مجله دانشگاه علوم پزشکی بابل
سال چهاردهم شماره 1 (پیاپی 64، دی 1390)

Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality, decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of nitroglycerine on tourniquet pain and intraoperative analgesia when added to lidocaine for IV regional anesthesia. In a clinical trial, 50 patients with upper extremity injury were scheduled for IVRA, randomly allocated into two groups. They were unified by age and gender. Under identical condition, control group received a total dose of 200 mg lidocaine diluted with saline (40 cc) and study group received 200 mg lidocaine plus 200 µg nitroglycerine diluted with saline (40 cc). Anesthesia quality, tourniquet pain and opioid requirement were measured during surgery. After the tourniquet deflation, time to first analgesic requirement was noted. Intraoperative pain scores were not different between two groups and fentanyl requirement was similar. The onset of tourniquet pain was similar in case (21.96±3.87 min) and control group (21.12±3.33 min) (p=0.41). Analgesia time and time of initial analgesic requirement after tourniquet deflation was 54.4±9.95 min in control group and 60.40±10.17 min in case group (p=0.625). Addition of nitroglycerine to lidocaine was not improved the quality of IVRA, postoperative analgesia and opioid requirements in patients undergoing hand surgery.

Recent studies were reported that H. Pylori infection and gastric atrophy were associated with an increased risk for esophageal squamous cell carcinoma (ESCC). However this finding needs to be confirmed in other ethnic group due to the wide geographic variation of this cancer. This case-control study was designed to evaluate the association between H. Pylori infection and gastric atrophy and ESCC. In this case-control study, 33 patients suspected with ESCC who underwent upper gastrointestinal endoscopy and confirmed by histology, and 33 sex-and age-matched controls were enrolled. Gastric atrophy and H. Pylori infection were evaluated by histology of biopsy specimens. The association between two groups was compared. Twenty (60.6%) patients in case group and 8 (24.2%) in control group were infected with H. Pylori. Severe H. Pylori infection defined histologically was associated with an increased risk of ESCC (p=0.035). There was no association between gastric atrophy and ESCC in our study. Our study showed a significant relationship between H. Pylori infections and ESCC. Further studies are warranted to explore the causal relationship.

Sour orange is known as an herbal plant in traditional medicine. Previous studies indicate a protective effect of citrus fruits or juices against risk of some chronic diseases such as diabetes. The aim of this study was to investigate the antioxidant and anti- hyperglycemic effects of alcoholic extract of sour orange peel in rats with alloxan induced hyperglycemia. In this experimental study, there were 120 Wistar rats weighing 150-200 gr that were divided into 6 groups (20 rats in each group) divided into two time groups (24 and 48 h). Ethanol extract of sour orange peel was prepared. Animals were pretreated for 4 days in 2 different doses 100 and 300 mg/kg. 100 mg/kg bw alloxan injected intraperitoneally. After 24, 48 h blood sample collected and glucose (via glucose kit), serum antioxidant levels (via FRAP) and serum insulin levels (via ELISA assay) were measured and the groups were compared. Twenty four hours after alloxan injection rats who received 300 mg/kg/day showed a significant increase in total antioxidant content (p=0.000) and significant increase in glucose level after 48 hours (p=0.001). The administration of sour orange peel extract (100 and 300 mg/kg/day) decreased serum insulin level in alloxan-induced hyperglycemic rats at 24 and 48 hours after alloxan injection (p<0.03). This study demonstrated that treatment with sour orange peel extract not only brought a significant increase insulin concentration but also decreased the insulin level and also increased glucose concentration in alloxanized rats.

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are significantly increased in postmenopausal ages. The mechanism about relation between menopause and SUI is not clear. Perhaps decreased level of hormone induced these problems. Therefore, this study was carried out to assess the relationship between estrogen receptor (ER), progesterone receptor (PR), P53 and the development of SUI and to elucidate the bimolecular pathophysiology of SUI.

This is a case control study. Ten menopausal women with pelvic organ prolapse and stress urinary incontinence and 10 menopausal women without POP selected for hysterectomy entered into this study. The sample of anterior vaginal walls and uterosacral ligaments were obtained. The relative ER, PR and P53 levels in the samples were obtained by immunohistochemical staining.

The mean age (±SD) of the control group was 56.2±5.6 years and in the sample group it was 56.4±6.8 years. The mean age and the body mass index and the number of vaginal deliveries and the number of years of menopausal in two groups were similar. The P53 in the control group was 14±6.21 and in the sample group was 0.7±0.67. The ER level in the control group was 36±9.36 and in the sample group was 1.20 ±1.61. The PR level in the control group was 42.5±6.34 and in the sample group was 2±1.33. The result in the anterior vaginal wall and uterosacral ligament were similar. Expression of ER and PR and P53 was significant lower in the study group.

The expression levels of P53, estrogen receptor and progesterone receptor in patients with POP and SUI were significantly lower than the control group.

With effect of acidic, basic and neutral soaps in bond strength and microleakage of dentin bonding agents, we found that neutral soap (sodium sulfonate) had the most effective on bond strength increase and microleakage decrease. The aim of this research was microscopic examination of sodium sulfonate effect on thickness of dentin bonding agents hybrid layer and resin tags thickness. In this laboratory study, 20 third molar teeth were randomly divided into two groups of ten and their occlusal surface enamel was removed by disc. First group was etched by phosphoric acid 35% and after using of Excite solution, a transparent cylinder with 2mm on height and diameter was put on dentinal surfaces and filled Tetric ceram composite resin and light cured for 40 seconds. In second group after etching and washing, sodium sufonate was rubbed for 30 seconds and washed and subsequent stages have done like first group. After preparation of buccolingual sections all of the samples were put in 6 normal solution of HCL for 8 hours and 1% NaOCL for 10 minutes and studied under electronic microscope. Thickness of hybrid layer and length and diameter of resin tags were calculated. The length mean of resin tags in second group (16.88±4.71µ) was more than first group (14.31±6.32µ). The diameter mean of resin tags in second group (3.04±0.88µ) was more than first group (2.1±1.3µ). The thickness mean of hybrid layer in second group (15.73±3.69µ) was more than first group (13.66±8.22µ). But there was no significant difference in none of them. Using of sodium sulfonate was not effect on diameter and length of resin tags and thickness hybrid layer.

The relation between cholinergic system and muscarinic cholinergic receptors (mR) associated with learning and memory has been recognized. Because of astrocytes contact to synapses, they are undergoing remarkable structural and morphological changes in learning. The aim of this study was to evaluate amnesia induced by scopolamine (Antagonist mR) on the number of astrocytes in rat's dentate gyrus.

In this experimental study, 48 male Wistar rats, 200-250 gr were used in 6 groups and each group contains 8 rats. The animals were bilaterally implanted with chronic cannulae in the CA1 regions, trained in a step-through type inhibitory avoidance task, and immediately after training, animals received saline or different doses of scopolamine (0.5, 1 and 2 µg/rat, intra-CA1) and tested 24 h after training to measure step-through latency. Then all rats were sacrificed 48h after behavioural test and cross sections were taken from the dorsal hippocampal formation of the right cerebral hemispheres and stained with PTAH (the specific staining for astrocytes). The area densities of the astrocytes was measured in dentate gyrus and compared in the all groups.

Scopolamine injection can induce amnesia. There was a significant difference in astrocyte number between control and sham group which only had surgical stress (p<0.05). Whereas there was no significant increase in astrocyte number of scopolamine received groups compared to control group.

The results of this study showed that amnesia induced by scopolamine can little increase astrocytes number in the rats dentate gyrus.

Paraoxon (active metabolite of parathion) is one of the most toxic organophosphate (OP) compounds. Acetyl cholinesterase inhibition is the main acute toxic mechanisms of OPs. Free radicals production and disruption of antioxidant defense systems is one of non-cholinergic effects of these compounds. In the present study, the effect of acute paraoxon administration on the oxidative stress indices in rat liver and lactate dehydrogenase (LDH) activity in plasma and liver were evaluated. In the present study, 32 male Wistar rats (200-250 g) were randomly divided into 4 groups (6 animals in each group): control (corn oil as paraoxon solvent) and three experimental groups received different doses of paraoxon (0.07, 0.35, or 0.7 mg/kg body weight) intraperitoneally. Four hours after injection, under ether anesthesia, blood sample is given, liver tissue removed and transferred to liquid nitrogen. Superoxide dismutase (SOD), catalase (CAT), and LDH activities and the levels of glutathione (GSH) and malondialdehyde (MDA) were determined in liver tissue homogenates. Significant increase in SOD activity and decrease in CAT activity at doses of 0.35 and 0.7 mg/kg of paraoxon were observed (p<0.05). The level of glutathione significantly decreased in all doses of paraoxon. Paraoxon in all treatments induced significant increase in plasma LDH activity and decrease in liver LDH activity. MDA concentration did not show any significant alteration. Present findings indicate that acute OP administration induces free radical generation, impairment of cell antioxidant balance and predispose the cells to oxidative stress. So measurement of plasma LDH activity might be a beneficial marker in OP toxicity.

Abstract: Fungal peritonitis is a relatively rare disease with serious complications in peritoneal dialysis patients and is associated with significant morbidity and mortality. Candida species are the most common cause of fungal peritonitis. The objective of this study was to isolate the Candida species in the patients with peritoneal dialysis by molecular methods, and thus to determine their drug resistance. In this cross-sectional study, sampling (peritoneal samples) was carried out on 210 suspicious patients with peritonitis after peritoneal dialysis in Tehran, Iran in 2010. Species identification was done by direct microscopic tests, culture on Chromagar and Corn meal agar, Germ tube test in bovine serum, Urease test, and biochemical identification with the API 20 kit. Identification of isolated yeasts was confirmed by PCR-RELF method. Antifungal susceptibility testing of isolated Candida species was conducted by the broth dilution method in accordance with the National Committee on Clinical Laboratory Standards guidelines [NCCLS-M27]. Totally 210 samples were surveyed that 40 cases (19.05%) with microbial peritonitis were identified based on experiments, which only 9 cases (22.5%) had Candida peritonitis which determined as specific species in accordance with PCR-RFLP molecular technique for confirming phenotyping methods. Among these 9 cases of isolated candida species, 5 cases of them (55%) were C. albicans, 1 case (11%) was C. Kefyr and 2 cases (22%) were C. guilliermondii and also 1 case (11%) was C. parapsilosis. The MIC determined by antifungal susceptibility testing were: C. albicans (Amphotericin B=0.125 µg/ml, Fluconazole=2 µg/ml, 5- Flucytosine=2 µg/ml), C. guilliermondii (Amph B=1 µg/ml; Flu=2 µg/ml, 5- Fluc=4 µg/ml), C. Kefyr (Amph B=0.5-1 µg/ml, Flu=0.5- 1 µg/ml, 5- Fluc=2-4 µg/ml) and C. parapsilosis (Amph B =0.5 µg/ml, Flu =1 µg/ml, 5- Fluc=0.5g/ml). Accurate identification of Candida albicans and non-Candida albicans species cases of Candida peritonitis in patients with peritoneal dialysis is necessary.

Tanacetum parthenium has been introduced as an analgesic agent in traditional medicine and it is widely used to relieve neuropathic pain and headache. The present study was conducted to investigate the analgesic effect of Tanacetum parthenium extract using formalin test.

In an experimental study the analgesic effect of Tanacetum parthenium was evaluated by formalin test in 10 groups of 100 adult meal mice, as follows: group distilled water, groups received 10, 20, 30, 40 and 80mg/kg of alcoholic extract, respectively, group received 100 mg/kg ibuprofen, group received 0.5 mg/kg morphine, respectively, group received 0.5 mg/kg naloxon and group received naloxon and extract. Fifteen minutes before formalin injection in foot floor of mice, different doses of extract, ibuprofen, morphine and naloxone injected intraperitoneally in mice. The analgesic effects with observed animal movements and compared in different groups in 30-minute intervals and recorded in two acute and chronic phases.

Among the different doses of extract, 10mg/kg has more analgesic effect in both acute and chronic phases (110.7±19.58), (61±1.15) and showed significant difference with groups ibuprofen and distilled water (p<0.05). The results indicate that the analgesic effect of Tanacetum parthenium is dose dependent and analgesic effect of the extract was inhibited by naloxon (193.6±17.35), (111.5±6.43).

Results in this study showed a dose-dependent analgesic effect of Tanacetum parthenium in both acute and chronic phases and the decrease in the analgesic effect of naloxone group is probably caused by activation of opioid system.

Labor pain is the most severe pain that a woman experiences during her life. With attention to different methods of painless labor such as entonox gas, but unfortunately the most people concerned about it. The purpose of this study was to assess painless labor with entonox gas.

This clinical trial study was performed on 98 pregnant women in active phase of delivery in Shahid Yahyanejad hospital, Babol, Iran. After getting consent, they were randomly divided in two groups: intervention group=49 and control group=49. Efficacy, experience and satisfaction were measured in five levels: excellent, good, moderate, weak and none. Expectation of pregnant women about entonox gas in two groups and also before and after using entonox gas in intervention group was compared.

The most pregnant women in intervention group had less labor pain (91.8%), and satisfied with it (98%). Reduction of labor pain was in moderate level in most cases (43.9%). Forty-nine percent of pregnant women receiving gas described their experience as good and excellent and 80.9% indicated that they will request entonox gas in future. The amount of suffering from gas complications was mild in most pregnant women in intervention group (63%). Expectation of the majority of pregnant women in intervention group (before receiving gas) and in control group was weak (65.3%, 40.9%). The percentage of positive expectations increased after receiving entonox gas (p<0.05). There was a significant difference between the expectations of intervention group before and after receiving entonox gas and control group (p<0.05). Positive expectations were more in intervention group than control group. Most differences of expectations in intervention group before and after receiving the gas were: higher efficacy (p<0.05), more satisfaction (p<0.05), less complications (p<0.05), information about gas as painless labor method (p<0.05), and also previous experience of intolerable labor pain (p<0.05).

This study showed that using entonox gas caused less labor pain, favorite expectation and experience, and also more maternal satisfaction.

Neck pain is very common in new industrial societies. Endurance and neuromuscular trainings are two types of exercise therapy to treat patients with chronic non-specific neck pain. So, the purpose of this study was to evaluate the effectiveness of two exercise protocols including: endurance training and proprioceptive exercise, in treatment of patients with chronic non-specific neck pain.

Forty seven patients (male and female) with chronic non-specific neck pain participated in this experimental study. Subjects were randomized into two exercise groups: endurance training (ET) and proprioceptive training (PT) to get their exercises for 10 daily sessions. To measure deep flexor muscle endurance (mmHg), pressure biofeedback (Chatannooga) was used, cervico-cranial joint position error (degree) calculated with laser resource device and neck pain and disability identified by using Neck Disability Index, Neck Pain and Disability Scale Questionnaires and Visual Analog Scale before, 10 days and 45 days after treatment.

Joint position error, endurance index and pain changed significantly after treatment in 2 groups; (p<0.05, p<0.01 and p<0.05). Mean percentage difference of variables for endurance index improved significantly more in endurance training group (p<0.03), and more improvement in joint position error measurement was found in proprioceptive group (p<0.05).

It seems that ten sessions of endurance and proprioceptive training can improve endurance and reduce joint position error and pain in patients with chronic non-specific neck pain. Endurance training appeared to be more efficient for enhancement of the level of muscle endurance in patients with chronic non-specific neck pain. However, proprioceptive training sounds more effective in reducing joint position error pain in such a group of patients.

Most of the anticholinergic agents abuse are among the medications used for the treatment of neuroleptics induced parkinsonism. These drugs are abused orally or parenterally in psychiatric patients dominantly in psychotic patients. We reported a case of anticholinergic drug dependence in a patient who received it for reduction of withdrawal symptoms but abused it by smoking later.CASE: A 25 year old opioid dependent man previously treated with methadone referred to psychiatry clinic for detoxification of opioids. But he abused prescribed Hyoscine-NBB tablets by smoking willfully in order to reduce nausea and abdominal pain. He continued to abuse because of its euphorogenic effects and withdrawal symptoms such as restlessness, anxiety, insomnia and loss of appetite appeared when he discontinued. During 16 days of admission maintenance methadone therapy began to treat the opioid dependence and hyoscine was tapered concurrently. Despite significant improvement he did not follow the treatment when discharged.

Anticholinergic medications may be potentially abused when prescribing for relief of withdrawal symptoms in substance detoxification.