نشریه دانشگاه علوم پزشکی خراسان شمالی
سال چهارم شماره 1 (بهار 1391)

Currently glucantime is used as first choice drug in treating kala- azar. Because of some rising unresponsiveness to this drug, in this study we attempt to compare glucantime with amphotericin B in treatment of kala-azar as first line of therapy. In these prospective study 19 patients aged 6.5 months to 10 years old with kalaazar were assessed. 12 out of 19 cases received amphotericn B and remainder treated with glucantime. Fever and throm bocytopenia were improved more rapidly in amphotericin B taking group. (P 0.05 and P 0.017 respectively). Two cases were died who belonged to glucantime treated group (p 0.02) all patients who received amphotericin B were successfully cured. Am photericin B can cure kalazar fully with improving fever and thrombocytopenia quicker than glucantime.

Hypospadiasis is a common congenital genitourinary malformation which has various surgical procedures for its reconstruction. Tabularized incised plate (TIP) is the most common technique and this study compares the use of buccal mucosal graft combined to double dartos flap with tunica vaginalis flap as second layers in TIP procedure. In a prospective study 43 patients with hypospadiasis underwent TIP. Patients were randomly assigned into two groups. In the first group, 21 patients undergo buccal mucosal graft combined to double dartos flap and in the a second group, tunica vaginalis flap were used as second layer in 22 patients. Patients were followed and development of complications such as wound infections, meatal stenosis, and urethrocutaneous fistula formation were recorded. Failure was defined as need for repeated surgery. The overall success rate was 87.5% (100% in first group and 60% in the second). 12 patients had complications (3 in the first group and 9 in the other group) which half of them needed surgical operation. In 5 patients of tunica vaginalis flap group developed urethrocutaneus fistula; nevertheless, no fistula was recorded in buccal mucosal graft combined to double dartos flap (P=0.048). Other complications were not significantly different in the 2 groups. The surgical success rate of patients undergoing buccal mucosal graft combined to double dartos flap was significantly higher than tunica vaginalis flap(P=0.021). Buccal mucosal graft combined to double dartos flap as a second layer is a good technique with reasonable results in hypospadiasis surgery.

Gestational diabetes is an state of glucose intolerance that is diagnosed during pregnancy. Metformin is a biguanide oral hypoglycemic agent and is used in treatment of type 2 diabetes mellitus, but its use in treatment of gestational diabetes has been controversial. The purpose of the present study was to investigate the effects of metformin on serum lipid profile in hyperglycemic pregnant rats and their progenies. Female Wistar rats were randomly divided into 5 groups: intact control, sham, hyperglycemic and 2 experimental groups treated with metformin at doses of 160 and 300 mg/kg. The hyperglycemia was induced by the intraperitoneal injection of hypertonic glucose (4g/kg) and medroxyprogesterone (3mg/kg) twice daily since the 5th day of pregnancy through the end of the gestational period. Furthermore, experimental groups received 160 and 300 mg/kg metformin in drinking water since 5th day of gestation through the end of the pregnancy. The maternal blood samples were taken on days 0, 5, 15 and 20 of pregnancy, while neonatal samples were collected on postnatal days of 15 and 30. Biochemical factors (triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol) were measured spectrophotometrically by routine laboratory techniques. Following injection of hypertonic glucose and medroxyprogesterone, serum glucose levels were significantly increased in hyperglycemic pregnant rats compared to control. Serum triglyceride and cholesterol levels in hyperglycemic pregnant rats and their newborns were partially increased in comparison to control group. Treatment of hyperglycemic pregnant rats with metformin at dosages of 160 and 300 mg/kg decreased the lipid levels in the mothers and their newborns compared to hyperglycemic group, although the changes were not significant. Our findings suggest that the hyperglycemic pregnant rat model is a reliable model for gestational diabetes in human. Metformin is a safe and effective treatment for rat dams during gestational diabetes and their progenies. Therefore, it may be suggested that metformin can be used in treatment of gestational diabetes in pregnant women.

There are some reports on hypotensive and antispasmodic effects of Teucrium polium. The aim of this study was to investigate the vasorelaxant effect of Teucrium polium extract on rat thoracic aorta. Sixty four male Wistar rats were divided randomly into 8 groups. The relaxant effects of cumulative concentrations of the extract (1, 2, 4 and 8 mg/ml) on phenylephrine (PE) and potassium chloride (KCl) induced contraction were evaluated in endothelium-intact and -denuded aortas. In another set of experiments the effect of extract (8 mg/ml) on PE and KCl induced contraction in the presence of cumulative calcium concentrations (from 10-5 to 10-2 M) were investigated. Then the effect of the extract on aorta precontracted by PE in the presence of L-NAME (L-NG-Nitroarginine methyl ester, hydrochloride) (100μM) and indomethacin (10μM) were studied. The cumulative concentrations of extract induced a concentration dependent relaxation in the aorta precontracted by PE and KCl. The extract reduced PE and KCl induced contraction in presence of cumulative calcium concentrations. All the extract concentrations (except 1 mg/ml) significantly relaxed PE induced contraction in the presence of L-NAME. The extract significantly relaxed the precontracted aorta by phenylephrine in the presence of indomethacin except by 1 and 2 mg/ml concentrations. The results showed that the extract had vasorelaxant effect on aorta precontracted by PE and KCl. The relaxation mainly was mediated by inhibition calcium influx in vascular smooth muscle cells. It seems the vasorelaxant effect of extract at lower concentrations mediated by nitric oxide and prostacyclin.

The treatment of textile industries wastewater due to excessive coloring matter and pollution is one of the environmental health experts concerns. As, adsorption is one of the effective process in colorfully wastewater treatment. The aim of this study was surveying about introducing an inexpensive and available adsorbent capability, orange peel ash, in removal of Direct Black 22 Dye from aqueous environments. In this study, orange peel ash was produced in vitro. The elimination of direct black 22 was studied in aqueous solution in a batch system by the adsorbent. Therefore, the effect of operational parameters such as contact time, pH, initial concentration of soluble dye Direct Black 22 and the adsorbent dosages were investigated. Measurements were performed using a UV-Visible spectrophotometer at a wavelength of 585.5 nm. Finally, adsorption isotherm and kinetic analyses were carried out. data showed high selectivity and efficiency of orange peel ash to rapidly remove the color from solution and equilibrium was achieved within 90 minutes. Maximum removal of color (95.2%) was observed at pH=2. Adsorption efficiency was reduced with increasing initial concentration of dye solution and decreasing the adsorbent dose. Adsorption isotherm studies revealed the binding occurred within surface and correlated with the Freundlich model. Kinetic models indicated a correlation between the adsorption processes with the pseudo second kinetic model. pH affects the cell surface and on physical-chemical reactions and adsorption sites. At low concentrations of color soluble, adsorption sites absorbed dye more easily, but at higher concentrations colored ions must be penetrated into the inner places. According to the results, the carbon obtained from orange peel as an agricultural product, showed good performance for Direct Black 22 dye.

In human preterm birth refers to the birth of a baby with less than 37 weeks gestational age. Preterm labor is defined as the initiation of uterine contractions of sufficient frequency and intensity leading to progressive effacement and dilation of the cervix every time between 20 and 37 wk gestational age. The purpose of this study was to determine the celecoxib effectiveness on stopping preterm labor compared to indomethacin and magnesium sulfate. This study is a double-blind clinical trial on 400 patients between 24 to 34 weeks with a diagnosis of preterm labor in the Imam Khomeini hospital in Sari during 2009-10. This was a randomized study of patients who had twin pregnancy and intact amniotic membrane, do not responding to treatment with hydration and analgesics and cervical dilatation and effacement was on the rise. patients were divided into three groups receiving magnesium sulfate, indomethacin and celecoxib. In order to measure the Amniotic Fluid Index (AFI), Ultrasonography was carried out at 24, 48, and 72 hours after beginning of the treatment. 400 patients mean age 26.1±4.6 years completed the trial. A significant statistical difference in favor of celecoxib was observed between these groups. Totally, 87.9% of patients used celecoxib and magnesium sulfate were respond to tocolysis. Celecoxib is as effective as magnesium sulfate for primary tocolysis.

lipids play (or have) a major role in many critical functions of body but their growing up can increase the risk of cardiovascular diseases. This study investigates the hyperlipidemia incidence and its relationship with nutritional pattern, life style and anthropometric indices in North Khorasan Province, Iran. it is a cross-sectional study, which was performed on the teachers of North Khorasan province since 2009 to 2010. Demographic features, nutritional patterns, life style and Anthropometric indices were measured and recorded by using of standard scales. An 8mL fasting blood sample was collected after 12h fasting. Blood samples were centrifuged at 3000 g for 10 minutes and the serum aliquots was separated and stored at -20 oC. The GPO-PAP and GHOD-PAP methods (Zist-chimi company kits) were usedin order to determine the cholesterol and triglyceride concentration respectively. LDL-c and HDL-c concentrations were determined using Biosystem company kits. Total of 11704 (99.9%) volunteers among the 11713 teachers (5730 males and 5983 females, age 50.64±6.62 years), participated in this study. The mean concentration of cholesterol, triglyceride, HDL-c and LDL-c in men were 196.4± 42.7, 164.2±96.4, 46.8±1.3 and 107.7±3.9 and in women was 190.9±39.8, 132.1±71, 50±1.2 and 110.9±3.4 respectively. The hypercholesterolemia and hypertriglyceridemia prevalence and increased LDL-c levelin the age group 20-45 yearswas significantly more than age group 45-70 years. Hypercholesterolemia was directly associated with the male gender, central obesity and BMI (body mass index) and smoking, and inversely with the age group. Data was shown that the serum HDL-c level in females was lower than males and the serum LDL-c concentration in males was lower than females. This study shows high prevalence of hypercholesterolemia, hypertriglyceridemia, serum increased LDL-c level, low physical activity in the age group 20-45 years. It seems that the lower age group expose to the heart disease more than age group 45-70 years.

One of the most important aspects in radiotherapy is target definition. Since routine methods of imaging (CT and MRI) are inadequate for treatment of glioblastoma multiforme (GBM), magnetic resonance spectroscopy (MRSI) as a functional imaging modality has recently been taken into consideration for target definition. In this study we tried to use MRSI in addition to CT and MRI in order to identify clinical target volume (CTV). The aim of the present study was to compare the clinical target volumes based on anatomical imaging (CT-MRI) and anatomical-biochemical imaging (CT-MRI-MRS). In this study, we used images of 16 GBM cancer cases. MRS and MRI images were fused with CT images. Then, treatment planning was preformed for each patient in two combined methods (CT+MRI and CT+MRS planning). CTVsCT+MRS were significantly larger than CTVCT+MRI (Pvalue<0.05). no other considerable changes in other important factors of treatment planning were found. Application of MRSI for target volume identification of GBM may lead to an increase in volume in comparison to CT planning alone; thereby, it is recommended to apply MRSI images for the purpose of target determination of radiotherapy because of its advantages.

Production of β -lactamases especially extended spectrum β -lactamases (ESBLs) by bacteria is one of the emerging health problems in the world. The prevalence of these enzymes varies greatly within different geographical areas and is changing over time. The purpose of this study was to determine the prevalence of ESBL producing bacteria among the urinary Enterobacteriaceae isolates and detection of blaPER gene from two selected hospitals in Mashhad. In this cross-sectional study, 100 Enterobacteriaceae isolates were collected from urine samples of inpatient and outpatient referred to 17-Shahrivar and Qaem hospitals from November 2010 to January 2011. Bacteria were identified by differential biochemical tests. Isolated bacteria were evaluated for antibiotic susceptibility. Double-disk approximation and phenotypic confirmation tests of ESBL production were performed according to CLSI (Clinical and Laboratory Standards Institute) guidelines. Molecular detection of blaPER gene was carried out by polymerase chain reaction using specific primers. Out of 100 bacterial isolates, 27 (27%) were ESBL producers without plasmid mediated blaPER. gene. Resistance to ampicillin, cefotaxime, ceftazidime and cephalothin among ESBL producing isolates was higher than non-producers (p<0.05). ESBL producers in comparison with non-producers were resistant to gentamicin, co-trimoxazole, and nitrofurantoin and there was significant difference for resistance to gentamicin and co-trimoxazole (p < 0.05). Results shows that ESBL production among Enterobacteriaceae isolates in the studied community is relatively high; blaPER gene was not found among isolated strain; therefore, production of β-lactamase is related to other types of ESBLs among isolated Entrobacteriaceae.

nowdays in daily life stress is a fact that cannot be denied from which it is impossible to separate. major stressor in individual life is job and nursing is one of the stressful professions. Because job stress causes physical and necessary to take emotional exhaustion and decreasing job efficiency, it is some measure to subside it. the research carried out aiming of determining job stress in nursing personnel. The subjects of this descriptive research were 154 nurses how had the qualifications of job research unit at educational and medical centers medicine of north Khorasan using stratified random sampling. Data affiliated to school including personal and job information, degree through questionnaire of job stress which was completed by research unit. For the purposes of data analysis software, SPSS 15 depending on the appropriateness of the methods of descriptive statistics, chi-square test, t test, ANOVA and post hoc Tukey test was used. major findings of this research showed that 62 percent of research units reported job stress with low amount, 30 percent job stress with medium amount and 8 percent job stress with high amount. the decrease in job stress can be the result the high application of coping strategies that need further studies.

chest pain control is one of the most important components of guidelines for acute myocardial infarction. An analgesic effect of glucose, insulin potassium solution has been suggested in a few studies. Hence this study was performed to evaluate the effect of this solution on the intensity of chest pain in patients with myocardial infarction. This randomized clinical trial enrolled 72 patients who had myocardial infarction that was treated with 25% glucose, 50 unit of soluble insulin per liter, and 80 mille mol of potassium chloride per liter at 1 ml/kg/hour (case group) or normal saline (control group) as adjunct to thrombolytic therapy. We evaluated pain intensity at baseline, after receiving thrombolytic therapy and 1 hour later, in both groups by a Numeric Rating Scale. Statistical analysis was performed using SPSS 15. Variables were compared using independent t tests and repeated measure ANOVA or chi-square test. In both groups pain intensity after receiving streptokinase and an hour later dropped, but there was no significant differences between two groups (P = 0.121). Difference between intravenous drug consumption in the two groups was not significant (P = 0.93). The administration of potassium, glucose, insulin has no effect on chest pain in patients with myocardial infarction.

Nowadays it is very desirable to investigate and discover new antibacterial and anticancer agents from natural products and medicinal plants. In this regard, the current study is conducted in order to explore the antibacterial and antioxidant properties of a rare plant named Uvaria grandiflora Roxb.

The antibacterial disc diffusion method, the DPPH radical scavenging test and the preliminary phytochemical screening were performed for six different extracts obtained by hexane, chloroform and ethanol.

Data exhibited the stem bark and leaves ethanolic extract of the plant, have high amounts of flavonoids and poly-phenols and therefore they have strongly inhibited Staphylococcus aureus and Bacillus cereus growth at the concentration of 2mg/disc. These samples illustrated the highest radical scavenging activity with the percentages of 95.32% and 86.38% at the concentration of 100µg/ml, respectively.

Following the results, it was concluded that the flavonoids and poly-phenols play crucial roles in the properties of Uvaria grandiflora Roxb., thus more investigations and isolations are recommended.

Sensory deprivation is one of the complications threatening the comatose patients. Sensory stimulation is a treatment that awakes the brain's reticular activating system, which helps brain re-organization. This study aimed to investigate the impact of familiar sensory stimulation on level of Consciousness in patients with head injury in ICU. This clinical trial was conducted on 60 patients with head injury in ICUs of Mashhad Emdadi Hospital. Intervention was the presence of family members and provides sensory stimulation in first 6 days of admission. Patients consciousness checked on GCS score on the first day and sixth and findings was analyzed with the SPSS 11.5. According to the non-normal distribution of the GCS, the Mann-Whitney test was used. The results of this test showed that the GCS in first day were homogeneous in two groups (P=0/402). Increase of GCS on the sixth day in the intervention group was more statistically significant than the control group (P=0/002). Early sensory stimulation is increase consciences in patients with brain injury. Revising in visiting policy in intensive care unit can be appropriate to provide positive effects of family presence on patient.

Sleeping fracture is a very rare condition found among patients with hyperparathyroidism; to the best of our knowledge this is the first case. The patient was a 54 years old man that had pain and swelling in right femur at waking up after a diurnal sleep.The patient has experienced weakness and fatigue with a general pain and tenderness for 16 years. The patient had difficulty with walking during this long period. Radiographic findings revealed subperiosteal bone resorption in fingers, pepper appearance in skull X-RAY, loozer zones in humerus and sever osteopenia in all bones. Laboratory findings presented that total serum calcium was normal, serum parathyroid hormone was mildly elevated, and alkaline phosphatase was highly elevated. The patient underwent total parathyroidectomy and then fixation of the femur. Hyperparathyroidism with sever bone disorders is still existing in Iran. In conclusion, it is reasonable that when the serum calcium is usually in normal range and the pathologic fracturs result from severe osteopenia, the attention should be paid to primary hyperparathyroidism with calcium normal range.