فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال چهارم شماره 3 (پیاپی 15، پاییز 1387)

The administration of either intrathecal or epidural opioid can provide deep neuroaxial anesthesia without significant changes in sensory or motor functions. This technique may reduce both mortality and morbidity, in comparison with systemic opioids. It seems, then, that using opioids (e. g. Fentanyl or Sufentanil) along with anesthetics (Lidocaine) in spinal anesthesia may also provide better pain control both during and after caesarean sections. This study was a prospective, randomized, double-blind and controlled trial on 86 pregnant women, ASA I-II, who were scheduled for elective caesarean section under the subarachnoid block in the year of 2008. The patients were divided into two groups (1 and 2) on the basis of a randomized digital table according to their taking sufentanil or fentanyl. In both groups, the local anesthetic used was hyperbaric lidocaine 5% (80 mg) with a total volume of 2. 2 ml. of the solution. Then, the onset of pain and the need for analgesia after the caesarean section were evaluated. Both groups received drugs intrathecally as follows: Group 1:20μg Fentanyl, 80 mg lidocaine %5, 0. 2 mg Epinephrine. Group 2:2 μg Sufentanil, 80 mg lidocaine %5, 0. 2 mg Epinephrine. In addition, Visual Analogous Scale (VAS: 0-10) was used to assess the intensity of pain and the patient’s sedation both in the recovery room and in the ward every one hour for 6 hours. The side effects and the need for drugs were recorded. As the findings of the study suggest, the onset of pain after cesarean section was more significant in the Sufentanil group than the Fentanyl group (P=0. 046). In this study, the Sufentanil group`s pain began about twenty minutes later than that of the Fentanyl group. Although the patients in the Sufentanil group appeared to need analgesic about twenty-six minutes later than those in the Fentanyl group, there was not any significant difference between these two groups of the study (P=0. 173). In terms of side effects, only more shivering was observed in the Sufentanil group than in the Fentanyl group (P=0. 003). As for Neonate ׳s APGAR and the other side effects, there weren’t any significant differences between the two groups, either. Fentanyl and Sufentanil plus intrathecal Lidocaine provided a good pain control for elective caesarean section; however, no significant difference was noted in terms of side effects. As a whole, Fentanyl and Sufentanil plus 5% Lidocaine can intrathecally induce sufficient analgesia after cesarean sections. More specifically, spinal anesthesia with lidocaine 5% and 2 µg of Sufentanil may bring about sufficient analgesia after the operation and is recommended for induced anesthesia in operations.

Association of asthma with Type 2 T- helper system is well realized. Recent clinical evidence show that acute, sever exacerbations of asthma are associated with recruitment and activation of neutrophils in the airways. The lymphocytes T helper 17 (Th17) cells can probably recruit neutrophils to an inflammatory site through producing IL-17. The objective of this study was to investigate the level of interlukin-17(IL-17) in serum and sputum of asthmatic subjects. Also, the study aimed at evaluating the correlation between concentrations of IL-17 and the frequency of inflammatory cells in the sputum of asthma at different stages. Fifty newly diagnosed asthmatics and 12 non-asthmatics healthy subjects, as the control group, entered this prospective study. None of them reported any recent history of infection and steroid usage. Then, samples from venous blood and sputum (Induced by Hypertonic saline %5) were obtained. The severity of asthma was classified according to GINA 2004 guidelines. The Concentrations of IL-17 in serum and supernatant of induced sputum were determined by ELISA method. Total serum IgE level was also determined in order to classify asthmatic subjects into allergic and non-allergic groups.As the findings of the study suggest, serum IL-17 level was significantly higher in asthmatic patients than in the normal control subjects (78.8 ±58.7 vs 17.7 ± 2.4 pg/dl, P=0.025). IL-17 was found to be significantly increased in sputum of the subjects with asthma, as compared to the control subjects (31.6 ±20.9 vs 21.5± 16.6 pg/dl, P=0.012). In addition, allergic and non-allergic asthmatic patients showed a significantly higher concentration level of serum IL-17 than the normal controls (80.8±50.3, P=0.023 and 102.7±43.6, P= 0.002vs 17.7 ±2.4 ng/ml). But, it was found that the levels of both serum and sputum IL-17 in the allergic asthma group were not significantly higher than those in the non –allergic asthmatics. Moreover, serum IgE level was significantly higher in allergic asthmatic patients than non –allergic asthmatic and normal control subjects (295.8± 168 vs. 99.1±90.0 P=0.001 and 49.7±41.8, P=0.001). The results further revealed that macrophage was decreased in sputum but neutrophil and eosinophil were significantly increased. However, the increase of IL-17 was not correlated with asthma severity. Besides, there was no significant difference between allergic and non- allergic asthmatic subjects, in terms of IL-17.We propose that IL-17 may play a role in the airway inflammation of asthmatics by recruiting neutrophils into the lung, no matter if they are suffering from allergic or non-allergic asthma.

Laparoscopy is one of the diagnostic and therapeutic methods used for infertility. With this method, the causes of infertility (including pelvic, tubal and ovarian factors) which are not usually signified in primary evaluations can be diagnosed and treated; thus, avoiding some unnecessary therapeutic expenditure such as ART (Artificial Reproductive Techniques). This cohort study was performed on 140 infertile patients referring to a professional clinic of gynecology and infertility from 1383 (H. S.) to 1386 (H. S.). Having gone under primary clinical and para-clinical evaluations as well as medical treatments, these patients were nominated for laparoscopy in Aria and Mousa-ibn-Ja’far hospitals. According to the laparoscopic results, the patients were identified with either primary or secondary infertility. Then, the patients were treated accordingly. Finally, the follow-up evaluation of the fertility outcomes (pregnancy rate and miscarriage) was carried out within one year thereafter. 74% of the patients were diagnosed with primary infertility and the other 26% with secondary infertility. The most common cause of primary infertility was found to be PCOS while secondary infertility was mostly caused by tubal factor. The successful rate of pregnancy in patients with endometriosis was 58.1%; with tubal factor 44.1%; with PCOS 66.7%; with uterus anomaly 40%; with both PCOS and endometriosis 71.4% and in patients with both PCOS and tubal factor, it was measured as 22.2%. As for miscarriage, the rate was found to be 6.4% in patients with endometriosis; 8.8% in patients with tubal factor; 2.5% in those with PCOS and 11.1% in the patients who were diagnosed with both PCOS and tubal factor. No miscarriage was observed neither in the patients with uterus anomaly nor in those with both PCOS and endometriosis.According to the results of this study, laparoscopy is a safe method in diagnosing tubal, pelvic and ovarian factors and can improve the fertility outcomes in the patients.

Cryptorchidism is the most common urologic congenital malformation in males which contributed to increasing male infertility and testicular tumors. So, it seems to be necessary to identify its risk factors.
Being a case-control study, the investigation consists of 37 cases of cryptorchid boys and 40 normal boys as the control group. Both cases and controls attended a faceto-face interview, using the same questionnaire. The collected information was then analyzed by running a chi-square test using SPSS.
We found significant positive associations between cryptorchidism and each of the following variables: hypertension during pregnancy (P=0.0327); premature birth (P=0.0028); low birth weight (P=0.0478); UTI during pregnancy (P=0.0162) and brich presentation (P=0.0302). However, although some risk factors like maternal age, fever during the first trimester of pregnancy, maternal blood group, cesarean section, being the first-born child of the mother and twins have been reported to cause cryptorchidism, we found no evidence to suggest so. In addition, It was the first time that maternal education and UTI during pregnancy were investigated, too. We concluded a significant positive association between UTI during pregnancy, but did not find any relation between cryptorchidism and maternal education.
These findings suggest that not only might cryptorchidism be associated with genetic factors, but also can be increased by environmental factors. In order to arrive at more definite conclusions, further studies are needed to be carried out, in this respect.

Transmission of infection via multiple dose vials has been well documented. Thus, the probability of contamination in these vials, no matter how little, is very important because they are supposed to be a potential source of nosocomial infection in patients. Therefore, a prevalence study on the contamination of multiple dose vials (MDV) seams to be necessary. The purpose of this study was to identify bacterial contamination and red blood cell (RBC) contamination in multiple dose vials used in Bahman 22nd Hospital.In a cohort study, different types of MDVs used in different sections of Bahman 22nd Hospital were periodically collected during one year. Information about the medication, wards, labeling of vials, the date and time of opening and storing temperature was recorded. Then, 0.5 ml of each vial was cultured in Blood Agar media at 37˚c for 48 hours. Also, the samples were tested for Red Blood Cell contamination after they were centrifuged.Totally, 300 MDV’s were collected and studied. No bacterial contamination was found in the cultures. Of the 300 vials available, 2 vials were contaminated with RBC (2 RBC in one vial and 3 RBC in another) at a contamination rate of 0.67%. Although the results of bacterial culture of multiple dose vials used in different wards of the hospital were negative, the contamination of two vials with Red Blood Cells is still very important. The finding should raise concerns about the potential risk of transmission of blood borne pathogens through such vials.

Asthma is a common pulmonary disease in children that was associated with reversible hypersensitivity of pulmonary airways. It introduces as a psychosomatic disorder with interrelated different psychic and somatic domains which can exacerbate each other. It has been documented that for the effective management of this disease both medical and psychological considerations are crucial. In this regard, we aimed at evaluating psychiatric symptoms in the mothers who have uncontrolled asthmatic children.This is a case–control study that was done on 50 mothers of uncontrolled asthmatic children and 50 mothers of healthy children. Considering the inclusion and exclusion criteria, a method of simple non- probability sampling was adopted to evaluate each of the cases for psychiatric symptoms, using SCL-90-R. SCL-90-R is a standard tool that is used for evaluating nine psychopathological elements, including psychosis, paranoid ideation, phobia, hostility, anxiety, depression, interpersonal sensitivity, obsessive and compulsion symptoms and somatizations. It shows the existence and severity of the psychiatric symptoms occurring for one past week. Two groups of participants were evaluated and matched based on some intrusive elements.There was not any significant difference between the two groups of study in terms of children’s and mothers’ age, birth age, number of children in the family, job, parents’ education and their marital status, argument in the family, physical or mental diseases, smoking and addiction in the family. However, it was found that the mean scores of depression, somatizations, psychosis, anxiety, obsession, interpersonal sensitivity and phobia were significantly higher in the asthmatic group. Moreover, mean global severity index was significantly higher in the asthmatic group. Further, as the findings suggest, the odd ratio for serious psychiatric symptoms in the mothers with asthmatic children was 2 while it was calculated as 2.54 for any other psychiatric symptoms.Due to the fact that psychiatric aspects are prominent among both children suffering from asthma and their family, we suggest that psychiatrists cooperate in managing asthma. We believe that the psychotherapy of asthmatic children’s family would be an effective way for better management of the disease as well as helping to improve mental health in the society.

Depression is an important issue among the university students. It affects their educational performances and decreases their progress in academic achievements. Thus, it is important to detect the causes and relating factors of depression among university students. In this study we intended to evaluate the frequency of depression and it's relating factors among medical and paramedical students of Mashhad Islamic Azad University.This research is a descriptive- analytic study that has been done on 780 medical and Paramedical students of Mashhad Islamic Azad University. The sampling method adopted for the study was a clustering probability method. As for the instruments, a questionnaire including two sections was used. Section one consisted of demographic information and section two was Beck Depression Inventory with 21 questions for determining the level of depression. The collected data were then analyzed using Maan Whitney, kruskal Wallis and Chi-Square methods. 28.6% of the subjects showed various degrees of depression. 14.6% had clinical depression. The most frequent rate of depression was observed among the students of the School of Hygiene while the students of Medicine rated the lowest (23.7%). There were positive associations between depression and gender, field of study, satisfaction with the field of study, section of study, marital status, site of life and father's income (P=0.001).The findings show high frequency of depression among medical and paramedical students of Mashhad Islamic Azad University. Also they reveal negative influences of some factors on depression. Thus, it seems crucial to develop some preventive programs and complementary researches on causes and relating factors of depression.

Refractive errors are the most frequent reasons for which patients refer to ophthalmologic clinics. The previous studies have found that the factors of the environment and the type of light to illuminate it could have positive effects on the prevalence rate of refractive errors. Since there is little research about this relationship at industrial workers in Iran, we decided to investigate the industrial workers’ refractive errors and their relationships with the types of light and the visual work environment.We carried out a descriptive-analytical study on 292 male and female workers working in Mashhad industrial factories. Using clustering sampling, the subjects of the study were selected to go under investigation for their age, sex, and years of working background. Then, the study examined the relationship between these factors and refractive errors. In addition, the effects of outdoor and indoor working environments as well as natural and artificial (florescent) light on refractive errors were determined by a specialist. Interesting results were obtained through statistical analyses such as Chi-Square, Fisher Exact Test and ANOVA.The results suggest that the subjects of the study ranged from 23 to 63 years old with an average age of 40±9.1. Also, their working background of an average of 16±9.3 years has showed a positive effect on refractive errors (P=0.039). Among the subjects of the study, 30 (10.3%) were diagnosed as suffering from refractive errors in one eye, 150 (51.4%) in both eyes and the other 112 subjects (38.3%) had no refractive errors. The results of investigating the symptoms accompanying refractive errors were found in the following order of prevalence: Red eye (28%); Ptergyume (17.5%); Hyperemia (16.1%); Burning (12.4%); Lacriamtion (11%) and others (15%). There was no significant difference, in terms of age, between the subjects having refractive errors and those without them (P=0.842). There wasn’t any significant relationship between age and refractive errors, either (P=0.896). However, outdoor environment (P=0.014) as well as natural light (P=0.016) were found to have had positive effects on the subjects’ refractive errors.Although the duration of working background has found to be positively effective on refractive errors, the subjects’ age hasn’t showed such effect. Natural light and outdoor work environment have had significant relationships with the subjects’ refractive errors. As for accompanying symptoms, Red eye (28%) was the most frequent.