مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و پنجم شماره 2 (پیاپی 116، تابستان 1391)

Thalassemia major is a hereditary anemia that becomes blood transfusion dependent. Iron overload consequence leads to multiple organ dysfunction and endocrinopathy. So deferoxamine (desferal) is used for chelation therapy. The aim of this study was to evaluate the growth rate of these patients and its correlation with endocrine complications and determine the role of secondary iron overload in these situations. This cross-sectional study was performed for a year (2010) on 280 patients (aged 3.5- 56 years) who received blood transfusion and chelation therapy at Amirkola Thalassemia Center. After basic evaluations, determination of height standard deviation, they were divided by serum ferritin level into two groups (good and poorly controlled). They were evaluated for hypothyroidism, diabetes mellitus, hypoparathyroidism and hypogonadism. Next, data were analyzed. A p <0.05 was considered significant. From 280 patients with mean age of 19.6 ± 8.5 years, 161 (57.5%) cases were female, short stature (<-2 SDS) was present in 90 cases (32.1%). Their mean height was 151.4±17.3 cm. 162 cases (57.9%) had endocrinopathy. There was a relationship between short stature and hypoparathyroidism (p= 0.009) and hypogonadism (p= 0.005) and also diabetes mellitus (p= 0.003); but no relationship was found between short stature and hypothyroidism (p=1.000) and serum ferritin level (p=0.091).According to higher prevalence of hypoparathyroidism, hypogonadism and diabetes mellitus in short statured thalassemic patients, screening should be done for such disorders with more sensitivity in these patients.

Widespread use of one-stage pull-through technique for Hirschsprung’s disease and its excellent results are dependent on the accuracy of intraoperative frozen sections (IOFS). The purpose of the present study is to determine the incidence and sources of probable errors during this process. This cross-sectional study included all patients who were admitted from 2000 to 2010 in Dr Sheikh Children Hospital and had undergone IOFS for diagnosis of Hirschsprung’s disease. This cross-sectional study included all patients who were admitted from 2000 to 2010 in Dr Sheikh Children Hospital and had undergone IOFS for diagnosis of Hirschsprung’s disease. Frozen section can be a reliable method for evaluation of suspected Hirschsprung’s patients with consideration that the favorable outcome is totally dependent on quality and number of prepared frozen sections for careful evaluation by pathologist.

Peripheral neuropathy has been known as the main cause of diabetic foot ulcer and limb amputation. Early diagnosis of this complication can prevent more severe morbidity as well as enormous economic costs.

Based on the duration of the disease, 110 diabetic patients were divided in two groups of less than 10 and more than 10-year history. After taking complete history about the symptoms of neuropathy, the patients were examined neurologically. Then, electrodiagnostic studies were performed on the patients.

96 patients (87/2%) had diabetic neuropathy. The prevalence of neuropathy had a significant relationship with the duration of the disease (P value= 0.004). 61 patients (55/4%) complained of neuropathic symptoms. The results of the neurological exams were abnormal in 65 patients (59.09%). The most common symptom was paresthesia (50% of patients) and the most frequent sign was abnormal Achille's reflex. 77 patients (70%) had abnormal indices in nerve conduction studies the most common of which was decrease amplitude of peroneal and sural nerves. 16 patients (14/5%) showed alterations in NCS in the absence of clinical signs or symptoms and 19 patients (17/2%) had normal NCS indices despite the presence of signs or symptoms of neuropathy.

High sensitivity of taking history and a careful neurological examination in the diagnosis of diabetic neuropathy necessitates physicians to pay more attention to clinical examinations and patient complaints, and avoid costly electrodiagnostic investigations. Thus, early diagnosis of sub-clinical neuropathy in these patients and providing them with necessary recommendations, irreversible complications such as amputation can be prevented.

Hemostasis disequilibrium is one of the coronary risk factor diseases. According to the effects of physical capacity on coagulation system, therefore, the aim of this study was to determine and compare coagulation markers responses to a moderate aerobic exercise in active and inactive young girls. The present study enrolled on 22 volunteer girls students (11: active and 11: inactive) who were 21-24 years old. Inactive subjects did not perform any regular exercise during 1one year ago; on the other hand, active subjects had regular sport activity in past four years. Current protocol was 30 minutes running with 75-70% intensity of maximal heart rate reserve in two groups. For checking the response of coagulation factors, blood sampling conducted in 3 different times (before, immediately and 30 minutes after the running) in all subjects. Independent T-test conducted for statistical analysis at level p≥0/05.After moderate exercise session, the PT of active subjects (11.45±0.47) was significantly more than inactive subjects (11.05±0.43) (p=0/0050). On the other hand, there was no significant difference between the degree of PLT, MPV (p=0.14 0), aPTT (p=0. 082), fibrinogen (p=0.59), and factor VIII (p=0.694) in active and inactive subjects, respectively.The Level of physical fitness effects on some of blood coagulation factors responses, so that reaction time, the amplitude response to exercise, and recovery could be different in the active and inactive young girls.

The role of mechanical stress (sport) on bone under the effect of physical exercise in calcium and phosphorus metabolism was investigated first by RedHall (1999) 23. In this regard, the researches investigated the effect of various exercise on bone density and its markers.

Thirty healthy postmenopausal women with mean age 54.85 years and 68.35 kg weight has been randomly selected from among retired employees in kerman city. Their age range was 48-60 years were participating in this research and were divided into three groups. The first group included combined sport, the second group combined sport with calcium (1500 mg) and vitamin D (1600 IU) intake and the third group were taking calcium (1500 mg) and vitamin D (1600 IU). The combined sport included some physical practices such as weight exercises, aerobic exercises, jump and agility exercises and they practice in 6 month, 3 sessions a week, and at least for 60 minutes.Evaluating the level of calcium, vitamin D, parathyroid hormone and alkalin phosphatase enzyme was done by blood test with enzyme synthetic method. After applying independent variable, the primary measurement was repeated again. With the test of kelmogrove-smirnov the analysis of one-way variance and post hoc test was used for checking the variables relationship.

The amount of calcium, vitamin D, parathyroid hormone and alkaline phosphatase enzyme to arrange in sport – drug, drug and sport groups was significantly higher.

The combined sport (excersice) caused an increase in bone reconstruction and increased alkaline phosphatase enzyme in post menopausal women. Increasing the process of involved enzymes in bone building, prevents delay of osteoprosis, and leads to improvement in nervo-muscular function.

Of the major causes of infertility are male factors (30-40%). obesity is Causes disorders in males fertility with influences endocrine, temperature and genetic mechanisms. The purpose of this study is the survey association of BMI with semen parameters and sex hormones in men.During the examination of the couples referred to infertility center of Kosar city of Urmia. 180 men were randomly selected and semen analysis, measurements of sex hormons such as testosterone, FSH, LH, Estradiol, Prolactin, SHBG was performed, and their height and weight and calculated BMI was measured The above parameters correlated with BMI in infertile and fertile groups and were compared with each other. Statistical analysis was performed based on ANOVA Pearson correlation coefficient and P value <0.05 was considered as significant.Significant differences was observed in different BMI groups between estradiol, testosterone, SHBG and TES/EST. In the fertile group a significant negative correlation was observed between BMI and testosterone, BMI and SHBG, BMI and TES/EST. In the infertile group between BMI and TES, BMI and SHBG, BMI and TES/EST, BMI and LHa significant negative correlation was observed. No significant correlation was observed in the other sex hormones and semen parameters.Obesity influenced estradiol, testosterone SHBG, and TES/EST in males but had no significant effect on semen parameters.

End Stage Renal Disease (ESRD) patients need vascular access for hemodialysis and infection is the most common late complication of central venous catheters.A descriptive prospective study was done on hemodialysis patients to evaluate the prevalence of the catheter-related infections. Patients with possible central venous catheter infection were enrolled from July 2009 to April 2011 at Imam Reza Hospital, Mashhad. We checked the apparent exit site infection as well as the systemic signs and symptoms of catheter-related infection. Specimens were obtained from the catheter blood, the catheter tip and the peripheral blood for culture and antibiogram. Then data was collected by using SPSS. Frequency tables, graphs and mean were prepared for describing data.From total 65 hemodialysis patients (34 females, 31 males with a mean age of 54.9), 41 ones (63/1%) had a past history of catheter-related infection. As for the local signs of infection, 52 patients (80%) had tenderness, 41 (63.1%) had induration, 35 (53.8%) had redness and 32 ones (49.2%) had pus discharge from the catheter insertion site. Staphylococcus aureus was the prevalent organism among 76.7% of patients with positive culture out of which 79.6% were vancomycin sensitive. Catheter had to be removed in 21(33.3%) of the dialysis patients.Staphylococcus aureus was the most common organism involving in catheter-related infection among hemodialysis patients and the most common clinical sign of infection, was tenderness at the catheter insertion site. We suggest that these findings could be used for early diagnosis and starting the empiric antibiotic regimen in patients with central venous catheters.

Parenting style has significant impact on the growth and development of adolescents. Family factors like inappropriate parenting, parents, disagreements and loss of positive relationship between parents and children are considered as strong predictors to cause and maintain adolescents’ emotional-behavioral problems. This study aims to evaluate the effect of the Positive Parenting Program on the parenting styles, adolescents’ behavioral problems and improving the relationship between parents and their adolescents. In an interaction with control group study (pre-test, post test) 60 mothers of female students of Varesan-Nour high school of Mashhad (6th zone), were evaluated in case and control groups. Data were collected before and after sessions using Demographic Questionnaire, Parenting Scale, Being a parent Scale, Parenting Problem Checklist, Depression-Anxiety-Stress Scale, Strengths and Difficulties Questionnaire (SDQ) and Client Satisfaction Questionnaire.Positive Parenting methods were taught in 6 two-hour sessions. Data were analyzed using descriptive statics, variance analysis and the SPSS 16.The mean age of mothers, fathers and adolescents in two groups had no statically significant difference. The results related to SDQ in adolescents showed that a change in the mean total score at the end of the intervention is statistically significant (p<0.001). The mean scores related to Parenting Scales (p<0.001), Being a Parent (p<0.001), and total score of Stress-Anxiety-Depression score (p<0.001) were statistically significant in case group in comparison with control group. Positive parenting education can be effective in improvement of different aspects of parenting styles, parents’ adequacy, adolescents’ behavioral problems and relationship between parents and adolescents.

Lead poisoning can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. [Case report:A 57-years-old Was man admitted to the hospital due to abdominal pain of 40 days duration and 9 kg of weight loss. He had addiction to the oral opium from years ago. He had anemia and jaundice in physical exam. His abdominal pain was after eating and we evaluated upper and lower parts of gastrointestinal and we didn’t find any clue. All of the other imagings incuding,small bowel follow through,abdominal C.T. angiography and magnetic resonance enterography were normal. Finally,serum lead levels were measured and were 1961 mic/ dl (normal range of 10 mic/dl)elevated;Therefore established diagnosis was lead poisoning.We reported a patient with lead poisoning that was presented with abdominal pain and abnormal liver biochemistries. Because of his addiction to the oral opium agents and some reports, it seems the most probable source of lead poisoning is oral opium agent.