مجله پزشکی بالینی ابن سینا
سال هجدهم شماره 1 (پیاپی 59، بهار 1390)

Introduction & Hypoxic-ischemic encephalopathy is one of the most important causes of permanent damage to brain tissue that redound to mortality and/or late sequelae such as cerebral palsy or delayed neural development. 15-20 percent of Hypoxic-ischemic encephalopathy (HIE) cases die during neonatal period and 25-30 percent of those who survive suffer from neural development problems such as cerebral palsy and mental retardation. Hypothermia or lowering temperature of brain or total body is a new and promising treatment. The present study was done to assess therapeutic effects of induced local hypothermia in hypoxic-ischemic encephalopathy (HIE) among neonates admitted to Fatemieh and Beset hospitals of Hamadan city. The present study was performed as a randomized clinical trial upon 36 neonates who had inclusion criteria to be imported into the study. In the first 6 hours after birth, the neonates were randomly classified into two 18 person groups. In the control group the neonates were managed with routine treatments consisted of preservative measures and anti-convulsive treatments, if necessary. In the case group the neonates received induced local hypothermia for 6 hours in addition to routine therapeutic managements. The data were analyzed using SPSS Version 13. 72.7% of the neonates of the case and control groups were male. There was no significant difference between the case and control groups in sex, birth weight, gestational age and perinatal obstetric complications. The mean duration of admission was 7.72±4.23 days in the case group and 10.06±5.99 days in the control group with no significant difference between the two groups (P=0.199). The mean time of starting oral feeding was 3.44±3.11 days and 4.53±2.74 days in the control and case groups respectively and this difference was not statistically significant either (P=0.737).The mean time of regaining consciousness was 3.72±3.19 days in the case group and 4.80± 3.34 days in the control group, and here again there was no statistically significant difference between the two groups (P=0.606). With respect to seizure we noticed a statistically significant difference (P=0.038) between the two groups after observing 16.7% of the neonates in the case group and 50% of the neonates in the control group with seizure. 3 neonates in the group who received routine managements died whereas no death was observed among the patients receiving hypothermia. We saw no difference in the mortality rate between the two groups (P=0.114) using statistical test. In the present study it seems that performing local hypothermia as a therapeutic measure can reduce seizure rate because seizure rate among the patients receiving only local hypothermia was significantly lower than the patients receiving routine

Introduction & Pain in neonates can lead to various risks. So, it seems essential to find a simple, safe, and acceptable method for relieving pain. The objective of this study was to assess the effectiveness of olfactory stimuli (familiar and unfamiliar) on physiological and behavioral responses to the pain of arterial blood draws in term neonates. In this quasi-experimental clinical trial, according to the conditions of the study 135 term neonates were chosen by convenience sampling and were assigned to three groups. During the procedure, familiar odor group was presented with the vanilla smell with which they had been familiarized prior to the procedure for 9 hours. Unfamiliar odor group was presented with the vanilla smell to which they had not been previously exposed, and the control group was presented with no odor. The heart rate and O2 saturation levels were measured before, after inserting and after removing the needle. Also, their cry duration was measured from onset until a crying free interval of more than five seconds. The infants exposed to the familiar odor cried significantly less during the procedure compared to the unfamiliar odor and no odor group (P<0.001). Moreover, there was no statistically significant difference in the heart rate among the groups after inserting and removing the needle and in the O2 saturation rate after inserting the needle. The O2 saturation rate was significantly higher in the familiar odor group compared with the other groups (p<0.05) after the needle removal. A familiar odor is effective in reducing crying during arterial blood draws in neonates, but does not affect on physiological parameters.

Introduction & So far, despite the wide range of methods such as analytic methods used for differentiation of Mycoplasma, the diagnosis of Mycoplasma species is still difficult. Generally the low-level discriminatory power of serological methods because of the rapid changes in size and phase of the dominant antigens in the immune cell surface of Mycoplasmas greatly limits their applicability to the typing of Mycoplasmas. On the contrary,molecular methods do not suffer from these drawbacks and can be used for typing of Mycoplasmas. The aim of this investigation was molecular identification and genotyping of ureaplasma SPP in women with genital infections by 16S–23S rDNA PCR-RFLP. Genital swabs were taken from 210 patients who referred to gynecology clinic of Rasool hospital in Tehran, Iran during December 2007 until June 2008. The swabs suspended in PBS, were immediately transferred to laboratory. Following DNA extraction, PCR assay was performed using a genus specific primer pair. These primer sets amplified a 559 bp fragment for Ureaplasma Spp. Samples containing bands of the expected size for Ureaplasma strains were subjected to digestion with different restriction endonuclease enzymes (AluI, Taq I, CacI8, BbsI, EcoRI). Of the 210 samples, Ureaplasma Spp was isolated from 93 patients (44.3%) by PCR and 69 samples by culture. In the present study only Biovar 1 (Ureaplasma parvum) was isolated from clinical specimens and the results were confirmed using a cutting enzyme TaqI (enzyme specific species of ureaplasma SPP). The results of this analysis using PCR-RFLP and sequencing showed that all had the same genotype and shared identical sequence with the genome sequence of serovar 3 Ureaplasma parvum. Ureaplasma parvum is generally isolated from the genital samples. In this study all isolates were identical and no difference was found among the enzyme patterns of the bacteria after PCR-RFLP. So, genetic heterogeneity was not observed here and infections were due to the dissemination of a single strain of Biovar 1 (Ureaplasma parvum). PCR-RFLP offers a sensitive, rapid and easily applicable protocol for detection and typing of Ureaplasma SPP from clinical samples.

Introduction & Nosocomial pneumonia is pneumonia that occurs at least 48 hours after hospitalization. In total, this infection is the second most common cause of hospital-acquired infection in intensive care units. The purpose of conducting this research was the detection of etiology of nosocomial pneumonia in the ICUs of teaching hospitals of Hamadan University of medical sciences. In this cross -sectional study, 353 patients hospitalized in the ICUs of Hamadan hospitals (Besat and Ekbatan) were analyzed. Different variables including age, gender, cause of hospitalization and underlying diseases were recorded in a number of questionnaires. On repeated visits to the ICUs, these questionnaires were completed for different patients and in the next weekly visits the patients’ conditions and paraclinical aspects were recorded in the files. The criteria for onset of nosocomial pneumonia was the appearance of fever after 48 hours and leukocytosis, the increasing pulmonary secretion and the alteration of chest x-ray together with the culture results of secretions obtained by suction of tracheal tube. In the case of infecting with nosocomial pneumonia some more variables including connecting a ventilator, the period of connecting the ventilator until infection, the type of consumed antibiotic before the onset of nosocomial pneumonia, the obtained organisms, and the period of hospitalization in the ICU until infection were also recorded for these patients. The chi-square test and Fisher’s exact test were used for data analysis and the meaningful levels for the tests were less than 0.05. The average age of study population was 51.2 years with the standard deviation of 21.9 years. 36 people (10.2%) of the hospitalized patients in the ICUs were infected with nosocomial pneumonia. Trauma with a rate of 47.5% (168 people) was the most common cause of patient hospitalization in the ICUs. 66.5% of these patients (24 patients) were affected by nosocomial pneumonia (VAP) after connecting to ventilation device. In 91.7% of the cases, the hospitalized patients in the ICUs consumed antibiotics, out of which 50% were treated with cephalosporins. It is also necessary to note that 42.5% of patients took more than one type of antibiotics. The findings of this study indicates the high consumption of cephalosporins, a predisposing factor to nosocomial infections, in the ICUs of teaching hospitals of medical university of Hamadan. On the other hand,the consumption of floroquinolones were less compared to the findings of other similar researches.

Introduction & Vertigo in the elderly is relatively common, but only a few studies are available. Vestibular rehabilitation (VR) therapy is an important therapeutic option in treating patients with significant balance deficits. The purpose of this study was to analyze the effect of vestibular rehabilitation on vertigo symptoms in elderly patients with benign paroxysmal positional vertigo (BPPV). In a clinical trial design, 46 patients older than 60 years (aged 61 to 72 years) with BPPV who referred to the ENT center of Imam Khomeini Hospital, Ahwaz, were studied. After an otologic evaluation, videonystagmography and dizziness handicap inventory (DHI) evaluations were performed for each case. Then, vestibular rehabilitation (VR) therapy was carried out by means of Epley maneuver. Efficacy of a VRT was tested by comparing pre-treatment with post-treatment VNG and DHI assessments. The data were analyzed by SPSS 16 software. The average age of the patients was 67.28 ± 4.5 years. VR caused normal Hallpike findings in 31 (67.4 %) and noticeable reduction in nystagmus amplitudes in 9 patients. We found a significant correlation between nystagmus amplitudes and DHI scores (r=0.77). The mean DHI scores decreased from 53.26±16.12 points to 15.36±9.23 points (p<0.001) at the end of the treatment course. Our investigation revealed that VR plays an important role in reducing vertigo in at-risk elderly patients. Lack of appropriate treatment in this population may cause a serious balance problem (such as bone fracture and long-term handicap) that may interfere with their daily activities.

Introduction & The role and frequency of HHV-6 and HHV-7 in central nervous system (CNS) diseases of our children are unclear. The aim of this study was to search for the presence of HHV-6 & HHV-7 DNA-s in CSF samples in children with meningoencephalitis. In a cross- sectional study (2007-2009) done in the pediatric ward in Hazrat Rasoul hospital, Tehran, Iran, 150 CSF samples were obtained from children with meningoencephalitis. The conventional and BACTEC Ped Plus medium; Latex agglutination tests; and in some cases bacterial PCR assay were used. We examined the DNA-s of HHV-6 & HHV-6 quantitavively by real time - PCR in the CSF samples. Cases were 91 (60.7%) male; 59 (39.3%) female; 1-180 months old. Fever (>38.5° C) was observed in 74%; irritability in 70% and convulsion in 53% of cases. All herpes viruses were detected in 18 (12%) cases, HHV-6 DNA was detected in 6 cases and HHV-7 DNA detected in 2 cases with no correlation with age, sex and clinical signs. HHV-6 & HHV-7 were found in nearly 6% of all studied cases. HHV-6 was slightly more frequent than HHV-7 and its incidence is lower. Our data indicates that herpes viruses are not uncommon causes in children with meningoencephalitis. Our findings are different from those of previous studies perhaps due to the epidemiologic and geographic variations (differences in methods and age groups should be added to this).

Introduction & Dysmenorrhea nearly occurs in five percent of women with regular menstruation. Different therapeutic methods were performed for the treatment of dysmenorrhea and obviously a method with the fewest side effects is preferred. The aim of this study was to compare the effects of echinophora-platyloba with fennel on the primary dysmenorrhea. This clinical trial was carried out in sixty unmarried students with mild and moderate dysmenorrhea in Shahrekord University of medical sciences. The students were randomely selected and classified into two equal groups one of twitch received echinophora-platyloba and the other fennel extracts. The severity of pain was detected by the visual analogue scale during two cycles before and two cycles after the intervention. The data was analyzed by spss software, t-test, chi-square and Pearson correlation tests and P<0.05 was considered significant. There was no significant difference in the mean of dysmenorrhea severity during the two cycles before the intervention between the two groups, but during the two cycles after the intervention, both drugs could reduce the severity of dysmenorrheal. However, this reduction was lower in recipients of echinophora-platyloba extract than the recipients of fennel extract and the difference was significant (P<0.001). Echinophora-platyloba and fennel extracts could reduce the dysmenorrhea during the intervention and the effects of fennel were greater than echinophora-platyloba so the consumption of fennel extract is suggested for dysmenorrhea.

Introduction & Obesity is independently associated with increased oxidative stress in men and women. Natural antioxidants showed substantial antioxidative and anti-inflammatory activities in vivo. The aim of this study was to examine the preventive effect of antioxidant supplements and/or restricted diet on the stress oxidative index (8-Iso-PGF2α) and total antioxidant capacity (TAC) in obese rats induced by a high-fat (HF) diet. In this experimental study forty-eight male Wister rats were randomly assigned to HF purified diet (61% kcal from fat) ad libitum, HF restricted (30%), HF supplemented with astaxanthin, vitamin E and C (HFS), HFS restricted (30%) for 12 weeks. Their daily food intake and weekly body weight gain were measured. Serum 8-Iso-PGF2α and TAC measured by EIA methods. Energy intake was not significant in HF with HFS (58.8 and 58.6 kcal/rat/d, respectively) and in HF restricted with HFS restricted (41.7 and 41.6 kcal/rat/d, respectively). Serum 8-Iso-PGF2α in HF was 1416.2±443.5 and in HF restricted was 1209.4±424.4pg/ml (p>0.05) and equal for other groups. The lowest TAC was seen in HF and highest was in HFS (0.36±0.43 and 3.0±1.13 mM, respectively) (p<0.001). These results suggest that antioxidant supplements and caloric restriction may improved TAC and partially suppress stress oxidative index in high fat diet induced obese rats.

Introduction & Chronic ulcer is a significant problem in patients referring to dermatologists and plastic surgeons. Diabetes delays or impairs wound healing. Fifteen percent of diabetic patients have lower extremities ulcer with high morbidity. Retinoic acid is a vitamin A derivative which has significant effect on cellular proliferation and connective tissue extra cellular proteins differentiation. Our purpose in this study was to observe the effects of tretinoin on wound healing. This study was a case-control study performed on 48 Wister male rats. The rats were made diabetic and then divided into two groups. We induced a full thickness wound on back of all rats. The wounds were treated with 0.1% tretinoin lotion once daily in the case group and with normal saline in the control group. Both groups were examined macroscopically and histological on the 5th, 10th, and 15th days. At last, the data was analyzed by ANOVA and t- student statistical tests. In the macroscopic evaluation on the 5th and 10th days, wounds that were tretinoin treated, healed more rapidly than that of the control (P=0.002, P=0.001), but on the 15th day, this effect was not significant (P=0.212). At the histological level on the 5th day an increase was observed in the granulation tissue, epidermal thickness and collagen density but it was not significant(P=0.417, P=0.999, P=0.470). On the 10th day, this increase was rather observable, but not significant (P=0.400, P=0.999, P=0.999). According to our findings, topical tretinoin treatment improves wound healing in diabetic ulcers.

Introduction & All cases of gestational trophoblastic tumors are curable if exact diagnosis and early treatment is done. The serum level of βHCG is a sensitive marker of the disease. In this study we intended to compare the "βHCG regression curves" in patients with molar pregnancy and trophoblastic tumor to determine which patients require chemotherapy and should start early treatment. Recorded data of 80 patients, consisting of 40 uneventful hydatiform mole cases and 40 trophoblastic tumor patients referred to Meshed Ghaem gynecology clinic were gathered and studied. Mean age was 26.7 years in the molar group and 27 in the gestational trophoblastic tumor group. There was a history of abortion in the past in 25% of the patients of both groups. 67.5% of patients were in the stage 1 and thus were 100% curable. The βHCG regression curve exceeded the normal range in the gestational trophoblastic tumors groups (P= 0.001). This study showed that βHCG regression curve can be used to diagnose these tumors much earlier (a few weeks after evacuation) and thus start treatment sooner.