مجله دانشگاه علوم پزشکی اراک
سال پنجم شماره 4 (پیاپی 21، زمستان 1381)

Cisplatin is a drug widely used as an antineoplastic drug for treatment of malignant tumors. But because of its side effects on the different systems especially kidney (nephrotoxic), the use of this drug is very limited. Clinical as well as, laboratory animal studies have supported this observations. In this research study we have used stereological technique (3-D) for finding the changes, due to nephrotoxic effect of this drug, in the number of glomeruli in kidney (numerical density and total number).

For experimental, 30 rats were separated by random sampling in to 3 groups of 10 animals cache. The first group received acute dose (7.5 mg/kg) of the drug (cisplatin) in serum physiology (experimental group). The second group received equivalent placebo dose in serum physiology through peritoneum (control). The third group received chronic dose (1.25 mg/kg) for 5 days, in serum physiology. All the 30 animals, after 96 hours, were anesthetized, dissected and their right kidneys were removed and placed in fixative (10% formalin). Whole kidney specimens were processed for stereology by special method of sectioning for physical disector and glomeruli number were counted.

Number of glumeroli and numerical density was estimated for experimental groups (control, acute and chronic) was 31707, 30415 and 30802 as well 162, 119, and 140 respectively.

Stereological methods could be very useful for investigation of chemical drug effects in organs with good validity.

Tribulus was traditionally used as a diuretic, mild laxative, urolithiasis, dysurca for treatment of urinary tract problems including stones, cystitis and infections, particularly Gonohrea. Antimicrobial cffects of methanol extract of Tribulus fruit on few gram positive and negative bacteria, the causative agents of some bacterial infections was evaluated and then compared with some in use antibiotics for these infections.

In this research as an experimental study. 40 gr powder of Tribulus fruit was dissolved in 100 ml pure methanol as a solvent with cold maseration method, the suspension was filtered after 5 day. The filtered suspension were concentrated with rotary evaporator apparatus in vaccum and was then dilluted with methanol to yield different concentrations. The antimicrobial activity of the extract and antibiotical were examined with disc diffusion and tube dilution standard methods to measure the diameter of inhibition zones, minimal inhibitory concentration and minimal bacterial concentration.

The results were shown that the antimicrobial effect of the methanol extract of Tribulus fruit on ATCC strains of Streptococcus faecalis, Staphylococcus aureus, Escherichia coli and Pseudomonas acroginosa had bactriostatic effect with the concentration of 400, 200, 100, 100 ug/ml in order. The comparison of urinary tract infections, including Oxacilin, Ciprofloxacin, Penicilin G, Gentamycin, Cotrimoxazole, Nalidixic acid and Nitroforantoin were shown that Tribulus fruit extract in concentration used in this research had a similar or even better effect than some antibiotics on some of the bacteria used in this evaluation.

The Tribulus fruit extract has an efficient bactriostatic and bactricidal activity of few gram positive and negative bacteria, the causative agents of some bacterial infections and these cffects are comparable to those antibiotics in usc for treatment of these infections. Tribulus fruit extract could be suggested for treatment of these infections after the pharmacological and clinical complementary studies.

Diabetic neuropathy is a common complication of diabetes, leading to great morbidity and mortality and resulting in a huge economic burden for care of the patient with diabetes. It is the most common of neuropathy in the developed countries of the world, accounts for more hospitalizations than all the other diabetic complications combined, and is responsible for 30% 1075% of nontraumatic amputations.

This investigation is a descriptive analytic, cross-sectional study among 40 diabetic patients without symptoms of peripheral neuropathy referred to Aruk Vali-Asr diabetes clinic from March to september of 2003. Patients were referred to one neurologist for study of peroncal and tibial motor nerves and sural sensory nerve conduction velocity in electrodiagnostic clinic of Arak Amir Kabir hospital. The results of this group were compared to the results of 70 age and Gender matched normal control subjects. Independent samples T-Test, Pearson correlation coefficient and Fisher's exact test were used in analysis.

A total of 40 patients were studied with mean age of 42.6 years and mean duration after the first diagnosis of diabetes 5.72 years. Mean investigated nerves conduction velocity in the normal control group was meaningful more than in diabetic patients. Asymptomatic neuropathy was present in 27 (67.5%) of patients. In these patients mean duration after the first diagnosis of diabetes was 6.5±5.16 years.

Asymptomatic diabetic neuropathy is common (67.5%) sural sensory. Nerve conduction velocity is a sensitive test for early diagnosis of diabetic neuropathy.

Infection due to hepatitis B virus (HBV) could be due to wild or mutant viruses. The HBeAg negative chronic hepatitis B (HbeAg-CHB) is unable to produce hepatitis B, e antigen (HbeAg), so that patients with this varient do not present with HBV characterized by HbcAg in the serum. HbeAg-CHB usually proceeds to serious liver disease. The prevalence of different viral forms in patients with chronic liver disease in Iran has not been established.

Seventy-six Hamadanian patients with over 6 months HBSAg positivity were enrolled. Patients with co-infection of HIV, HCV, past history of alcoholism, fatty liver, using of hepatotoxic drugs, autoimmune hepatitis and other metabolic liver disease were excluded. All patients were screened for Hhe Ag. HbeAb. HBV DNA by PCR, AST, ALT, ALK. pH and bilirubin.

Eleven (14.5%) patients had HheAg-CHB (HbsAg +ve, HbeAg-ve / ve/anti HbeAb + ve, HBV DNA + ve and elevated AST, ALT) and 6 (8%) had normal transminases (AST and ALT) accompanied by the remaining criteria of HbeAg-CHB. 59 patients (77.5%) were infected with wild type HBV, ie: HBSAg + ve, HbeAg-ve, HbeAb + ve, HBV DNA- ve, and normal AST, ALT.

Frequency of HbeAg.CHB in Hamadan is 14.5% knowing of this varient of chronic hepatitis B is important since the HbeAg-CHB have worse prognosis than wild type and more better response to lamivudine than interferon.

Basal cell carcinoma is the most common malignancy in humans. A number of treatment modalities are available. We performed this study in order to determine the efficacy of Mohs micrographic surgery in treatment of basal cell carcinoma.

This retrospective descriptive study was performed on 194 basal cell carcinoma (in 175 patients) were treated in Isfahan Al-Zahra Hospital from september 1999 to March 2003 with Mohs micrographic surgery. Data were obtained from patient's files and were analized by SPSS software.

Of the 175 patients (with 194 basal cell carcinomas), 110 (62.85%) paticnls were male and 65 patients (37.14%) were females. The mean age of patients was 58±12.38 years. The majority of tumors were located on face and scalp. 180 of tumors were primary and 14 were recurrences. 17% of tumors were larger than 2cm. Recurrences of the tumor occured in 3 patients. The cosmetic results were excellent and good in 81%. The incidence of recurrnce rate was 0.9%.

Kecurrence rate is low when basal cell carcinomas treated with micrographic surgery so this treatment modality (when indicated) is also strongly recommended in Iran for the treatment of basal cell carcinoma.

Patient hospitalization rate (P.H.R) is an important issue in health decision making because its increasing can imposes abundant expenditure on each patient or therapeutic or health systems like assurance companies. Moreover, it can increase the danger of nosocomial infections. So, description, examinating and modelling of P.H.R. can be as a guideline for above subjects and as an introduction would lead one to study the issue with insight.

For determining of P.H.R., Iwo samples of size 1428 and 816 of patients were chosen systematic randomly from Vali-Asr and Ta'min-Ejtemai hospitals, respectively during the year of 2002. Hospitalization rate, age, sex, location of birth place and residence place of patients recorded. Mixed distributions modelling and Poisson regression models as well as ordinary regression methods were applied to analyze and modelling the data.

Means of P.H.R of patients at Vali-Asr hospital was 4.1±5.4 days. Two component Poisson was a relatively appropriate model was a very relevant model for analyzing of their P.H.R. By using mixed Poisson regression method a significant relationship among patient's age, marriage status and location of life with P.H.R was obtained. Findings in Ta'min-Ejtemai showed that the mean of P.H.R was 4.7±3.2 days. One component Poisson model was appropriate model for data distribution. A significant relationship among age, sex, location of life with P.H.R in this hospital was seen.

Our findings showed that P.H.R in Vali-Asr hospital follows two component Poisson model. For Vali-Asr data, the normal model was not appropriate even with changing the statistics variables, but for P.H.R data of Ta'min-Ejtemai, changing the logarithmic variable could transform data into approximate of normal model. Finally, comparison between mixed distribution Poisson model and acquired regression with simple linear regression in Val-Asr hospital presented different results, but in Ta'min-Ejtemai hospital had similar results.

Sympathetic stimulation and pressor responses including tachycardia, hypertension and tachyarrhytmias caused by laryngoscopy and tracheal intubation may result in severe complications in susceptible patients. Opioid anesthetics are one of the several drugs used to attenuate this response but prolonged postoperative respiratory depression is the major complication distracting from their high dose administration which is nceded for complete amelioration of pressor response. In this study Alfentanyl, as a rapid acting and short duration opioid (without prolonged respiratory depression), was used in two different dosages for controlling of pressor response.

In a single blind, controlled clinical trial, 236 patients in the range of 18 to 70 years old), whom needing laryngoscopy and tracheal intubation were selected and randomly divided into two equal groups. First group received low (current) dose (15u gr/kg) Alfentanyl, and the other received high dose (450gr/kg), prior to laryngoscopy and tracheal intubation. Type and dosage of induction drugs were the same and matched in both groups. Blood pressure and heart rate were measured before intravenous induction and after intubation of the tracheal in all patients. Mercurial sphygmomanometer and pulse oximeter were used for these measurements. Incidence of such complications as hypotention, muscle stiffness and neurologic hyper reactivity, were also measured. Data were analysed by Z distribution and Chi square tests.

Alfentanyl was cffective in controlling pressor response in both groups. In the case of heart rate, the mean difference between two groups was not significant. There was a significant difference mean arterial pressure between two groups (p<0.05). In high dose group, incidence of complications was higher for severe hypotension (p<0.05), stiff chest syndrome (p<0.05), and neurologic hyperreactivity (p<0.05).

High dose of Alfentanyl is more efficient in controlling of pressor response than low dose of the drug. High dose administration also may results in some complications. In this study current dose of Alfentanyl is recommended for controlling of pressor response, but high dose may be used with some modification in the dose of induction agents.

Depression is one of the psychiatric disorders that causes loss of energy, decrease of concentration and daily activity that these also became decreased in motivation and educative activity of students. The aim of this study was assesed to determine the prevalence of depression and it's related factors of Arak university of medical sciences in 79-80.

This study was cross-sectional and the sample of study consisted of all medical sciences students that came to university on fall of 79 (N=153) that were screened for depression at the biginning time of educational course and then 3 terms later by using personal data questionair and short form (21 statements) of Beck Depression Inventory Test.

From 153 students, 38 (%22.1) respondants at biginning of course obtained the score in between 17 and>17 were determined as depressive case, then after 3 terms this figure increased to 58 (%38.5), this differences was significant differences between depressive and nondepressive groups in variables such as proper of dornitory condition 3, satisfaction of field of study 3.64, satisfaction with the educative conditions of the university 3.49, satisfaction with student-management relationship 3.77, appropriate cmotional-supportative and security condition in between family and students 4.32, economical condition of safe and families 3.58, at biginning time and then 3 terms later in arrangement of above were 2.82, 3.66, 3.37, 2.79, 2.66, 4.17 and 3.67 that these diffrences due to constant samples were significant and has had significant roles in prevalence of depression.

This study showed that depression was increased in students of Arak University of Medical Sciences after 3 terms and it is related with some stressful factors such as family, social and economical factors.