مجله فیض
سال پنجم شماره 3 (پیاپی 19، پاییز 1380)

History and Considering the incidence of? -thalassemia major and the presence of hypogonadism in affected individuals and the absence of the effect of dysferal on Zinc level and the significance of Zinc in spermatogenesis, this study was carried out to determine the effect of Zinc therapy on hypophyseal-gonadal axis in patients with? -thalassemia major and Zinc deficiency in 1996. The clinical trial and two-blind strategy of this study was conducted on 23 male and female patients with an age range of 14-18 years. They were randomly divided into control and case groups. Case group received 25-mg capsules and control group received its vapor for 3 months. LHRH test was done before and after Zinc therapy and hormonal responses were recorded at minutes 0, 30 and 60. Four patients were excluded from the study and the research was conducted on 19 patients including 9 cases in control group and 10 cases in case group. In case group, Zinc level increased from 15±6 µg/dl to 120±49 µg/dl (P<0.001), but there was no such increase in the placebo group. In addition, there was no increase for FSH and LH level after treatment in both groups. Conclusion and Recommendations: It is concluded that Zinc therapy for three months could not affect the response of hypophyseal-gonadal axis. It is strongly recommended to conduct researches whether Zinc deficiency may lead to irreversible damages or Zinc is not the only factor responsible for hypogonadism.

History and During Iraq-imposed war against Iran, various chemical wares were used. The short-term and intermediate effect of such agents has been previously reported. Considering various reports on the effect of mustard gas in chemically injured soldiers and in order to follow up its effect on hematological parameters, this study was conducted on war-injured soldiers in Guilan province during the years 1998-1999. This study was carried out on 102 chemically injured soldiers (case group) and 102 normal soldiers without facing any chemical attack (Control group). Blood specimens were analyzed regarding number of red and white blood cells, platelets and monocytes using SE RONNO 9010 and data were evaluated statistically. This study was performed on 204 individuals in two equal groups. Case group had a history of chemical injury equal to 10.7±2.3 years. Number of RBC, WBC, multinuclear cells and monocytes in control group was 4.6±0.39, 6858±1238 and 3702±952 and 96±14. There was a similar count for eosinophils in both groups. In addition, MCV and MCH were greater in control group (19.6%) compared to case group (6.9) (P<0.02). Conclusion and Recommendations: In spite of a 10-year duration after war, there existed chemical-related complications. Therefore, it is recommended to carry out more studies in this field.

History and Insertion of intragastric tube through nose in infants for evaluation of congenital abnormalities of nose, esophagus and stomach in early hours after birth can lead to some complications (Bradycardia, apnea and/or cyanosis) as a result of the stimulation of receptors of pharynx. This study was carried out to determine the complications in Javaheri hospital affiliated to Islamic Open University during the years 2000-2001. The clinical trial strategy of this study was carried out on 550 mothers and their infants. Infants were randomly divided into case and control groups. In control group, after controlling vital signs intragastric tubing was performed using standard method within 15 min post-partum and its effect on heart rate, number of breaths and skin color were evaluated. In case group, vital signs were recorded without tubing twice with an interval of one min. Heart rate in case group was 151.6±14.5 and 150±19.7 (A change of 1.1%) for the first and second measurement respectively. In control group, heart rate was 152.8±14 that increased to 155.3±15.8 after tubing (A change 1.6%). Breath rate was 54.8±11.6 and 54.7±11.3 (A change of 0.2%) in case group for the first and second measurements respectively. In control group, breath rate was 53.6±10.8 that increased to 53.7±9.8 after tubing (A change of 0.2%). All of these differences were non-significant statistically. Central cyanosis was observed in 3 infants of case group one min after first examination (1.1%). Meanwhile, 7 infants had such a condition after tubing (2.6%). Conclusion and Recommendations: Intragastric tubing could not affect the infantile vital signs during the first hour post-partum. It is recommended to evaluate the effect of duration of tubing on the development of complications.

History and Myopia is the most common refractive disorder with a prevalence of 25% in the world with different etiologic factors including the role of focusing on nearby objects. This study was conducted to determine the relationship between carpet kneading and the incidence of myopia in Birjand in 1994. The cohort strategy of this study was performed on 453 carpet-kneading workers as case group and 100 other ones as control group not involved in this occupation. They were matched regarding age and gender. All of them were examined by an optometrist using retinoscope and autorefractometer and then examined by an ophthalmologist. For statistical analysis, chi-square test was used. There was an incidence of 29.2% for myopia in case group and 10% in control group (P<0.0005), that is, 2.9 times than that of control ones. Meanwhile, the incidence of myopic astigmatism in case group was 4 times greater than control group (In all age groups). In addition, a significant relationship was found between period of occupation and duration of work in each day and the occurrence of myopia (P<0.001). Conclusion and Recommendations: Carpet-kneading could lead and/or accelerate the occurrence of myopia and it is recommended to perform more studies more studies in this field.

History and Considering the incidence of osteoarthritis and its known complications and significance of its etiology and the relationship between articular cartilage and its occurrence and lack of a histopathologic study based on radiologic scoring, this study was conducted to determine the relationship between the thickness of articular cartilage and intensity of osteoarthritis in referrals of Maabari hospital and Forensic medicine center in Tehran in 2000. The case-control strategy of this study was carried out on 30 patients with fracture of femur neck and having total hip arthroplasty. For control group, 5 samples of femur head were collected from normal individuals. Samples were fixed in 10% formalin and then sliced into 6 segments. Therefore, radiological examination was performed and according to Jeffery and Meachim methods were scored into normal and grades 1-4. After decalcification, two mid-coronal sections were done on each segment and through dehydrating and blocking in paraffin, they were stained by hematoxylin and eosin. For measurement of thickness of articular cartilage, an ocular graticule (#18) was used. For statistical analysis, t-test was applied. This study was performed on 5 samples of femur head of normal cadavers with an average age of 26.4±2.7 and 30 patients including 20 cases with fracture of femur neck and 10 cases with osteoarthritis and have undergone a surgical operation. Thickness of femur head was less in patients with osteoarthritis compared to control group. There was no significant difference between case and control groups regarding anterior portion of femur head. Thickness of cartilage in middle and posterior portions in control group was 2.12±0.55 (0.52±0.83 according to scoring, P<0.05) and 1.47±0.42 (0.66±0.81 according to scoring, P<0.01) respectively. Conclusion and Recommendations: Thickness of articular cartilage, especially in upper and posterior portions of femur head is less in patients with osteoarthritis than is in normal individuals. Therefore, it is recommended to conduct research study to determine the value of radiological findings in diagnosis of changes in the thickness of articular cartilage on a histological basis and use of devices to reduce pressure in upper and posterior portions of femur head.

History and Considering the significance and role of blood lipid in cardiovascular disorders and lack of information on the effect of consumption of Iranian animal fat on blood lipids, this study was carried out in rural areas of Birjand. This study was conducted on 30 rural inhabitants, consuming mainly animal fat (Case group) and 30 ones consuming mainly saturated solid plant-derived oil (Control group). Both groups were similar regarding personal characteristics, social activities and existing disorders. Fasting blood samples were collected and levels of total cholesterol, triglyceride, HDL and LDL were determined. For statistical analysis, t-test was used. Both groups were similar regarding age, gender, related factors and level of blood lipids. In this respect the difference between two groups was not significant. The level of total cholesterol was 232±7.6 in case group and in control group was 195.3±40.9 (P<0.001). The level of other parameters in case group was 8-20% of control group. Conclusion and Recommendations: Long-term consumption of animal fat could lower the level of blood lipids. Therefore, it is recommended to carry out similar studies in other regions.

History and Thyroid disorders are variant in different regions. Considering the significance of thyroid disorders, time-consuming and costly diagnostic methods and the suggestion of a scoring for early diagnosis, this study was carried out to compare the clinical and paraclinical criteria for thyroid disorders in referrals over 15 years in health centers of Kashan from 1997 to 2000. This diagnostic strategy of this study was conducted on patients at an age range of 15-60 years and suspicious to have thyroid disorders. In this respect, Flipp Fling scoring was used. A net score greater than 18 was considered hyperthyroidism, between 11 and 18 was considered as suspicious and less than 11 was considered as euthyroidism. In hypothyroid scoring, net score greater than 19 was considered as hypothyroidism. For all patients, measurement of T3, Free T4 and TSH was requested. Patients with TSH level lower than 0.3 microgram and T4 greater than 12 and T3 greater than 180 microgram were considered as hyperthyroid and patients with TSH level greater than 5 microgram and T4 less than 4 and T3 less than 8 microgram were considered as hypothyroid. This study was carried out on 200 patients. Out of 150 suspicious cases, 31 (20.7%) were male and 119 (79.3%) were female. In addition, 100 out of them were supposed to have hyperthyroidism and 50 were supposed to have hypothyroidism. Most of the hypothyroid patients were female (80%). 78% of hypothyroid patients were female. Therefore, thyroid disorder was more common in female ones. Sensitivity of scoring method for hyperthyroid state was 91% and for hypothyroid state was 76%. Conclusion and Recommendations: Considering the costly paraclinical tests, Flipp Fling criteria are recommended to be used for diagnosis of thyroid disorders.

History and Extraction and purification of polysaccharide capsule is the first step for preparation preventive vaccines in infections as a result of encapsulated Staphylococcus aureus. This study was carried out to extract and purify Staphylococcus aureus type 2. The descriptive and explorative strategy of this study was conducted on Staphylococcus aureus (Smith diffuse variant) in BHI broth in a shaking incubator (200 rpm) in an aerobic condition at a temperature of 37°C. The capsule was extracted using dilute acid and heating method. Then, dialysis was done overlight at 4°C and the product was lyophilized. Lyophilized powder was purified using a cellulose DEAE column (2.6×50 cm) by gradient method using bicarbonate ammonium buffers (0.01-1 M) at a velocity of 60 mt/h (Ion exchange chromatography). Finally absorption spectrum was plotted and purified capsule was analyzed using scanning spectrophotometer. Polysaccharide capsule was collected in final growth phase at 0.1 HCL and at a temperature of 100°C. Absorption spectrum were evaluated using H2SO4/galacial acetic acid assay at wavelength range of 350-620 nm. The result showed that chromatographs are well matched with previously purified antigens. Conclusion and Recommendations: It is concluded that it is possible to extract and purify the capsule of Staphylococcus aureus type 2 and it is recommended to produce the related preventive vaccines.

Historand y Inappropriate antibiotic treatment can lead to resistance with various incidences in different populations and is one of the major problems facing treatment of diarrhea. This study was carried out to determine the incidence of antibiotic resistance in referrals of reference laboratory of Kashan University of Medical Sciences from 2000 to 2001. The descriptive strategy of this study was conducted on 1800 patients with acute diarrhea. Fecal specimens were collected and transferred to specific culture medium. Antibiotic discs of ciprofloxacin, ceftizoxime, chloramphenicol, co-trimoxazole, nalidixic acid, doxycyclin, tetracycline, cephazolin, furazolidone, cephalotin and amikacin were used for determination of sensitivity of Shigella, Salmonella, Vibrio cholera. Out of 1800 fecal specimens, there was a growth rate of 11.9% (215 cases), that is 58.1% (125 cases), 30.7% (66 cases) and 11.2% (24 cases) for Shigella, Salmonella and Vibrio cholera respectively. For Shigella, the sensitivity to ciprofloxacin, ceftizoxime, chloramphenicol, nalidixic acid, co-trimoxazole, doxycyclin, cephazolin, furazolidone, ampicillin and cephalotin was 99%, 97%, 84%, 74%, 58%, 54%, 47%, 35%, 23% and 22% respectively. For Salmonella, the sensitivity to ciprofloxacin, chloramphenicol, ceftizoxime, co-trimoxazole, cephazolin and furazolidone was 100%, 96%, 78%, 20% and 12% respectively. For Vibrio cholera, the sensitivity to ciprofloxacin, doxycyclin, tetracycline, ceftizoxime, co-trimoxazole, nalidixic acid, furazolidone, cephazolin, cephalotin and ampicillin was 100%, 100%, 100%, 95.8%, 87.5%, 83.3%, 79.2%, 79.2%, 75% and 62.5% respectively. Conclusion and Recommendations: Considering the incremental trend for antibiotic resistance for Shigella, Salmonella and Vibrio cholera, it is strongly recommended to avoid inappropriate and unnecessary use of antibiotics in patients with diarrhea.

History and Considering the significance of analgesia and lower complications following surgical operations and the existence various and sometimes reports controversial reports on the efficacy of addition of fentanyl and for comparison of its effect, this study was carried out on patients under thoracotomy in Masih Daneshvari hospital. The clinical trial, two-blind strategy of this study was performed on 74 patients and cases with contraindication for drugs were excluded from the study. Control group received morphine (0.5 mg/kg) and experimental group received a mixture of morphine and fentanyl. The intensity of pain was measured using verbal pain scoring and they were followed up for post-operative complications for 48h and data were statistically analyzed. From each group, 7 cases were excluded and study was carried out on 60 cases. In this regard, 31 cases were in control group and 29 cases were in experimental group. Both groups were similar regarding age and gender. Complications rate was 71% (22) in control group and 48.3% (14) in experimental group (P<0.07). There was a complication rate of 92.3% and 55.5% in female cases of control group and experimental group respectively. Meanwhile, duration of unexpected analgesia in control group was 8±4.8 and in experimental group was 9.03±4.5 h. in addition, duration of unexpected analgesia for control and experimental groups were 2±4.8 and 5±4.5 h respectively. Conclusion and Recommendations: Simultaneous use of fentanyl and morphine could reduce the complications and extension of analgesia. Therefore, it is recommended to carry out further studies using fentanyl.

History and Considering the incidence and incremental trend for kidney grafting and the significance of initiation of diuresis and the positive effect of mannitol and overhydration and for evaluation of simultaneous use of them, this study was carried out on referrals of Labafinejad hospital in 2000. The quasi-experimental strategy of this study was carried out on 40 patients with indications for kidney grafting with their written consent. Twenty min before anastomosis of renal vein, intravenous injection of mannitol (5 ml/kg) was initiated and its effect on the initiation of diuresis in min was recorded with a confidence interval of 95%. This study was performed on 40 patients (25 females and 15 males) with an average age of 33.6 years and average weight of 52.6kg. The results showed that in 80% of patients, diuresis was initiated in less than a minute and in 90% of them, diuresis was initiated in less than 2 min. Conclusion and Recommendations: Simultaneous use of mannitol and overhydration could accelerate the initiation of diuresis and because this is very important in survival of grafted kidney, therefore it recommended to carry out thorough experimental study.

History and Fluoxetine is an anti-depressant drug that specifically inhibits serotonin re-uptake. Since fluoxetine can lead to bradycardia and may have pro-arrhythmic and anti-arrhythmic properties, this study was carried out to evaluate the effect of fluoxetine on ouabain-induced arrhythmia in isolated atrium of Guinea pig. In this study, Guinea pigs from both sexes (350-600 g) were used. The animal’s atrium was totally isolated from the ventricle. Thirty-two isolated atria were studied in 4 groups, that is, control, fluoxetine, ouabain and ouabain in combination with fluoxetine. The isolated atria were inserted into modified Oxygenated Krebs solution. Therefore, the mentioned drugs were added to the bath and 20 min later, ionic content of the tissue was measured. Fluoxetine (2-16 µg) can produce a short increase in contractile force (4 min), but finally decrease force and rate of isolated atrium. Ouabain (1.2 µg/ml) can lead to atrial arrhythmic after 1.5 min and after 16 min leads to total toxicity, asystole and atrial cease. Fluoxetine pretreatment (4 µg/ml) can delay the occurrence of arrhythmia up to 5 min (P<0.05). Meanwhile, survival time for atrium increased to greater than 40 min (P<0.05). Ionic measurement of atrial tissue showed that ouabain by itself can increase the level of sodium, but no such effect on potassium and calcium levels. In addition, fluoxetine in itself can significantly increase potassium level (P<0.05). Administration of fluoxetine and therefore, ouabain can attenuate the toxic effect of ouabain on ionic changes and even return it to normal level. Conclusion and Recommendations: It is concluded that fluoxetine has a direct negative inotropic and chronotropic effect on isolated atrium as a possible result of inhibition of sodium and calcium channels and it can probably prevent ouabain-induced toxicity and arrhythmia in atrium of Guinea pig through stabilization of cell membrane and/or prevention of ionic changes that is a quinidine-like effect.

History and Considering the role significance of Giardia and Sarcocystis in contamination of human beings and domestic animals and lack of information on its condition in Iran, this study was carried out to determine the contamination rate of dog-related animals for Giardia and Sarcocystis during the years 1999-2001. The descriptive and randomized strategy of this study was conducted on 142 carnivores during four seasons from different regions of Kashan and captured by shooting. After capturing, small and large intestine were isolated and incubated in 10% formalin and transferred to parasitologic laboratory. Animal’s characteristics including genus, age and microscopic findings were recorded in special forms. Data were classified and statistically analyzed with a confidence interval of 95%. Out of 142 carnivores, 70 dogs, 40 jackals, 22 foxes and 10 wolves were identified. Their age range was from 2 months to 5 years. Contamination rate for intestinal protozoa was 76.1% (108). Contamination rate for Giardia caies in dog and jackal was 5.7% and 5% respectively. Contamination rate for Giardia flis was 22.7% in fox. No contamination with Giardia caies was observed in wolf. Contamination rate for Sarcocystis in jackal, wolf, dog and fox was 50%, 50%, 41.4% and 18.4% respectively. Contamination rate for both Giardia and Sarcocystis was 40%, 32.5%, 28.6% and 9.1% in wolf, jackal, dog and fox respectively. Conclusion and Recommendations: Contamination rate for Giardia and Sarcocystis in dog-related animals was greater than expected in Kashan region. In this respect, appropriate controlling measures should be taken and it is recommended to determine the most appropriate preventive method

History and Population development is one of the major problems in many countries of the world and it is necessary to apply family planning strategies. In this regard, knowledge of reasons for agreement and opposition to apply these strategies is very effective. This study was carried out in rural areas of Kashan in 1997 to determine the reasons of opposition. The descriptive strategy of this study was conducted on 520 married men with an age of 15-49 years in rural regions of Kashan. For collection of information, a questionnaire was filled out through interviewing. The most opposed method was vasectomy (79.5%) because of its possible complications (34%). For contraceptive method, its high rate of complications was mentioned as an opposing factor (51.9%). Unreliability of condom (51%) was the most opposing factor for this method. Illegality of tubectomy (24.8%) was the most opposing factor. Conclusion and Recommendations: Considering the above-mentioned reasons, it is recommended to perform an experimental study to evaluate the effectiveness of health education on opposing factors to pave the way for attainment of goals regarding family planning.

History and Cardiopulmonary resuscitation is a critical emergency measure that health personnel are encountered. Because of its unpredictability regarding time and place, it is necessary to have skilled personnel, especially inn emergency center. There are some reports on inappropriate skill and knowledge of health personnel in this field. Therefore, this study was carried out to determine level of knowledge and skill of health personnel in Kashan hospitals in 1999. The descriptive strategy of this study was performed on medical and health personnel of Kashan hospitals. For this purpose, a 20-item questionnaire on resuscitation prepared. Personal skills for tracheal tubing and cardiac academic massage were evaluated and a scoring of appropriate, moderate and inappropriate was used. For statistical analysis Kruskal-Wallis and Mann-Whitney tests were used. This study was carried out on 93 individuals, 47 males and 46 females with average age of 30.2 years. The results showed that none of them had appropriate knowledge and 82% of them had in appropriate knowledge and there was a positive relationship between this parameter and their academic field (P<0.0001). In addition, 71% of them showed inappropriate skill and only 7.5% had appropriate skill. Meanwhile, interns, midwives and health-assistants had not appropriate skill. Medical techniques showed appropriate skill with a positive relationship with their academic field (P<0.02). Conclusion and Recommendations: There is not enough skill and knowledge regarding cardiopulmonary resuscitation and it is necessary to hold appropriate re-educational programs.

History and Considering a prolonged treatment process for paronychia and a high complication rate for griseofulvin, in this study a case report on the treatment of pitted nail with Artemisia was introduced. Case Report: A 36-year old man (An inhabitant of Kashan) noticed thickening and development of congregations, fragility and a change in color (Yellowish brown) and appearance in nail of little finger of his right hand. With recommendation of a dermatologist, he referred to laboratory of mycology of Kashan University of Medical Sciences and his disease was diagnosed as dermatophytosis. Because his liver was hypo-functional and there was contraindications for griseofulvin and since Artemisia had fungi static properties prepared by Baridje Essence Corporation, therefore local treatment with drop extract of this plant was begun three times/day for a period of 15 weeks. After 14 weeks, the nail restored to normal and no complication was observed. Conclusion and Recommendations: Artemisia drop could effectively treat paronychia. Thus, it is recommended to carry out more studies in this field.