مجله پزشکی بالینی ابن سینا
سال شانزدهم شماره 2 (پیاپی 52، تابستان 1388)

Introduction & Tuberculosis is an ancient disease that will affect human health in the future. Tuberculosis is a systemic disease and more body systems are affected such as hematologic system. This study was conducted to determine peripheral blood changes in pulmonary tuberculosis detecting by H3 technicon in Urmia hospitals in the west of Iran. In this study 85 patients with active pulmonary tuberculosis were evaluated for peripheral blood manifestation before and after anti tuberculosis chemotherapy. Subjects were diagnosed as active pulmonary tuberculosis with two sputum smears positive for acid fast bacillus or one smear plus one positive culture. Peripheral blood count and indices were determined by H3 technicon system and peripheral blood smear. Data were analyzed with SPSS. Win software and using Mac Nemar and Paired – Sample t-test. According to the result of this study 60 percent of our patients were male. Prevalence of anemia at the time of presentation was 53 percent, in 18 patients (21.2 percent), anemia was severe. In the post-treatment phase, anemia was significantly lower than pretreatment phase (P=0.001). Leukocytosis was found in 31 percent and eosinophilia in 12.9 percent that was 3.5 and 2.3 percent respectively in post-treatment period. Thrombocythopenia was seen in 23.5 percent of our patients before treatment and 16.4 after it. Considering these results, prevalence of anemia among patients that were diagnosed as suffering active pulmonary tuberculosis was very high. Anemia in these patients was contributed to anemia of chronic disease and was not closely evaluated. After successful treatment some of anemic patients were still anemic. Anemia in presentation of tuberculosis has to be adequately evaluated and managed.

Introduction & The aim of this study was to investigate the effect of electromagnetic field on the count and motility of adult rat's sperms and the protective effect of different dosages of zinc sulfate on it. Thirty two adult male rats were subdivided randomly into 4 groups: group1:serve as untreated controls,group2:was exposed to an electromagnetic field but received no additional treatment, groups 3 and 4: were exposed to electromagnetic radiation but respectively received 200 ppm and 500 ppm oral zinc sulfate daily. After 40 days all rats were killed and their epidydimises were removed and after extraction and incubation of sperm in incubator fewer than 37°C and 5% co2 for an hour the count and motility of sperms were examined under ×10 power of inverted microscope. Sperms were categorized into three groups on the basis of their motility: progressive motility, non progress motility and immotile. Sperm count determination by counting of 10 chambers in which sperm were counted. The mean sperm count was56.6±7.96 in the group 1 and in the groups 2, 3 and 4, 30.2±1.31, 38.6 ±2.09and 42.5±6.74 respectively. Therefore the group 2 had a significantly lower sperm count in comparison with the other groups(p<0.05).sperm with progressive motility was 52.25±3.88 in group 1, 22.35±1.82 in group 2, 49.26±1.66in group 3 and 46.11±4.05 in group 4. Therefore the group 2 had a significantly lower sperm motility in comparison with the other groups (p<0.05). There was no difference between the other groups (p>0.05) Testicular tissue damage can be caused as a result of exposure to an electromagnetic field. This damage can be preserved by zinc supplementation but there is not any significant difference between different administrated dosages of zinc sulfate.

Introduction & Decreased labor period can reduce the incidence of cesarean section. The aim of this study was to evaluate the effect of increased hydration on labor in nulliparous pregnant women. This randomized double blind clinical trial was done on 180 nulliparous term pregnant women (GA³37weeks), whose active phase of labor had started. They were grouped as case and control groups. The case group received 250 ml of ringer lactate and control group received 125ml of ringer lactate. The duration of each phase (active and second phases) and total duration of labor, severity of pain by means of visual analogue scale, need of oxytocin, cesarean section ratio and apgar of neonate were studied. Both phases of labor were significantly less than what was for the other group (p<0.005) and this reduction in period was calculated 66 minutes for active phase and 20 minutes for the second phase. The control group needed to receive oxytocin significantly more than the other one (p<0.001), pain score and cesarean section ratio were significantly less than the case group (p<0.012, p<0.001 respectively). The analysis of the data showed that neonates whose mothers had been hydrated, had a better apgar score than the others (p<0.03). This study showed that hydration of pregnant women during labor will lead to independently significant reduction in duration of labor and also lower severity of labor pain. According to our results, it is recommended administer in the patients who have no contraindication for hydration, to 250 ml/h intravenous fluid.

Introduction & Diabetes is a metabolic disorder caused by low secretion or resistance to the insulin action. Oxidative stress, as a result of imbalance between the free radical production and antioxidant defense systems is strongly related to diabetes and its complications. The aim of the present study is to evaluate the effect of experimental diabetes and forced treadmill exercise on oxidative stress indexes in heart tissue. 40 male wistar rats (200±20g) were divided into four groups(n=10): control, control with exercise, diabetic, diabetic with exercise. Diabetes was induced by a single dose injection of streptozotocin (50 mg/Kg-1, i.p). Treadmill was performed for 1 hour, 5 days in 8 weeks. At the end of the experiments, the rats were anesthetized by sodium pentobarbital (50 mg/Kg-1, i.p) and left ventricle dissociate from heart and maintenance in -80 ºC. Supernatant from homogenization were used to determine the superoxide dismutase (SOD), gluthatione peroxidase (GPX), gluthatione reductase (GR) and catalase (CAT) activities as enzymatic antioxidant status. Also Maolnyldealdehyde (MDA) level as index of lipid peroxidation and total glutathione (T.GSH) of the heart tissue were measured. Diabetes significantly reduced CAT and GR activities in diabetic rats compared with control rats. SOD and GPX activities werent changed in the hearts of the diabetic rats. MDA level, as a lipid peroxidation index, increased in non exercised diabetic rats. In response to exercise, MDA level, CAT, GR and SOD activities showed a significant increase in exercise diabetic rats compared with non exercise diabetic rats. Forced treadmill with moderate severity has harmful effects on cardiovascular system in diabetes because it increases MDA level of heart tissue in exercised diabetic rats.

Introduction & Spontaneous pregnancy loss is the most common complication of pregnancy. However, after a thorough evaluation the potential cause remains unexplained in about half of the cases. Autoimmune disorders appear to play a prominent role among multiple factors implicated in pathogenesis of adverse pregnancy outcome, including thyroid antibodies. The purpose of this study is determination of antithyroid antibodies titer on the outcome of recent pregnancy that aborted or continued until delivery. This study was descriptive cross sectional research. The information of 80 pregnant women being between 20 to 40 years old with gestational age of below 20 weeks were gathered for this study. 40 of these women aborted within 20 weeks and others, their pregnancies continued until delivery. All samples with known causes of abortion were waived. With written consents, blood of each pregnant woman was taken for the examination of antithyroid antibodies, FBS and TFT. If the two latters results were normal, the antithyroid antibodies were considered to be valid and the information was registered in prepared questionnaires. The values more than 75 u/ml for anti Tpo and 100 u/ml for anti TG were abnormal. Afterwards, using excel program the data were gathered, and the results were analyzed with t-test, c2 and spss software. 8 out of 80 women, had abnormal antibody results; 6 women had abnormal anti TG while 3 women had abnormal anti Tpo, and in one case both of them were abnormal. 7 out of 8 women who had abnormal antibody were in the group aborted and one of them was in the group who delivered her baby. The results show that the differences of anti thyroid antibodies between the 2 groups were statistically meaningful. The results show that the differences of antithyroid antibodies between the two groups were statistically significant. Furthermore, significant levels of these antibodies were only in the group with recent pregnancy abortion and were not dependent on their previous abortion.

Introduction & Cancer patients face with psychosocial and physical problems that may have an impact on the patient's quality of life. The purpose of this study was to investigate the relationship between mental health and quality of life in cancer patients. This study is a cross-sectional and correlation research. In this study, 90 patients that referred to Shafa hospital in Ahvaz were selected through convenient sampling in 2008. Data were collected by general health questionnaire and short form quality of life questionnaire (Sf-36) and were analyzed using Spearman's correlation, independent t-test and one way ANOVA. The results showed that most domains in quality of life were correlated with mental health domains. General health perception and physical function domains were correlated significantly with 3 domains of mental health: anxiety, social function and depression. Somatoform symptoms were significantly correlated with mental health domain of quality of life (P<0.02). Finally, social function was significantly correlated with social dysfunction domain of life quality (P<0.05). Also, anxiety and somatoform domains of mental health had been more significantly correlated in women than men (P=0.006, P=0.025). Of quality of life domain, physical function is more significant in men than women (P=0.03) and bodily pain is more significant in women than men (P=0.001). According to the findings, many quality of life domains were correlated with mental health domains and cancer had effect on different aspects of patient's life.

Introduction & There is limited evidence on chronic low back patient's perception and satisfaction of the treatment with spinal stabilization exercises and their overall experience of the treatment program. The objective of this study was to evaluate the satisfaction level of patients with mechanical nonspecific chronic low back pain after participating in a stability training program. At first, a methodological study was designed to develop a satisfaction questionnaire, and then content validity and test-retest reliability of it were determined. All patients (n=43) participated in a stability training program within a randomized controlled trial. Finally they filled in satisfaction questionnaire. Distribution of demographic variables were normal (P>0.43). 53.5% of the patients had solitary type occupations. 58.1% had history of sport activities. Also, pain location and extension in 46.5% and 65.2% were in lumbar region only. After stability training program, pain decreased (p<0.001) and functional ability as Oswestry and Quebec scales scores increased (p<0.002) significantly. Overall score of satisfaction questionnaire was 16±4.07. Patients with chronic mechanical low back pain were satisfied after participation in stability training program. Pain reduction and better functional ability may be two factors contributing to the satisfaction of these patients.

Introduction & Hospital records are representative evidences of medical team activities. In this study, we analyzed hospital records in Hamadan teaching hospitals to find out the problem extent and possible solutions for the problem. In a cross-sectional study, hospital records from teaching hospitals were gathered and put in check lists. We used convenient sampling from all departments, so that by referring to hospital achieve, all new discharged cases from different wards were extracted. We used a 16 item check list which targeted some basic questions like: admission order, discharge order, early and final diagnosis and so on. In each case perfect answer was registered in yes or no boxes. Collected data were analyzed by SPSS16 hardware. We achieved the following results after analyzing 457 records from 4 teaching hospitals; there were admission note in 94% of the patient's files. 93% of physicians and residents had signed the orders. 88% of the history sheets were being singed by medical students and/or residents. Differential diagnoses were present in only 75% of cases. Final diagnoses were found in 90% and discharge notes in 84% of the files. 86% of physicians had recorded therapeutic and/or surgical procedures. Paraclinical procedure recordings were present in 83% of the files. Only 63% of residents and/or interns had signed their progress notes. And nursing papers were signed in 99% of records. There was exact counseling information in 83% of the files which needed to be consulted; meanwhile 82% of the consulted files had been signed by physicians. This study shows that, there are important defects in hospital records. It seems that there are multiple factors contributing to the problem, such as overcrowding of the hospitals, careless medical students and the most important factors is insufficient training about the problem.

Uterine rupture in pregnancy is rare and often catastrophic with high incidence of fetal and maternal morbidity and mortality. The most common cause of uterine rupture is separation of previous cesarean hysterotomy scar. Other common predisposing factors to uterine rupture are previous traumatizing operations or manipulations such as curettage, perforation, myomectomy and excessive or inappropriate uterine stimulation with oxytocin.Case Report: In this case, spontaneous rupture of uterine at 25-26 weeks gestation (twin pregnancy) in a 36 year old woman has been reported(G5P2A2L1). She was hospitalized so that preeclampsia can be rule out for her. She underwent laparoscopic removal of myoma and 3 months later IVF was done for her because of secondary infertility. During hospitalization, suddenly she had mild vaginal bleeding and decreased fetal movement. Emergency sonography reported that the two fetuses died and severe oligohydramnius and myomatosis uterine with the biggest size was 90mm. Try of labor was done for her but she didnt respond to induction and the patient was qualified for cesarean section. During the operation, the rupture of the uterine wall was seen in the site of the previous myomectomy and the two dead fetuses were observed in the abdomen without myoma in the uterin. The myoma that was reported by the sonologist was hematoma and omentoma. Uterine wall was repaired.

: Nowadays establishment of a safe and secure airway for general anesthesia is necessary and establishment of the airway, according to the anatomical and physiological state, may be accompanied with complications such as piriform sinus damage resulting to subcutaneous emphysema. Subcutaneous emphysema and pneumomediastinum are rare complications of tracheal intubation and if not be treated they may be life threatening.Case Report: A 48-year-old female patient with main complain of tearing due to bilateral lacrimal duct obstruction was scheduled for endoscopic dacryocystorhinostomy surgery. Preopreative routine physical examination, laboratory tests and laryngoscopic view were normal. The patient had not any problem during tracheal intubation and surgery, but 90 minutes after recovery from anesthesia, severe subcutaneous emphysema in the neck occurred followed by coughing.Therefore the patient was shifted to the intensive care unit for complete care and discharged after 13 days. Candidates for general anesthesia patients without any problem in tracheal intubation regarding to their laryngoscopic view and routine examinations, undergoing invasive techniques such as all intubation stages, nasogastric tube insertion and deep oral suction especially with thick catheter have a high rates of air way injuries and subcutaneous emphysema.