مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و دوم شماره 1 (پیاپی 85، فروردین و اردیبهشت 1389)

Regional anesthesia (spinal and epidural) is the method of choice for cesarean surgery, and frequency used during elective cesarean section. In emergent situation, general anesthesia is preferred. The aim of this study was to compare between general anesthesia and spinal anesthesia on neonate's Apgar score delivered by cesarean surgery. In a prospective study, 75 patients who were candidate for cesarean section with term fetus were randomly divided into three groups each 25 patients. The first group underwent spinal anesthesia with 5% Lidocaine, second group received general anesthesia with propofol (2mg/Kg) and third one anesthetized generally with thiopental sodium (5mg/kg). Apgar score of neonates were evaluated and recorded in each group at 1,5,10 and 15 minutes after delivery. Data were analyzed with SPSS.13 software by ANOVA test. Average neonatal Apgar's in first minute of delivery in different groups was as the followings: propofol 9.04±1.31, sodium thiopental 8.80±1.41 and spinal anesthesia 9.12±0.93 (P=0.636).The result of apgar score measurements in each group at fifth minutes after delivery was as the following: sodium thiopental 9.72±0.67, propofol 9.44±0.77 and spinal anesthesia 9.68±0.56 (P=0.289). The results of the same measurements at 10th and 15th minutes are as the following succedingly: sodium thiopental: 9.80±0.65, propofol: 10 spinal anesthesia 9.96±0.20 (P=0.166) and sodium thiopental 9.92±0.28, propofol 10, spinal anesthesia 10(P=0.132). General anesthesia with sodium thiopental or propofol and spinal anesthesia didnt have any significant effect on neonatal Apgar.

Autonomic nervous system (ANS) dysfunction such as postural hypotension, impotence and ventricular arrhythmia are common problems in uremic patients. It is thought that they are due to retained uremic toxins that lead to neuronal damage. Sympathetic skin response is a non-invasive and simple examination of Autonomic nervous system. In his study 30 patients on continuous ambulatory peritoneal dialysis (CAPD) and 30 patients on hemodialysis (HD) were allocated and Sympathetic skin response (SSR) study was performed in these two groups. SSR was intact in 22 of PD patients (73.3%), while it was detectable only in 4 patients (13.3%) on HD (P<0/001). We concluded that sympathetic nervous system impairment was more prominent in HD than CAPD patients. It would be because of better clearance of middle molecule toxins with moderate molecular weight in peritoneal dialysis.

Creatine monohydrate (CrM) ingestion is a popular ergogenic aid among young athletes to enhance muscle mass and exercise performance. However, there are controversies about the adverse effects of this supplement particularly cardiovascular system. Therefore, this study was conducted to determine the effect of CrM ingestion during eight weeks of resistance training on serum CK & CKMB in non-athlete men. Seventeen non-athlete healthy male volunteers were randomly divided into experimental (n=9) and control (n=8) groups and participated in a randomized and double-blind design. All subjects completed 24 sessions of weight training (3d/w, and 3 sets/10 reps with 75% 1RM) in eight weeks period. Experimental subjects consumed 250 ml Creatine monohydrate supplementation solution (0.07 g/kg/day) during the training protocol, but control group was took placebo (wheat flour). Venous blood samples were obtained before the training and 24 h after the last session of weight training. Serum CK and CKMB activities (IU/L) of samples were measured. Data was expressed as Mean ± SD and statistically analyzed by statistical methods. The results indicate that CK and CKMB activities were significantly increased in experimental group (CKpre: 146.12±14.61; CKpost: 253.66±21.32 IU/L, P<0.001; CK-MBpre: 10.03±1.21; CK-MBpost: 14.63±1.48 IU/L, P=0.007) while, CKMB activity change was not significant in control group (CKpre: 130.33±18.16; CKpost: 162.50±20.53 IU/L, P<0.009; CK-MBpre: 10.72±1.35 IU/L; CK-MBpost: 11.69±2.03 IU/L, P=0.91). This observation suggests that CrM ingestion might have adverse effects on myocardium damage indices. However, more research is needed to identify the acute and chronic side effects of Creatine monohydrate supplementation in the future.

Diabetic retinopathy and macular edema are the most important cause of severe visual loss. At this study we evaluated the effectiveness of combined Intra Vitreal Triamcinolone Acetonide with panretinal laser photocoagulation on concomitant diabetic macular edema and high risk proliferate diabetic retinopathy. In a non randomized clinical trial, between Aug 2005 to Aug 2006 on 50 diabetic patients with advanced proliferative diabetic retinopathy and CSME were entered. Group 1 received Panretinal Photocoagulation and Macular Photocoagulation and Intra Vitreal Triamcinolone Acetonide (4mg) (right eye) and group 2 received only Panretinal Photocoagulation and Macular Photocoagulation (Left eye). Complete ophthalmologic examination, fluorescein angiography and optical coherence tomography (OCT) were performed before intervention and 2, 6 and 9-12 month after intervention in each groups. Two months after intervention Mean BCVA in group 1 was 0.35 0.33 and in group 2 was 0.47 0.28, (P=0.137). Mean centeral forveal thichness after 2, 6 and 9-12 months between two groups were as the following (257.38 73.91 P<0005 vs 341.81 110.380), (280.41 120.54 P<0005 vs 377.86 119.63) and (311.19 97.47 P=0.043 vs 369.62 123.53). Combination of intra vitreal triamcinolone acetonide injection with panretinal laser photocoagulation may be effective treatment on concomitant diabetic macular edema and proliferative diabetic retinopathy.

Recently, exercise-induced biochemicals, electrical and functional changes of cardiovascular system are used as a diagnostic measurement in the field of cardiology. Therefore, this study was conducted to investigation the above parameters in a group of untrained males after one bout of maximal isometric exercise (MIE). In this prospective study, we entered 17 healthy untrained young male volunteers. They performed a dead-lift exercise on the maximal voluntary contraction (MVC) for 30 second. Rate-pressure product (RPP), serum CK-MB and ECG monitoring were recorded before and immediately after one bout of maximal isometric exercise in each participant. Data were expressed as means ± S.E and analyzed by paired t-test and Pearson´ correlation coefficient at α≤0.01. The results indicate that all functional indices (HR, SP & RPP) and serum CK-MB were statistically increased in the participants (aged = 22.47±1.54 year; BF% = 17.01 ± 1.03) after the training protocol. Indeed, T wave and QT interval were significantly changed after MIE but ST segment was not changed after the protocol. Thus, the results indicate meaningful linear correlation between and RPP and CK-MB (r=0.73; P<0.0003) and between T wave changes with RPP (r=-0.66; P <0.002) and CK-MB (r=-0.52; P <0.01). Based on the present findings, it can be concluded that the rate-pressure product can be used as a simple and noninvasive method for estimating cardiac strain during isometric exercises.

Hepatitis Delta Virus (HDV), is a defective single strand RNA virus that requires the provision of hepatitis B virus (HBV) infection for its replication and expression. According to prevalence of HBV infection in this area, this study was carried out to determine the seroprevalence of HDV among hepatitis B surface antigen HBsAg - positive individuals.

In this prospective study from March 2007 to March 2008, 368 HBsAg- positive samples in five high risk groups; 100 Hemodialysis subjects, 165 blood donors, 90 intravenous drug addicts, 11hemophilic and 2 thalassemia patients from Tabriz Regional Educational Blood Centre in East Azerbaijan province of Iran were enrolled. All cases were evaluated for the presence of anti-HDV antibodies using commercially available ELISA method. ALT and AST levels also measured with IFCC method.

Anti-HDV antibody was positive in 8 of 100 hemodialysis subjects (8%), 3 of 165 blood donors (1.8%), 9 of 90 intravenous drug addicts (10%), 2 of 11 hemophilic patients, but anti-HDV antibody was negative in 2 thalassemia sera.

Considering to the results of this study, the highest rate of HBsAg positive were found in high risk group (intravenous drug addicts and Hemodialysis) and there were no significant relation between age and sex in patient group (P > 0.05). Tabriz city is located in endemic area of Hepatitis D virus infections, so more study in different high risk group infections with effective factors and parameters is completely essential.

Verocytotoxin-producing: Escherichia coli strains are important human pathogens. Here we studied the prevalence of virulence genes and O stereotyping in strains isolated from urine samples. In this study, 300 urine samples from individuals with urinary tract infections E. coli was isolated using enterobacteriase diagnostic kit. The strains were examined with polyvalent and monovalant antiserum for O-serotyping. Verocytotoxin-producing E. coliv strains were characterized by polymerase chain reaction. O157 groups were distinguished from non O157 groups by culturing in sorbitol macconkey agar. Rapid Passive Latex Agglutination (RPLA) technique was performed in order to find the expression of vtx1 and vtx2 genes. From total number of 300 urine samples, 180 samples had positive culture result for E. coli of these, 158 strains had virulence genes and all of them showed a toxic effect after applying Rapid Passive Latex Agglutination technique. Twenty four percent of samples were classified as O157 group and 76% as non O157 group. The most prevalent virulence genes were found in O26 strains containing vtx1 genes. Our findings showed that non-O157 verocytotoxin-producing E.Coli is more prevalent than O157 strains in our study.

Neonatal jaundice is one of the most common problems during neonatal period. The objective of this study was to determine whether measurement of total serum Bilirubin (TSB) by transcutaneous method (BiliCheck) correlates with spectrophotometric and Diazo methods or not. In a cross-sectional and descriptive study from October 2006 to November 2007 total Serum bilirubin levels were measured in a group of term neonates with hyperbilirubinemia by three Diazo, spectrophotometric and Bilicheck, data were gathered and analyzed by Pierson’s Correlation Coefficient and Chi square tests. The study group consisted of 85 infants with hyperbilirubinemia (M/F 47/38). Result of measurement of total serum Bilirubin with: Diazo, spectrophotometric and Bilicheck were (16.74 ± 4.39) mg/dl, (16.16 ± 4.57) and (14.73 ± 3.48), respectively. Significant direct liner correlation was found between total serum bilirubin measured by Bilicheck, Diazo and spectrophotometric methods. Sensitivity, specificity, positive and negative predictive values of Bilicheck method in comparison with Diazo method were 94/82%, 44/5%, 78/57% and 80%, respectively. Transcutaneous Bilirubinometry by Bilicheck is a simple and accurate method for measurement of serum Bilirubin level in neonates.

Severe corneal ulcer is an ocular emergency. The aim of this study was to identify the predisposing factors, microbial isolates and therapeutic results of patients with corneal ulcer. In a prospective study, between" 2003-2004" all patients with corneal ulcer, who admitted to Nikookari hospital, were evaluated by corneal scraping. All samples were studied by gram staining and micro biological culture. Corneal scraping was performed in 100 patients (M/F = 65/35, 51-80 years). Thirty one percent were farmer. Previous corneal surgery had been performed in 30% of patients. The most common organism in gram stain was staphylococcus Epidermidis (58%) and topical Cephazolin and Gentamycin were used in 89% of cases. Corneal ulcer was healed in 74% of patients with medical therapy. In this study, staphylococcus epidermidis was the most common organism and previous eye surgery was the most predisposing factor for development of corneal ulcer.

Alzheimer disease (AD) is a neurodegenerative disorder manifested by memory lost and other cognitive dysfunctions. Its neuropathological characteristics include presence of neurofibrillary tangles and senile plaques. It has been hypothesized that the stored metals might be the key to the damage. One of these suspected elements is iron. This study aimed at evaluating the serum ferrous level in a group of patients with AD. In a one year case-control study, a group of patients with definite diagnosis of Alzheimer disease were evaluated by Global Deterioration Scale (GDS) for their disease severity, the serum ferrous level also has been measured by atomic absorption method in each individuals. We also measure the serum ferrous level in a group of controls. The serum ferrous level was compared between the case and the control groups, and also its relation with disease severity was assessed. Fifty patients, (26 / 24 M / F mean age of 71.34±6.69) and 50 healthy persons, (17/33 M / F mean age of 68.96±6.39).The serum ferrous level was 0.41±0.16 ppm and 0.46±0.20 ppm, respectively (P=0.229).There was no significant correlation between the serum ferrous level and the severity of Alzheimer disease (r=0.186, P =0.195). The current study showed that there is no significant difference between patients with Alzheimer disease and healthy controls in terms of the serum ferrous level.

Enteroccoci organism producing life threatening infections such as endocarditis, septicemia, meningitides and urinary tract infections create a state of necessity of more research in this area. Hence we studied the antibiotic susceptibility patterns of Enterococci isolated from clinical samples. Between 2001-2002 enterococci were isolated from different clinical speciments. Antibiotic susceptibility of isolates were examined with disk diffusion test to vancomycin and other panel of antibiotics. For vancomycin, minimum inhibitory concentrations (MICs) were also determined by macro-dilution broth according to Clinical and Laboratory Standards Institute (CLSI) method. The presence of plasmids in vancomycin resistant and vancomycin susceptible enterococci was also compared. From a total number of 52 enterococci isolates the majority of isolates were E. faecalis (92/3%) while only E. faecium were isolated in (7/7%). Two (3.8%) out of 52 isolates were VRE, with MIC of 8 ≥ μg/ml to vancomycin. Among 52 isolates, we found resistance to oxacillin in (100%); penicillin: 98.1%, co-trimoxazole: 94.2%, doxycycline: 84.6%, gentamicin: 69.2%, nitrofurantoin: 34.6%, ampicillin: 57.7%. Plasmid bands of 4.5, 17.2, 23.5kb were only observed in two vancomycin resistant isolates. The findings of this study show an emerging of vancomycin resistant enterococci among resistant entrococci. Resistance of enterococci isolates against majority of common antibiotics has been increased.

Interaction between special personality style and stress is a predisposing factor for depression. The aim of this study was to evaluate the theory of cognitive vulnerability of beck about the relation between sociotropy / autonomy personality styles and stressful life events in patients with depression. One hundred depressive patients were selected non randomly from consequtive referees to psychiatric and psychological clinics of Tabriz university of medical sciences. All patients were asked to complete the Beck Depression Inventory (BDI-II), Personal Style Inventory (PSI-II), and Stressful Life Events questionnaire. There was a significant relationship between personality style, as a predisposing factor, and stressful life events, (P<0/01). Depression was experienced by sociotropy people, when they were encountered with loss experience, separation and interpersonal problems. Depression was experienced by Autonomous people, once they were frustrated and they had experienced failures. Sociotropy was seen more among women and autonomy was more observed among men. But there was not any significant difference between depression symptoms and personal style. In conclusion when sociotropic and autonomic people combat with congruent stress they often experience depression episodes.

CatSper 1-4 are a unique family of sperm cation channels that are restrictly expressed in the testis and play an important role in sperm motility and male fertility. Aim of this study was to evaluate the effects of selenium, on the expression of CatSper genes in aged male mice.

Thirty 11-13 months aged male mice and thirty adult male 2-3 months old mice were randomly divided into three groups. Control group received no injection. Sham group received intraperitoneally normal saline injection. Experimental groups of male mice received intraperitoneal injection of selenium (Na2Seo3) 0.2 mg/kg daily for 5 weeks in row. Animals were scarified on days 21, 28, 35 and 42 after Selenium treatment and one of the testes extracted and used for Semi-Quentitative RT-PCR. RT-PCR reaction was performed for both CatSper and β2m genes. After gel electrophoresis, the intensity of each band was quantified using Uvidoc Software. We used immunohistochemistry to determine the location of CatSper protein. SPSS software was used for data analysis. P<0.05 was considered as significant.

The results revealed that there was significant up-regulation of CatSper gene experimental groups compared to the control ones (P<0.05). Selenium treatment in the aging male mice caused more CatSper expression compared to the adult ones (P<0.05). Results of immunohistochemistry staining showed that CatSper proteins were localized in main part of the sperm tail and acrosomal region.

Selenium treatment in aging subjects could up-regulate CatSper gene expression which is one of the responsible genes of sperm motility.

E. coli O157:H7 strain is known cause of bloody diarrhea and haemolytic uremic syndrome (HUS). The aim of this study was to determine the effect of milk fermentation by Bifidobacterium angulatum as a probiotic on infection induced by E. coli O157:H7 in mice. In this study 45 female mice, 6-8 weeks age were randomly divided into 5 groups, each containing 9 mice. Control group (A), Infected group (B), non-infected group feeded by probiotic (C), pre-infected group feeded by probiotic (D) and post-infected group feeded by probiotic (E). Each of the mouse in groups (B, D) and (E) received 1.5×108 CFU of E. coli O157: H7 by intra gastric tube. Group (C) feeded with 0.5 ml of B. angulatum fermented milk daily for 14 days, group (D) and group (E) were feeded with 0.5ml of B. angulatum fermented milk daily for 7 days before and after infection respectively. Stools of the mice were examed for E. coli O157:H7 before getting infected and on days 3, 5, 7 and 9 after getting infected. For identification of E. coli O157:H7 we used MacConkey sorbitol agar medium. Specific antiserum also was used for more confirmation. Alive E. coli O157:H7 was not isolated in control group (A), and non-infected group feeded with the probiotic (C). Statistical analysis showed significant differences between groups B (11.53±2.81) ×105 and D (2.67±0.56) ×105 cfug-1 (P<0.01) and B (11.53±2.81) ×105 and E (1.47±0.57) × 105 cfug-1 (P<0.01). Consumption of milk fermented by B. Angulatum shortens the duration of E. coli O157:H7 and reduces the severity of the illness.

Measurement of postvoid residual (PVR) urine volume in patients with benign prostatic hyperplasia (BPH) is a practical method for diagnosis, treatment and follow-up of these patients. This study was conducted to evaluate the accuracy of Ultrasound study method in compare with standard bladder catheterization for measurement of PVR volume. In this prospective study that was done between January to November 2007 consecutive patients who were admitted in the Urology unite because of BPH evaluated were enrolled. All patients were examined with full bladder, and after voiding PVR volume was measured by ultrasound in supine position. Immediately after ultrasound examination the bladder was catheterized and the PVR determined accurately. In this study total number of 60 patients were studied (67.10 8.33 years). In dose with PVR volumes lower than 50 ml the mean difference between ultrasound measurement and catheterization measurement was 7.89±0.86ml, in those with PVR volumes between 51-100 ml the mean deference was 14.46±1.87, and with PVR volumes higher than 100ml the mean difference was 32.73±2.99 ml. Conventional transabdominal ultrasound is a roughly reliable method for assessing the residual urine volume in patients with BPH.