مجله دانشگاه علوم پزشکی بابل
سال پانزدهم شماره 2 (پیاپی 71، اسفند 1391)

Eighty percent of spontaneous abortion occurs in the first 12 weeks of pregnancy. Little information about the predictive value of ultrasound in predicting risks of spontaneous abortion is available. The aim of this study was to predict the risk of spontaneous abortion with the use of ultrasound markers. This prospective study was performed on 239 pregnant women with regular menstrual cycles. For all patients at 6-8 weeks of gestation with vaginal sonography, gestational sac diameter, yolk sac diameter, and crown Rump length was measured and embryonic heart rate (HER) was recorded with Color Doppler sonography. Then the patients were followed between 3-4 weeks to the end of 20 weeks of pregnancy. Of 239 pregnant women, who were studied, the pregnancy is continued in 221 (92.5%) patients after 20 weeks of pregnancy and 18 (7.5%) pregnancies have been resulted in abortion before 20 weeks of pregnancy. Using Pearson correlation between gestational age and EHR in the ones who their pregnancies were without abortion showed that there was a significant relationship (r=0.31, p<0.001). Among ultrasound variables to predict the risk of abortion during pregnancy EHR is more capable to predict than other variables (OR=0.85; 95%CI, 0.77- 0.94; p. value, 0.003). The results of this study show EHR compared to other indicators of ultrasound in pregnancy has greater predictive value.

Labor induction in the presence of an unfavorable cervix often requires a long hospitalization before delivery and may result in cesarean section. There has been a considerable interest in the use of nitrous oxide donors for cervical ripening in the last year, especially for its lower complications. This study was conducted to evaluate the efficacy of vaginal isosorbide mononitrate (IMN) for cervical ripening and labor induction. A double-blind, randomized, placebo-controlled trial was conducted with 72 nuliparous women with singleton postdated pregnancy and unfavorable cervix. They randomly assigned to receive either 20mg IMN (n=36) or placebo (n=36) tablets vaginally twice each 12h prior to admission for induction of labor. The outcomes were change in Bishop score, mean time from admission to active phase of labor, admission to delivery interval, and presence or absence of fetal and maternal morbidity and the rate of cesarean section that compared in both groups. IMN was more effective than placebo in inducing a change in Bishop score (3.69±0.89 vs 1.05±0/67;p=0.001), the mean time to active phase of labor was 2.82±0.67h in the IMN group; and 3.33±0.55 h in placebo group (p=0.01). IMN shortened the admission to delivery interval as compared with placebo (6.61±3.74 vs 11.48±3.55 h; p=0.001). There was no statistical difference in terms of maternal-fetal complications or cesarean section rates in two groups. Using of vaginal IMN in an outpatient setting is more efficient than placebo in cervical ripening and shortening of induction-labor interval without increasing maternal-fetal complications, or cesarean section rate.

Recently, therapeutic strategies for reducing hemoglobin decrease during and after coronary artery bypass graft surgery was evaluated in a lot of clinic trial studies. In this paper we evaluate effects of single dose of erythropoietin on blood transfusion requirement after coronary artery bypass graft surgery.

In this clinic trial study, 60 patients that were candidate for elective coronary artery bypass graft surgery randomly divided into two groups, study and control group. Patients in study group received intravenous infusion of erythropoietin (700 IU/kg), during coronary artery bypass graft surgery. The number of units of pack cell that was infused during surgery and postoperative period was measured. Also hemoglobin concentration was measured and compared before surgery and 5, 15 and 30 days after surgery.

The mean number of units of pack cell transfused per patients during surgery and postoperative days was significantly decreased in the study group, as compared with control group (2.93± 1.11 vs. 3.7± 1.08, p=0.013). The mean level of hemoglobin concentration on 15 days after surgery (11.03± 1.51 vs. 10.24± 1.14, p=0.018) and also 30 days after surgery (12.6± 1.45 vs. 11.84± 1.21, p=0.03) was significantly higher in study group.

The results showed that a single dose of erythropoietin during surgery reduced a perioperative transfusion requirement in the patient undergoing coronary artery bypass graft surgery. Erythropoietin injection also raised a hemoglobin concentration on 15 and 30 days after coronary artery bypass graft surgery in patients in erythropoietin group

Hyperglycemia and oxidative stress are found in patients with diabetes. Pyrus boissieriana Buhse leaves extract has many biological activities such as antioxidant, antilarva, antibacterial and antifungal in vitro. The aim of this study was to evaluate the preventive effect of Pyrus biossieriana Buhse leaves extract (PbBLE) on lipid and protein peroxidation in hyperglycemic rats. In this experimental study 120 adult male rats of Wistar strain, weighing 150 to 200g were randomized into normal control, extract control (500mg/kg), hyperglycemic and hyperglycemic+ extract (500mg/kg) groups. Each group divided into 3 subgroups (24, 48, 72h). Serum and tissues (liver, kidney, pancreas), total antioxidant capacity, thiobarbituric acid reactive substances (TBARS), carbonyl content and serum glucose measured by spectrophotometry and compared. Pretreatment with Pyrus boissieriana Buhse leaves extract exhibited a significant reduction in elevated serum glucose induced by alloxan in all subgroups. The extract increases total antioxidant after 72h. Mean of liver total antioxidant was 831±147 in alloxan+ extract group vs. 428±25 in alloxan group (p=0.045). Administration of Pyrus boissieriana Buhse leaves extract decreased serum, tissues and serum carbonyl. The results showed that Pyrus boissieriana Buhse leaves extract caused a decrease in serum glucose level, TBARS, some tissues and serum carbonyl, also it caused an increase in ferric reducing antioxidant power (FRAP) levels in some tissues.

Today only three-dimensional dosimetry is used by polymer gel that it is sensitive to beam and in the recent decade it has been paid attention very much. The aim of this study was to evaluate the absorbed dose enhancement with the application of conformal distribution of gold nanoparticles as a contrast agent with high atomic number material in MAGICA polymer gel. In this experimental and modeling study, polymer gel dosimeter MAGICA was used for measuring absorbed dose enhancement by adding gold nanoparticles that irradiated with x-rays with energies of 18 MV linear accelerator. Reading of dose done with MRI, then it was simulated using MCNPX code and the results were compared with experimental results. MAGICA polymer gel dose response at the dose ranges of 0 to 600 cGy was linear and dose resolution in less than 300 cGy dose level was less than 0.7 Gy. Absorbed dose enhancement factor by adding 0.1, 0.2 and 0.4 mM gold nanoparticles concentration was 10%, 2% and 4%, respectively, also the absorbed dose enhancement factor simulated by MCNPX code for 0.1, 0.2 and 0.4 mM gold nanoparticle concentration was 10%, 2% and 3%, respectively. The results of this study showed that for achieving maximum dose enhancement, the optimum concentration of gold nanoparticle was 0.1mM in modeling and experimental study that can be used for doing clinical study.

One of the side effects of diabete is subfertility. Diabete induces oxidative stress and cellular death in testis. Lepidium sativum is a plant with antidiabetic effects. The aim of this study was to investigate the protective effects of lepidium sativum (LS) extract on diabetic and injured rat testis induced by streptozotocin (STZ). In this experimental study, 36 adult rats were used. They were randomly divided into 6 groups. Group 1 (control) received normal saline. Groups 2 and 3 received 200 and 400 mg/kg, LS respectively. Group 4 received 65mg/kg, STZ for induction of diabetes. Groups 5 and 6 received 200 or 400 mg/kg LS plus STZ. STZ were administered in a single dose. LS extract and normal saline were administered once daily for 21 consecutive day. On the 22nd day after the experiment all animals were dissected and their testis were analyzed for histologic and morphometric studies. STZ induced spermatogenesis impairment and a significant decrease in germinal epithelial height 70.8 ± 4.65 µ compared to control 95.60± 6.87 µ (p<0.05). Treatment with 200 and 400 mg/kg LS reduced germinal epithelial height to 70.20 ± 7.56 and 77.5± 6.12 µ respectively (p<0.05). Administration of LS in doses of 200 and 400 mg/kg for 21 days has toxic effects on testis. Therefore it cannot protect spermatogenesis in diabetic testis induced by STZ.

Treatment of unstable upper and middle thoracic spine (T1-T10) fractures is challenging because of the high rate of associated injuries and frequent spinal cord injury. In spite of this importance, literature has not been addressed exclusively about this condition. Various surgical modalities have been reported for it and main advantage of surgery is restoration of sagittal and coronal alignment of vertebral column and spinal cord decompression. In this study, the results of surgery by using pedicular screw in these patients were assessed. In this quasi-experimental study, 16 patients (14 males and 2 females) with the mean age of 31 years (17 to 63 years) with unstable upper and middle thoracic spine (T1-T10) fractures who underwent surgery during three years (2009-2011) were assessed. Polyaxial pedicle screw was used in all patients two level above and below the fractured vertebra. Mean follow-up period was 16 months (9 -22 months). Radiologic evaluation was performed before and after surgery with plain X-ray, and degree of kyphosis and anterolisthesis was calculated before and after surgery. Neurologic injury to spinal cord before surgery and the amount of improvement after surgery was assessed by American Spinal Injury Association (ASIA). Instability was described by 3 column theory of Denis. Each of three variables ie kyphosis, anterolisthesis, neurologic deficit has been improved (p<0.05) with pedicular screw fixation technique. Kyphosis has been reduced up to 12 degrees, anterolisthesis decreased up to 7mm. From neurologic point of view 10 patients remained unchanged (ASIA A) but 4 patients improved dramatically from ASIA B to ASIA D and 2 patients remained neurologically intact as well (ASIA E). Surgery with pedicular screw and rod is a safe procedure for treatment of unstable upper and middle thoracic spine fractures that could efficiently correct kyphotic deformity and anterolisthesis and indirectly decompress the spinal cord and can improve neurologic status and maintain this correction in long term period.

Arsenic compounds toxicity have been reported of many parts of the world. Those are one of global clinical problems that affect all body organs and many cases of death every year. Arsenic compounds exist in environment and human body as form of inorganic and organic arsenic. Inorganic arsenic includes arsenite (As III) and arsenate (As V). The inorganic arsenics can be methylated to form monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) in vivo. Aasenic, especially inorganic arsenic is well absorbed (80-90%) from the gastrointestinal tract, distributed in the body, often metabolized by methylation, and then primarily excreted into urine. Methylation of inorganic arsenic compounds is considered as a detoxification process. Arsenic compounds cause to DNA damage, lipid peroxidation, and decreased antioxidant defense levels.The wide human exposure to arsenic compound especial inorganic arsenic in different sources throughout the world causes great concern for human health. Long term exposure to arsenic can lead to cancer of skin and internal organs eg., the liver, lung, kidney and bladder, also high mortality rate. The noncancerous effects of ingesting arsenic include clinical manifestation in gastrointestinal, cardiovascular, pulmonary, immunological, neurological systems, endocrine glands (e.g. diabetes) and skin. There are some laboratories tests available to diagnose poisoning can measure arsenic in blood, urine, hair, and fingernails. The urine test is the most reliable for detecting arsenic exposure.Arsenic toxicity can be life threating and necessitates supportive therapy (administration crystalloid fluids, inotropic drugs and treatment of cardiac dysrhythemias), decontamination (GI tract irrigation & use activated charcoal in some patients), chelating agents that should be initiated as soon as in arsenic toxicity. These chelating agents include: BAL (British anti lewisite, dimercaprol), 2,3-dimercaptosuccinic acid (DMSA. Succimer), dimercaptopropane sulfoxid acid (DMPS), and also, long term follow-up of these patients. This review article offer to ascertain: a) find out contamination areas that exposure to arsenic to the people by water, food, soil and air; b) common diseases of arsenic poisoning in human; c) education level, awareness and treatment of contaminated people.

Annually, a lot of patients experience motor problems due to nerve lesions. One of procedures for treatment of peripheral nerves injuries is cell therapy. The aim of the present study was to investigate transplantation of umbilical cord Wharton's jelly derived mesenchymal stem cells for improvement of sciatic nerve of rat after cutting and suturing two parts of proximal and distal nerve. Mesenchymal stem cells (MSCS) were isolated from human umbilical cord Wharton's jelly by non-enzymatic procedure. The morphology, proliferation and immunopheotype of the 3rd passage cells were analyzed. Twenty five male rats (200-250 g) were randomly divided into 3 groups: control (n=5), sham (n=10) and transplantation group (n=10). After anesthesia, surgery was performed on the three groups of rats but only the sciatic nerve in sham and transplantation groups was cut and then end proximal and distal nerve's epineurium were sutured. In transplantation group 700000 mesenchymal cells in the third passage injected into epineurium. Twelfth weeks after surgery, electromyography and foot print test were used to determine the restoration of nerve function and for each rat axon counted and compared. Flowcytometry analysis revealed that the MSCS derived from human umbilical cord were positive for CD90, CD49 and CD13 and could be induced to differentiate into osteogenic and adipogenic cells under proper inducing conditions. Results of EMG showed that in transplantation group, nerve was better regenerated (p<0.05). In histological study number of regenerated axons in transplantation group (283.3±2.35) were higher than sham group (239.6±15) (p<0.05) and significant differences in SFI (Sciatic Functional Index) were observed between groups (-100.37±35 and -84.1±7) (p<0.05). This research shows that transplantation of MSCS isolated from human umbilical cord Wharton's jelly proves nerve repair and functional recovery after severe sciatic nerve in rats.

A large number of new development drugs are soluble poorly in both organic and aqueous media which shows a low bioavailability using formulation traditional methods. A promising approach to solve this problem is the formation of nanosuspensions. Various articles about the increasing solubility and bioavailability of poorly soluble or insoluble drugs by nanosuspension were evaluated. In formulation of nanosuspensions, submicron-sized drug particles are dispersed in a liquid phase then they stabilize using surfactants. With respect to the studies in the subject, in order to eliminate the toxicity or to increase efficiency of drugs, nanosuspension formulation was used to formulate drug components. The main advantages of this approach are its application for the most drugs and doing it simply. In this work, common approaches of the preparation of nanosuspensions, its unique properties, advantages, potential applications and stability evaluation techniques, is mentioned. Considering the specific features of nanosuspensions such as, increasing saturation solubility and dissolution rate, increased adhesion, ease of manufacturing process and scale-up and versatility (flexibility offered in the modification of surface properties and particle size), there will be many applications for this formulation in different routes of drug delivery.

One of human needs in life is communication and speech is the easiest way to communicate. Any disorder in fluency or stuttering can create difficulties in communication. Based on the reports, the prevalence of stuttering is related to English speakers and little researches have been done in this field in Iran. The aim of this study was to assess the effect of age and gender on stuttering in different ages of students of Babol.

This cross sectional study was performed in the educational year 2010-2011 on 33331 students from 139 elementary, middle and high schools of Babol. Samples were introduced by teachers, consultants and speech therapists (during a short conversation with the students). Then their speaking samples of general and descriptive speech and text reading were recorded by a MP4. Frequency of their stuttering was calculated by the formula "[(pw + ss). Ru] + (2 dp)]". The students were considered as stuttering persons who scored over 4.

Among all students of Babol city, 381 (1.1%) were stutterer. Prevalence of stuttering at the elementary school level was 1.5% (221of 14542), at the middle school level was 0.9% (116 of 12245) and at the high school level was 0.7% (44 of 6544) that showed a significant difference in different levels (p?0.001). According to gender differences, the percent of stuttering in boys was 1.4% (about 204 students of 14369) and in girls was 0.9% (177 students of 18962) (p? 0.001).

Results of this study showed that the prevalence of stuttering in boys was higher than girls that it decreases with increasing age.

Hospital is a dynamic and active system, therefore the location of building, building assessment, staff and personnel, hospital equipment and correct management are all important in the hospital safety survey. The purpose of this study was to determine the safety status of the hospitals affiliated to the Babol University of medical sciences in 2010. This cross sectional study was performed in all diagnostic and therapeutic units of hospitals (6 hospitals) affiliated to Babol University of medical sciences, Babol, Iran. Data collection tool was a yes/no checklist and it has been completed by direct observation of researcher and also interview with managers and officials of various departments and units. The method of responding to each question was yes and no. If the answer was yes, it would get the percent of the 100 score in proportion to the number of questions. Hospital safety situation was considered poor, average and good for acquired scores below and equal 49.9%, between 50% and 79.99%, and above and equal 80%, respectively. Mean of acquired score of safety situation in the hospitals affiliated to Babol University of medical sciences was 59%±18%. There was no significant relationship between the safety situation in the hospitals with the age of building, number of hospital beds, percentage of occupied beds and the date of last reconstruction. The average score for infection control, facing with emergency events and safety coordination was 84.1%±7.3%, 53.5%±2.1% and 61.5%±24.2%, respectively. The results of this study showed that the hospitals affiliated to Babol University of medical sciences are good in infection control and developing from medium to high in the other indicators.

Seizure is a transient brain dysfunction due to abnormal electrical discharges of some cortical neurons. Clinical manifestations of seizures depend on the types of involved neurons. Seizures are the most cause of admitted patients to hospital emergency. Etiology of seizures is important in managements of these attacks. So, the purpose of this study was to survey the etiology of seizure in cases admitted to emergency department. This retrospective cross-sectional study was conducted on all patients with a diagnosis of seizure admitted to emergency department of Roohani hospital during 2009-2011. Semi structured questionnaires in three sections, including primary causes (epilepsy, cerebrovascular lesions, head trauma and brain tumor), secondary causes (poisonings, infections, metabolic disorders and electrolyte disorders) and other causes (pseudosizures, drug withdrawal and unrecognized etiology) were completed for all of patients from their files. Then data was analyzed. Among all of 213 patients 138 (64.8%) were male and 75 (35.2%) were female and the mean age of patients was 38.5+ 20.8. The most prevalent cause of seizure were epilepsy in 77 (36.1%), idiopathic in 45 (21.1%) and the other causes were poisoning (11.8%), cerebral vascular lesions (9.8%), non-real seizure (8.4%), brain tumor (3.3%), electrolyte disorders (2.8%), brain trauma (0.9%), metabolic disorders (2.8%), and the other (2.3%). The results of this study showed that the most common cause of seizure in these patients was epilepsy. The causes such as cerebral vascular lesions, poisonings and non-real seizure in our study was higher than other studies. So, continuous control of epileptic patients will be effective to decrease occurrence of seizure.

In transfusion dependent thalassemic patients, if their transfusion requirement increases over 20 ml/Kg of whole blood, splenectomy is indicated. Portal vein thrombosis (PVT) is one of life threatening complications of splenectomy. Follow up of splenectomized patients in order to the earliest diagnosis and treatment of PVT can improve the survival of them. The aim of this study was to assess the frequency of PVT in splenectomised thalassaemia patients. This cross sectional study was performed on 63 splenectomized thalassemic patients who referred to Yahyanejad hospital of Babol for follow up during 8 years (from June 2001 to June 2009). Patients were evaluated for age, gender, type of operation, splenectomy indication, spleen size, operation duration, clinical manifestation, PVT frequency, and time interval of splenectomy and occurrence of PVT, Color Doppler Sonography findings, PVT treatment and follow-up. PVT was identified in 6 (9.5%) patients (4 females and 2 males)(95% CI: 2.1-17). The mean time of patient’s follow up was 5.26±2.7 years. Average of surgery duration was 2.72±0.8 hours. The average of time interval of splenectomy and occurrence of PVT was 229±176 days. All of the patients treated by low molecular weight heparin during hospitalization and discharged by Warfarin for 4 months. Two patients received propranolol at the time of discharge, too. The results of this study show that early diagnosis of PVT by following up the patients who splenectomised and treatment of PVT with anticoagulant can reduce the adverse of this complication.

Bladder cancer is the ninth most common cancer worldwide and the fourth most common cancer in males in Iran and the second most common cancer of the genitourinary system after prostate cancer. The aim of this study was to assess demographic characteristics, clinical presentation, treatments and clinical course in patients with bladder cancer in Babol city in order to provide a way for future studies and enhancing treatment quality. This cross- sectional study was performed on 175 cases of bladder cancer within the period between 2001 and 2011 and treated at hospitals affiliated to Babol Medical University. All patients’ demographic data, tumor location, clinical presentation, smoking history, primary treatment strategy and histopathologic data were collected and finally 175 patients that their information was complete enrolled in the study. Then, the survival status of each patient was followed by their medical records and phone contacting. Out of 153 men and 22 women with the mean age of 62.76±16.25 years, 19 (10.9%) patients were under 40 years of age. About 55.3% of men and 7.7% of women were smoker. Hematuria was the most common symptom at first presentation (63.4%). With respect to pathological report, 96% of the patients had transitional cell carcinoma that of all 168 TCC patients, 36 had muscle invasion. There was no significant difference between the patients over 40 years old and invasion to the muscles but there was a significant difference between hematuria and invasion to the muscles in patients with bladder cancer (p=0.017). The results of this study show that hematuria is the most common clinical symptom in patients with bladder cancer. Since there is no specific tumor marker for screening, it seems that hematuria in the men over 40 years should be followed by more serious diagnostic actions.

Retained gauze after a surgery is an uncommon complication and may be associated with many complications. We report our case as attention may be paid to the fact that the retained gauze may get symptomatic even after a very long interval. CASE: The patient was a 60 year old man in whom infection and fistula developed 35 years after a surgery for femur fracture. The diagnosis was easily made because of a marker in the gauze by radiography. Removal of the gauze was associated with complete recovery of the patient in 1 year follow up.

Retained gauze after surgery is a preventable complication and may be asymptomatic for a very long period. If it diagnosed immediately after the surgery, the gauze should be removed.