مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال هفدهم شماره 4 (پیاپی 69، پاییز 1388)

Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein (ACC long) containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3rd postoperative day. Severity of atelectasis was also measured. Quantitative & qualitative data was analyzed by ANOVA and Chi-square tests, respectively. Pvalue<0.05 was considered as statistically significant. Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant (Pvalue<0.005) after extubation. Duration of mechanical ventilation was significantly shorter in patients who had N-acetyl-cystein, but duration of ICU stay was similar. Linear and segmental atelectasis was significantly less in the study group. N-acetyl-cystein can improve oxygenation and ventilatory parameters in pathological lungs, but further studies with different doses and different situations are needed.

The aim of this study was diagnosis of premature rupture of membranes in suspected patients by measurement of prolactin and B-hCG levels in vaginal washing in order to reduce perinatal mortality and morbidity. The study included 211 pregnant women who were referred to the emergency of Imam Hossein hospital at 28-38 weeks of pregnancy for leakage or prenatal care from April, 2007 to April, 2008. The expulsion of fluid from the cervix was evaluated and fern and nitrazin tests were done. B-hCG and prolactin levels of vaginal washing fluid were measured. The presence of 2 of 3 parameters of fern test, nitrazin and cervical fluid was defined as absolutely premature rupture of membranes. Mann-Withney U-test was used for analysis. The Roc curve was calculated. There were 132 patients in PROM group and79 patient in the control group. The average age in the PROM and control groups was 26.9‌±6.08 and 26.2±4.84 years, respectively(P=0.074). Both groups were matched for parity and gravidity. Prolactin levels in PROM group were 2930±3737mIU/l versus 23.18±120mIU/l in the control group (P=0.000). B-hCG was 439.78±1867mIU/l in PROM and 17.72±30mIU/l in control group (p=0.000). Sensitivity and specificity of prolactin according to cut-off of 16.0 mIU/l was 79.41% and 96%, respectively. Sensitivity and specificity for B-hCG with cut-off point of 12.5 was 69.85% and 69.33%, respectively. The measurement of prolactin and B-hCG levels in patients with suspected premature rupture of membranes can help in decision-making and treatment.

Hot flashes are common and discomfortable signs of menopause that present with blazing sweatiness, sense of hotness, tachycardia and agitation. Hot flashes cause disturbances in daily activity and quality of night sleep. In spite of the effect of Hormone Replacement Therapy (HRT) on hot flashes, nowadays, there are diverse opinions about HRT and the reason is that it has chronic complications. In addition, the acceptance of HRT by Iranian women is very low. Study of numerous texts has shown that isofliavone present in soybean is a phytoestrogen that could be effective in control of hot flashes. The purpose of the study is to examine the changes in time periods of hot flashes in response to consumption of 74 mg Isoflavone/day present in 60 grams soybeans in menopausal women.

This study was a clinical trial with before and after design that included 31 postmenopausal women. The participants were assessed with respect to daily hot flashes at baseline and after one, two and three months of intervention. Participants consumed daily 60 grams soybeans for 3 months. Blood samples were taken at the start and end of intervention for determining levels of gonadotropins and estradiol. Data was analyzed by SPSS software.

There was a decrease in time period of hot flashes from baseline of 5.88±2.61 to 3.45±1.82 after one month, 2.73±1.57 after two months and 2.16±1.48 after three months of consumption of soybeans (P<0.001). There was decrease in levels of FSH, LH & estradiol after 3 months, but this decrease was not significant, except in the case of estradiol.

In line with various studies proposing the use of soybeans in the form of concentrate, drink or capsule, this study suggests that consumption of soybeans (60 gr daily) as snacks may be a safe and effective method for controlling hot flashes in postmenopausal women.

Bleeding disorders are a common problem in daily practice, especially in premenopausal women. In our investigation, we compared the sensitivity and specificity of three different diagnostic methods; Trans-vaginal sonography(TVS), saline infusion sonohystrography(SIS) and Hysteroscopy.

It was a cross- sectional study with a study population of ninety-nine women suffering fromAUB attending the outpatient clinic of Imam and Razi hospital in Ahvaz- Iran. They were evaluated by three different diagnostic methods and the results were compared. This study started from March 2008 to December 2008. The sensitivity, specificity, positive predictive and negative predictive values were measured in TVS, SIS, and finally these two methods were compared with hysteroscopy (as a gold standard).

The sensitivity and specificity of TVS was 74.2% and 49.7%, respectively, while that of SIS was 91.6% and 86%, respectively. The positive predictive value and negative predictive value of TVS was 71.9% and 54.3%, respectively, while that of SIS was 85.9% and 85.75%, respectively. The sensitivity, specificity, the positive predictive and negative predictive values of SIS was more than TVS, and it was similar to hysteroscopy.

The findings obtained in the present study indicate that in AUB, sensitivity, specificity, positive and negative predictive value of SIS is more than TVS and therefore can be considered as a first step for diagnosis of AUB.

The aim of the present study was to assess variations in coagulating pathways after simultaneous administration of warfarin and vitamin C. A total of 50 Wistar rats were selected. The rats were divided into 5 groups (1 group as control and 4 groups as experiment; with 10 rats in each group). One group was control group, second group was given only warfarin for 10 days while the third group given warfarin and vitamin C simultaneously for 10 days, fourth group was given only warfarin for 20 days, and fifth group was given warfarin and vitamin C simultaneously for 20 days. After 10th and 20th days of administration of warfarin and vitamin C, blood samples were taken in order to measure the mean PT, PTT, BT and CT levels. vitamin C caused a decrease in PT and PTT after 20 days. PT and PTT showed a significant decrease after 10 days in the group that received only warfarin as compared to the group that received warfarin and vitamin C. BT levels showed a decrease after both 10 and 20 days in the group that received warfarin and vitamin C together as compared to the group that received only warfarin. There were significant statistical differences in BT of the two groups of rats (group receiving warfarin and vitamin C and group receiving only warfarin) (P< 0.05). Simultaneous administration of vitamin C and warfarin (20 days) results in decrease of PT, PTT, BT and CT and neutralization of warfarin effect. The effect of vitamin C on blood coagulation can be similar to vitamin K.

It is believed that prolonged and intensive exercise training may induce tissue damages due to production of free radicals and other reactive oxygen radicals. Antioxidant capacity status in Zourkhaneh (traditional wrestling) sportsmen has not been studied to date; therefore, the purpose of this study was to compare of antioxidant characteristics and cardiovascular risk factors of Zourkhaneh sportsmen and non-sportsmen. In the study, 17 male Zourkhaneh sportsmen who were active in the last 6 months for at least 3 sessions per week and each session of at least 45 minutes, and 20 male sedentary individuals who did not have any regular physical activity during the same time period participated in the study. Total antioxidant capacity (TAC), supreoxide dismutase (SOD) activity and lipid status was determined through standardized and valid methods in the biochemistry laboratory of Birjand university of medical sciences. T-tests were used to compare groups and statistical significance was also considered where P<0.05. The TAC and anaerobic power of the legs of Zourkhaneh sportsmen was significantly higher than non-sportsmen (P<0.05). In addition, it was observed that there was no significant difference between the two groups regarding their lipid profile, body mass index (BMI) and body fat percent (P>0.05). Zourkhaneh special trainings result in beneficial antioxidant status and better anaerobic power as compared to non-sportsmen and these factors make them more resistant against cardiovascular diseases.

Children’s obesity is strong predictor of obesity in adulthood, which increases the incidence of related diseases such as metabolic syndrome. Fatty liver is an abnormality related to metabolic syndrome with higher prevalence in obese children according to some previous studies. This study investigates the presence of Sonographic Fatty Liver (SFL) in Iranian obese children in comparison with normal and overweight children.

This was a cross-sectional study on 962 randomly selected children between the ages of 6 to 18 years. The subjects were divided into three groups of normal, overweight and obese based on body mass index (BMI). A questionnaire including demographic and anthropometrical characteristics was filled for each case. To detect the presence of SFL, all the subjects underwent assessment with ultrasonography by a radiologist who was not aware of their BMI. The incidence of SFL was determined on the basis of ultrasonographic diagnosis criteria.

The prevalence of SFL in obese children was 54.4% that was significantly higher than overweight (10.5%) and normal children (1%). There was no significant difference in prevalence of SFL between sexes.

The high rate of detected SFL in obese children in this study suggests that Iranian obese children are at risk of metabolic syndrome. It is therefore necessary to develop some plan to control obesity and its late complications.

Shiga toxin- producing Escherichia coli (STEC) is an emerging bacterial pathogen in developing countries that causes several diseases such as diarrhea, hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS), particularly in children. Aim of the research was detection of STEC in diarrheal specimens from under 5 year olds and study of the patterns of antibiotic resistance of these strains. In the study,300 fecal samples were collected from children with diarrhea referring to Ali Asghar Hospital. E.coli species were isolated by standard bacteriological and biochemical tests. Presence of shiga toxin genes (stx1/2) was investigated by PCR technique (Qiagen). Antibiogram test for strains containing the toxin gene was performed using 16 different antibiotic discs (MAST) by disc diffusion agar (Kirby-Bauer) method. From 39 E.coli isolates, 9(23.1%) strains were detected by PCR to contain stx1/2 gene. One strain was resistant to all 16 antibiotics. All the STEC strains were sensitive to meropenem (MRP), imipenem (IMI), gentamycin (GEN) and nitrofurantoin (NI). 4(44.44%) strains showed multi-drug resistant pattern. All these 4strains were resistant to cotrimoxazole(SxT). Also, 6(66.66%) strains were resistant to at least one antibiotic. In Iran, shiga toxin- producing Escherichia coli (STEC) may be a commonly bacterial pathogen causing diarrhea, particularly in children. Therefore, we should use new techniques for investigation of these strains. Increase in number of emerging and new strains that could be resistant to classic antibiotics such as cotrimoxazole may be foreseen. It is suggested that antibiotics prescription programs in treatment of diarrhea causing E.coli strains be updated.

Human T-cell lymphotropic virus (HTLV), is a member of the retroviridae family. Infection with this virus leads to adult T-cell leukemia (ATL) and tropical spastic paraparesis (TSP). HTLV is endemic in Japan, parts of central Africa, Caribbean basin and Iran (Mashhad). Transmission routes of HTLV are believed to be from mother to child, especially during breastfeeding, sexual contact, and through blood transfusion or needle sharing. Considering the risk of HTLV infection among injection drug addicts, the authors evaluated the seroprevalence of HTLV1,2 infection among injection drug addicts in Isfahan This cross sectional study included a total of 150 injection drug users who were recruited at the drug abuse treatment clinic and the infectious diseases department of Alzahra university Hospital. Participants were interviewed using a structured questionnaire. Epidemiologic data were recorded and their blood samples were tested for HBs Ag and antibodies against HTLV1,2, human immunodeficiency virus (HIV) and hepatitis C (HCV) by Elisa method. Results were analyzed by SPSS software version 13. Seroprevalence of HTLV1,2, HBV(HBs Ag), HCV and HIV was 2.7%, 1.3% 23.3% and 2.7%, respectively. Some of the subjects were co infected with two viruses. One patient was infected with both HCV Ab and HBs Ag, while another was positive for HIV Ab plus HBs Ag. Three were co infected with HCV and HIV. Among those with HTLV1,2, only one was HCV Ab positive. Only in one person with HTLV1,2 Ab had a positive history of blood transfusion. This study shows that this virus is present in injection drug users community of Isfahan and can be a potential source for transmission. But proposal of screening of HTLV1,2 among injection drug users in Isfahan requires further investigations.

The aim of the current research was to investigate and compare the effectiveness of Subjective Well Being Program and Fordyce Cognitive Behavior method in reduction of depression in high school students of Isfahan City. In the study, 150 high school girl and boy students who suffered from depression were randomly selected and were assigned in six groups (4 experimental groups and 2 control groups(n=25)). The intervention methods were Subjective well-being Program and Fordyce cognitive-behavior method. Kovacs questionnaire was chosen as a research instrument. Variance analysis showed some significant differences between the control and experimental groups with regards to depression reduction. The follow up Scheffe test also showed that there were no significant differences between the Subjective well-being Program and Fordyce cognitive-behavior methods. According to the performed research, both educational methods were effective in reducing depression without any significant difference between the two methods.

Traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs with the overlying skin remaining intact. Diagnosis of this problem is very difficult and delayed. Traumatic hernia is often diagnosed during laparatomy or laparascopy, but CT scan also has a role in distinguishing this pathology. Delay in diagnosis is very dangerous and can result in gangrene and necrosis of the organs in the hernia. The case report of a 35 years old man with liftruck blunt trauma is reported. His vital signs were stable. On physical examination, tenderness of RUQ was seen. He underwent Dpl for suspected hemoprotein. Dpl was followed up by laparatomy. Laparatomy revealed that the transverse and ascending colon partially herniated in the abdominal wall defect. The colon was reduced in the abdomen and repair of abdominal hernia was done. The patient was discharged after 5 day. The etiology, pathogenesis and management are discussed.