association between auto-antibodies and cardiovascular disease. One of the candidate autoantigens is the Beta 2-glycoprotein I (β2GPI). Determining risk factor of the coronary heart diseases is of huge significance, so we carried out the comparative study of Anti-β2GP1 autoantibody level in patients with Acute Coronary Syndrome and healthy controls in Gorgan, Iran.

A case-control, study was conducted on 179 subjects in 2007 in whom 79 subjects were healthy (Control group) and 100 subjects had coronary artery disease (Case group). A questionnaire was filled by all subjects. Blood and serum samples were assessed by commercial ELISA tests measuring IgM and IgG auto-antibodies to β2GP1 antigen. Data were analyzed using student t-test and Fisher test.

The positivity of IgG and IgM isotypes for anti-β2-GPI antibodies in serum of the cases were %68.6 and %43, respectively. Our results also indicated that frequency of IgG and IgM autoanti-beta2-GPI isotypes in serum of the controls were %48.1 and %2.5, respectively. The results from the serum of the subjects showed that IgG-antibody against β2GPI was found in %50 of the female cases and %73.2 of the male cases (P<0.01). On the other hand, this values were %48.5 of females and %47.8 of males in control group (P<0.05).

Our finding shows that there is a relation between serum levels of IgG-antibodies against β2GP and coronary artery diseases.

Arterio-venous fistula (A-V fistula) in the snuff-box region is one of the current fistulization techniques in patients undergoing dialysis. The aim of this study was to find out the efficacy and side effects of distal vein ligation in arterio-venous fistulas of the snuff-box region in chronic renal failure patients. In this clinical-trial study, 60 patients (30 males, 30 females) suffering from chronic renal failure who had been admitted for fistulization, were randomly divided into two groups. In group 1, the distal part of vein was ligated after the A-V fistulization. In group 2, the distal part of vein was not ligated. Patients were assessed for the efficacy and the complications of distal vein ligation 1 day, 30 days and 90 days after the surgery. Data were analyzed by students t-test and Chi-square test. Early efficiencies in the ligated and non-ligated groups were 100% and 96.7% and late efficiencies were 90% and 83.4%, respectively (p<0.05). Thrombosis was the most common complication (11.7%) in both groups (P<0.05). Venous hypertension and edema were observed in two patients (both from the non-ligated group) and the infection of the surgical site was observed in only one patient. Considering the high efficiency and low complication rate, A-V fistulas of the snuff-box region are of preferred possible vascular methods for hemodialysis patients. Ligation of the distal part of vein prevents occurring venous hypertension in the fistula.

Acoustic measurements have become substantial aspects of voice assessment during the last few decades and studies have established that normative data is necessary for acoustic analysis. Voice acoustic analysis including fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), and maximum phonation time (MPT) can now be easily recorded and analyzed using a computer. This study was designed to establish the normal acoustic analysis parameters in normal Iranian adults. This descriptive - analytical study was performed on 45 Iranian women and 45 Iranian men. We made use of Dr. Speech 4.0 software (Vocal Assessment subgroup) for recording and analyzing the acoustic samples under comfortable phonation. Each gender was divided equally into 3 age subgroups. We used the Kruskal-Wallis test to assess the differences between the 3 age groups for each gender. Student’s t-test was used to compare the overall mean value between genders. We used Mann-Whitney U test to analyze gender difference for each age range. Fundamental frequency (F0) of vowel/a/ was calculated in both genders and it was higher in females (213.4±25.4 Hz) than in males (121.3±16.4 Hz) (P<0.05). Conversely, the value of MPT was greater in males (28.0±9.4 sec) than in females (22.6±7.6 sec) (P<0.05). No significant difference was found in average of SPL between females (77.8±5.5 dB (and male (77.5±5.5 dB). We found a significant difference in shimmer and Harmonics-to-noise ratio (H/N ratio) in male subgroup and other acoustic variables were not significantly different. It seems that the majority of voice characteristics of adults was relatively stable and would not change with aging up to 50. More caution should be considered for the usage of shimmer and HNR parameters to compare the voice quality.

One of the most common causes of fear from the surgery in patients is post operative pain. Opioid analgesic and NSAIDs are commonly used to relieve pain in patients. Both groups have some side effects. In this study we evaluated the local anesthetic effect of bupivacain in pain relieving after cesarean section. This clinical-trial study was performed on 100 pregnant women who were referred to the Najmiyeh hospital in Tehran, Iran, for cesarean delivery. Pregnant women were randomly divided into two equal groups. Case group was injected bupivacaine 0.5% (10 ml subcutaneously) after the cesarean delivery. Pain Intensity was evaluated in 1st, 2nd, 4th, 6th, 9th and 12th hours after caesarean operation using Visual Analogue Scaling (VAS). Sedative (Petedin) consumption was measured and was compared in both groups. Results were analyzed using student t-test and Mann- whiney test. The results of this study demonstrated that mean analgesic consumption in case group was 25.63±16 (mg) and it was 35.05±13.6 (mg) in control group (P<0.05). Mann- Whitney test demonstrated that pain intensity is significantly lower in case group in 4th, 6th and 9th hours after cesarean operation compared to the control group. The data of this study shows that bupivacaine 0.5% can have a good sedative effect after cesarean operation.

The PH of pleural fluid is one of the most important criteria in determination of type of pleural effusion. It is important in decision making for chest tube insertion. Pleural PH is a sensitive index for predicting the pleurisies out come too. Pleural fluid PH is decreased in parapneomonic effusion, cancers, tuberculosis and collagen vascular diseases. This study was designed to determine the sensitivity, specificity, positive and negative predictive values for better management of patients with pleural effusion. This descriptive study was conducted on 350 patients affected with pleural effusion referring to the Shahid-Beheshti University hospitals. Pleural fluid (20-30 ml) was taken from the patients and the amounts of blood sugar, proteins, WBC and HDL were measured. From the total number of the pleural effusion patients (350 patients) 266 patients had exudative pleural fluid and 84 patients had transudative pleural fluid. The sensitivity, specificity, positive predictive value, negative predictive value and efficacy of the pleural effusion PH were 75%, 22%, 72%, 26% and 61%, respectively. Measuring the pleural PH can be useful for differentiation of exudative from transudative pleural effusion. It seems that PH measurement has lesser mistakes compared to the previous measurements.