مجله دانشگاه علوم پزشکی بابل
سال پانزدهم شماره 4 (پیاپی 73، تیر 1392)

Alpha 2 adrenergic agonist such as tizanidine and clonidine have sedative and analgesic effects that can be effective as premedication for the general or spinal anesthesia. Tizanidine is a clonidine derivative that has the same effects. The purpose of this study was to evaluate the analgesic efficacy of oral tizanidine in preventing pain after anorectal surgery under spinal anesthesia. This double blind and clinical trial study was carried out on 60 male patients scheduled for anorectal surgery under spinal anesthesia. The patients were randomized into two groups: control group and tizanidine group. The control group received placebo and tizanidine group received 4mg of oral tizanidine as premedication 60 minutes before arrival in the operating room. The patients in the two groups received lidocaine 50 mg intrathecally. Meperidine consumption، duration of postoperative analgesia and side effects were studied in all patients. (IRCT: 201210315381N3) The mean age was the same in two groups. The duration of analgesia was 332. 50±9. 62 and 144. 19±5. 16 minutes in the tizanidine group and control group، respectively (p<0. 001). The meperidine consumption was 26. 67±15. 99 and 42. 17±20. 62 mg in tizanidine group and control group، respectively that the difference was statistically significant (p=0. 002). This study showed that preoperative oral tizanidine improved the severity of postoperative analgesia without increasing the side effects.

Piperine (the alkaloid of piper nigrum) can change the activities of microsomal enzymes. Caffeine probe were applied to determination of CYP1A2 enzyme activity. CYP1A2 enzyme is important enzymes in drugs metabolism that induces over 13% of liver cytochromes. This study was done to determine of piperine pretreatment role on caffeine concentration. This cross over study was performed on 20 healthy volunteers (10 men and 10 women) in two groups of placebo and piperine before using caffeine. After recording personal data including age، gender، height and weight; piperine (15mg) was orally administered during consecutive 3 days and at the 4th day after taking saliva sample، 50mg caffeine given to individuals and saliva samples were taken at 0. 5، 2. 5 and 5h after using caffeine. The caffeine saliva levels were assayed using HPLC method (C8 analytical column، 40:60 methanol: water as mobile phase، UV detector at 210nm wave length and 0. 8ml/min rate of fluid flow). Data were fitted in a “double-compartment PK model” using P-Pharm 1. 5 software and analyzed under statistical tests. Pharmacokinetics parameters including clearance، volume of distribution and half-life were compared in two groups. The mean ± SD of the age and body mass index were 21. 1±1. 37 years (range: 19-23 years) and 24. 71±4. 69، respectively and the body weight range was 45-120 kg. The half-life and clearance of caffeine were respectively lower and higher than in piperine pretreatment group compared to the placebo، (3. 59±1. 42 vs 4. 39±0. 74h، p=0. 01 and 20. 17±8. 76 vs 14. 94±1. 86ml/min، p<0. 01) respectively. The elimination ratio constants in piperine group was greater than placebo (0. 22±0. 09 vs 0. 16±0. 02، p=0. 008). The difference between all PK parameters except volume of distribution was significant. According to the results، it is suggested that piperine may induce CYP1A2 enzyme activity in hepatic microsomal system.

After Iron، zinc is the second most abundant trace element in the body that is present in all organs، tissues and body fluids. It is a necessary component for maintaining immunological integrity antioxidant activity، and has critical role in the control and prevention of infection. The aim of this study was to investigate the effect of zinc sulphate syrup in treatment of children with respiratory tract infection.

In this randomized clinical trial study، one hundred and twenty four children with respiratory infection (62 in case and 62 in control group) from pediatric ward of Hajar hospital of Sharekord university enrolled. Both groups received standard treatment. In addition to، zinc sulphate syrup was given to case group and placebo to control group. Respiratory rate، bed and cough and fever duration were compared between the case and control groups (IRCT: 201103025951N1).

The mean duration of fever in the case group was 2. 6±0. 82 days and in the control group 4±1. 5 days (p<0. 001). The mean of bed duration in the case group was 4. 7±1. 5 days and in the control group 5±1. 8 days (p=0. 42). The mean of cough duration in the case and control groups was 3. 4±1. 3 and 4. 7±1. 6 days respectively (p=0. 09). Respiratory rate in the case group was 28. 3±4. 3 and in the control 28. 1±4. 9 (p=0. 77).

The study showed that zinc supplementation has a beneficial effect in decreasing the fever duration in children with respiratory infection. But there was no significant effect on respiratory rate، duration of bed and cough.

Control of hemorrhage after angiography is important and vital. Bleeding occurs due to ineffective homeostasis and topical homeostatic agents have an important role in controlling it. The purpose of this study was to compare bleeding control of Celox with usual dressing followed by angiography. This randomized clinical trial was conducted on 100 patients candidate for angiography in cardiac ward of Shahid Beheshti hospital of Qom in two groups of case (receiving 2g Celox powder) and control (normal pressure dressings) were studied. Time to homeostasis، underlying disease، anticoagulant drugs، hematoma and angiography location pain intensity were recorded and evaluated (IRCT: 201202209084N1). The mean age of patients in Celox group was 58. 06±7. 78 years and in the dressing group، it was 62. 90±11. 82 years. Homeostasis time was shorter in cases than controls (380. 94±206. 87 seconds versus 546. 88±258. 318 seconds) (p=0. 001). Four (8%) cases in Celox group and 6 (12%) in dressing group had hematoma which the difference was not statistically significant. There was no significant relationship between pain severity at the site of angiography in studied groups (p=0. 000) but no relationship was found between the hematoma، homeostasis and history of anticoagulant drugs (p=0. 370 and p=0. 073 respectively). Bleeding controls with Celox and dressing had no significantly difference with anticoagulation history and hematoma at 1h and 6h after hemostasis (p=0. 795 and p=0. 510 respectively). The results showed a significantly positive effect of Celox in bleeding control and reducing time to homeostasis of angiography location. So، it is recommended after coronary angiography.

Allium latifolium has polyphenolic compounds with power antioxidant properties which reduce serum lipids. Phosphatidate phosphohydrolase (PAP) is a key enzyme in controlling the synthesis of glycerophospholipids. The aim of this study was to determine the effect of the hydroalcoholic extract of Allium latifolium on the liver PAP and serum lipid profile in hyperlipidemic rats. In this experimental study، 40 male rats were randomly divided into 5 groups (8 in each group). Group I (normal) received standard diet، group II received cholesterol and oil diet (without treatment group)، and groups III and IV were the rats which received cholesterol (Chol) and oil plus 150 and 300 mg/kg bw Allium latifolium extract، respectively. Group V were the rats which received cholesterol and oil diet plus 30 mg/kg bw gemfibrozyl. At the end of the study، liver PAP activity، liver triglycerides (TG) and cholesterol، and serum lipoprotein levels were determined and compared. In group II، liver PAP activity showed a significant reduction (p<0. 05) compared to other groups. In groups III and IV (the rats which received Allium latifolium extract)، the liver Chol and TG، serum HDL-C، TG، total Chol، and VLDL (Very Low Density Lipoprotein) concentrations showed a significant reduction (p<0. 05) compared to group II (the rats without treatment). In group IV، serum total cholesterol indicated a significant elevation (62. 30%) with respect to group III (p<0. 05). The consumption of Allium latifolium in the low dose can reduce the side effects of hyperlipidemia such as elevated serum Chol and TG.

Although several investigators have evaluated the effects of the dietary glycemic index on obesity and hypertension among adults، few and controversial evidence reported for adolescents. Furthermore، no studies examined the effect of low glycemic index diet (LGI) on obesity and hypertension in comparison to healthy nutritional recommendation (HNR) based diet. This study was run to compare the effects of low glycemic index (LGI) diet on blood pressure and anthropometric measurements to HNR based diet in adolescent girls. Fifty mature adolescent girls aged less than 18 participated in this parallel randomized clinical trial. Those whose body mass index (BMI) was between 85th and 95th percentile of BMI for age table provided by WHO were determined as overweight and those whose BMI was higher than 95th percentile were determined as obese. Randomized allocation assigned subjects to LGI diet or healthy nutritional recommendation (HNR) based diet. Macronutrient distribution was similar between two groups. A menu of allowable foods and a list of HNRs were delivered to LGI and HNR group; respectively. Nutritional status during the study was evaluated by four dietary records. Measuring of blood pressure and anthropometric variables were conducted at baseline and after intervention. (IRCT: 201109272839N4) Finally، the information of 41 subjects was analyzed. Those in LGI group had GI lower than 50 (42. 67±. 067). Significant reductions were observed in weigh (71. 40±2. 23 vs. 68. 97±2. 03 in LGI group and 77. 95±3. 48 vs. 75. 81±3. 39 in HNR group; p=0. 0001 for both) and BMI (27. 97±0. 55 vs. 26. 71±0. 48 in LGI group and 28. 82±1. 01 vs. 27. 75±0. 97 in HNR group; p=0. 0001 for both) in both groups. Changes in blood pressure (diastolic blood pressure: -0. 25±4. 46 in LGI group vs. -0. 21±2. 72 in HNR group; p=0. 995 and systolic blood pressure: -1. 19±2. 52 in LGI group vs. -2. 36±2. 43 in HNR group; p=0. 743) and anthropometric variables (weight: -3. 24±0. 78 in LGI group vs. -2. 70±0. 60 in HNR group; p=0. 582، waist circumference: -4. 99±1. 18 in LGI group vs. -1. 07±2. 08 in HNR group; p=0. 221، BMI: -4. 35±0. 92 in LGI group vs. -3. 65±0. 58 in HNR group; p=0. 514) were not different between two groups. The result of this study showed that low glycemic index diet has no effects on obesity and hypertension.

Functional dyspepsia is one of the most upper gastrointestinal disorders that affect the life quality of patients and medical expenses. In spite of supporting evidences، the effect of the psychological factors on beginning and continuing of this disorder is increasing; little information is available regarding the relationship of personality traits with functional dyspepsia. The purpose of this study was to compare personality traits between healthy individuals and the patients with functional dyspepsia. This case-control study was performed on 60 patients aged 20-65 years old who referred to two gastroenterology clinics of Babol hospitals and diagnosed as functional dyspepsia according to laboratory and sonography tests. Sixty healthy individuals who were matched with case group regarding to age، sex and educational level were included in the study. They filled out the NEO-FFI five-factor model of personality questionnaire. Then two groups were compared regarding to psychological variables of neuroticism، extraversion، openness to experience، agreeableness and conscientiousness. The results showed that the mean of crude scores of neuroticism (with 12-60 ranges) in patients with functional dyspepsia (26. 43±7. 48) were significantly higher than healthy individuals (21. 22±7. 01) (p<0. 001). Also، the mean of crude scores of openness to experience (with 12-60 ranges) in patients with functional dyspepsia (23. 90±3. 86) were significantly lower than healthy individuals (26. 32±4. 71) (p=0. 003). There was no significant difference in extraversion and agreeableness as well as conscientiousness between patients with functional dyspepsia and healthy individuals. The results showed that functional dyspepsia is related to two personality traits: high neurotic and low openness to experience

Salivary gland tumors have low prevalence، and they are 3-6% of all tumors of the head and neck. Role and function of mast cells in tumoral lesions have conflicting results. Their role in salivary gland tumors is unknown and there are few studies about this. Thus the aim of this study was to evaluation and comparison of mast cells density in benign and malignant salivary glands tumors and their relation with grade in the malignancies. In this descriptive analytic study، 33 paraffin blocks of pleomorphic adenoma (PA) and 30 paraffin blocks of malignant salivary glands tumors [14 cases mucoepidermoid carcinoma (MEC)، 16 cases adenoid cystic carcinoma (ACC)] were obtained from archived files of Amir Alam hospital in Tehran. Then، two sections were carried out on each block and then stained with hematoxyllin-eosin to confirm diagnosis and determination of the grade of MEC، and toluidine blue staining for recognizing mast cells. Mast cells density in benign tumors، low grade and high grade malignancies were statistically analyzed. Mast cell density in PA was 3. 12±3. 03 and in low grade malignancies (MEC grade I) was 13. 25±6. 22 and in high grade malignancies (MEC grade III، ACC) was 1. 47±2. 74. There was no significant difference in mast cell density in benign and malignant salivary gland neoplasms (p=0. 107). Mast cell density in low grade malignancies was significantly higher than benign tumors (p=0. 001) and high grade malignancies (p=0. 007). Also in MEC grade I was higher than MEC grade III (p=0. 027). Mast cell density has relation with process of tumorigenesis and malignancy grade. Mast cell density increase in first steps of malignancy and decrease with progression of malignant salivary gland tumor.

In digital panoramic images، amalgam filled teeth may be observed with a radiolucent band called mach band (a visual illusion) which can be confused with secondary caries. The purpose of present study is performance evaluation of three versions of software designed for identification of mach band effect and caries. In this study، 40 digital panoramic images with 233 class I and II amalgam filled posterior teeth were selected. Three observers evaluated these teeth and agreed about the presence or absence of caries and mach band in them. All the cases were evaluated in three versions (A، B، C) of the software On the basis of agreement of 3 observers، 178 teeth had mach band، 23 teeth had caries and 32 teeth was normal. Sensitivity، specificity، positive likelihood ratio and negative likelihood ratio in version A for mach band detection was 94%، 11%، 1. 05، 0. 57 and for version B was 79%، 47%، 1. 50، 0. 44 and for version C was 82%، 47%، 1. 56، 0. 38 respectively and in detection of caries for version A was 13%، 96%، 3. 42، 0. 90 and for version B was 57%، 93%، 7. 91، 0. 47 and for version C was 70%، 91%، 7. 69، 0. 33. So، version C was better than others in both detection of mach band and caries. The results of this study indicate that this software can help users in detection of caries and mach band.

To create new developmental tasks، such as motherhood، pregnancy is a critical period for woman. Nowadays، due to the stress of birth، women''s desire to cesarean delivery has increased. This research is designed to identify the effect of educational coping skills on labor outcome. In this interventional study، 64 primiparous women were included in this study by cluster method and were randomly divided into two groups of case and control (32 subjects in each group). The experimental group attended eight coping skills sessions in 18-22 weeks of pregnancy and control group received routine antenatal care. Labor outcome were evaluated and compared in two groups. Mean age in case and control groups was 20. 25±1. 40 and 20. 43±1. 86 years، respectively. There was a significant difference between two groups in requesting cesarean delivery [3 subjects (10%) in case group versus 12 (48%) in control group] (p=0. 002). However caesarean rate، low birth weight and preterm neonate in case group were less than control group، but the difference was not significant. According to the results، childbirth preparation using behavioral-cognitive skill is a suitable method in decreasing childbirth outcomes including requesting cesarean delivery.

Emergency peripartum hysterectomy (EPH) is a major surgery that usually performs in severe and life threatening bleeding after vaginal or cesarean delivery. Since، maternal morbidity and mortality is important in health system of our country so we studied incidence، indications، risk factors and complications of this surgery in pregnant women undergoing emergency peripartum hysterectomy at the hospitals of Babol University of medical sciences during 10 years. This cross-sectional study was performed on pregnant women undergoing emergency peripartum hysterectomy in Shahid Yahyanejad and Ayatollah Roohani hospitals of Babol، Iran during 2002-2011. Data such as demographic data، type of delivery and hysterectomy، amount of blood transfusion، days of hospitalization، maternal and neonatal morbidity and mortality were gathered and the results were analyzed. Twenty two EPH cases were identified among 37595 deliveries giving an incidence of 0. 5 per 1000 deliveries that its rate in cesarean section delivery was 0. 7 per 1000 and in vaginal delivery was 0. 2 per 1000. The most indications of peripartum hysterectomy were 8 cases with uterine atony (36. 4%) and 6 cases with abnormal placentation (27. 3%)، and the cesarean section and curettage were major risk factors for abnormal placentation. Blood transfusion was performed in all of patients and intra and postoperative complications included: 11 cases (84. 6%) with intensive care admission that 5 cases (38. 5%) of them had febrile morbidity and also 2 cases (15. 2%) of them had vesical and urethral injury. There was 3 (13. 6%) maternal death due to hemorrhagic shock. According to the results of this study، incidence of EPH in our study was more in cesarean section than vaginal delivery and history of previous cesarean section and curettage were the risk factors for abnormal placentation.

Fetal and neonatal complications are more common in premature than full term. There are lots of prescription drugs to suppression of premature labor but they are not effective completely. The aim of this study was to compare the nifedipine and magnesium sulfate to delay premature labor.

This randomized case control clinical trial study was performed on 100 women with gestational age 24-37 weeks، singleton pregnancy and preterm labor symptoms who admitted to Al- Zahra hospital in Rasht، Iran. Women with fetal or maternal indications that need termination were excluded from the study. There are 50 cases in each group (magnesium sulfate 4gr IV loading infusion and then 2gr/hr until decreased or suppressed uterine contraction and nifedipine10mg capsule and if the contraction did not stop، the second capsule was administered. Vital signs، vaginal bleeding، ruptured membranes، fetal heart rate، uterine contractions and their blood pressure were controlled precisely. (IRCT: 2012062310089N1)

Delivery was delayed more than 48 hours in 48% (24) of cases in the magnesium sulfate group and in 72% (36) in nifedipine group (p=0. 03). The most cause of cesarean section in 28 of cases was fetal distress in two groups that in magnesium sulfate group was more than the nifedipine group. There was no significant difference in complication between two groups.

The results showed that nifedipine in more effective than magnesium sulfate to postpone delivery more than 48 hours.

Insertion of Intra uterine device (IUD) is known as the one of an effective method of family planning associated with pain. The aim of this study was to evaluate the effect of lavender on pain during insertion of intrauterine device. This was clinical trial study. Total 135 Iranian women candidate for intra uterine device insertion that had eligible criteria were randomly recruited into three lavender، placebo and control group. Data was collected by demographic questionnaire and visual analogue scale. The pain was determined in all three groups after insertion of intra uterine device compared to each other. There was significant difference between the mean of pain score between three groups. The mean of pain in lavender (2. 60±2. 71)، sesame oil (4. 57±2. 71) and control group (3. 82±2. 08) were reported (p<0. 001). The average pain score was decreased in lavender group after aromatherapy compared to placebo (p<0. 001) and also as compared to control groups (p<0. 004). The results of this study suggest that aromatherapy with inhalation of lavender essential oil is effective as pain relief before IUD insertion

Ascorbic acid (AA) is present in the most part of central nervous system (CNS) such as nucleus accumbens shell (Acbsh). Previous studies have shown that peripheral injection of AA can reduce anxiety. So the effect of intra-accumbens injection of AA، bromocriptine، and co-administration AA and bromocriptine (Br) on anxiety behavior of rats were investigated by Elevated plus maze (EPM).

In this study، 70 adult male Wistar rats (220-270 g) were used in 10 groups: control (intact)، sham AA (injected normal saline as AA vehicle)، AA (12، 24 and 48 µg/rat/side)، sham Br، Br (12. 5 and 25 µg/rat/side)، AA plus Br (24 and 25 µg/rat)، and sham AA plus Br. After surgery and recovery period، drugs were injected (volume= 1µl). Thirty minutes after each injection anxiety parameters (time percent in open arm and closed arm) were measured for 5 min by EPM task.

The result showed that Intra-accumbens injection of AA (24 µg/side/rat) (223. 28±15. 24)، (48 µg/side/rat) (248. 74±12. 57) (p<0. 001)، Br (12. 5 µg/side/rat) 235. 87±17. 45 (p<0. 001) and (25 µg/side/rat) 175. 57±20. 89 (p<0. 05) combined injection 228. 24±15. 99 (p<0. 001) significantly increased percentage of time spent in open arm in comparison with control.

We concluded that intra-accumbens injection of both AA and Br D2 receptor agonist as well as their co-administration induced significant decrease in anxiety behavior، dose dependent or dose independent manner.

An effective organizational climate that is defined as a collection of characteristics of an organization is an important resource for improving staff’s mental health that affects their morale، contribution in decision-making، and also innovation and creativity. This study aimed to assess the organizational climates of the libraries of Northern Iran’s medical universities based on ClimateQUAL indicators. This survey and cross-sectional study was conducted on all staff in the libraries of Northern Iran''s medical universities (Babol، Sari، Gorgan and Guilan) in 2012. A researcher-made questionnaire was used for data collection based on 9 indicators included in ClimateQUAL. Minimum and maximum total score in this tool was 36 and 252 and in each index was 4 and 28 respectively that on this basis، different indicators and educational and hospital libraries were evaluated and compared. Mean of organizational climate score in medical libraries of Northern Iran’s medical universities was 103. 06±51. 15. The highest and the least rates of organizational climates belonged to service to client (14. 61±4. 42) and team work (10±2. 65)، respectively. Organizational climate of the studied libraries were significantly different (p=<0. 05). Also، organizational climates of educational libraries were significantly optimal than that of hospital libraries (p=<0. 05). According to the results، the organizational climates of educational libraries are optimal.

Short-Chain L-3 Hydroxyacyl-CoA Dehydrgenase deficiency may be presented in years after birth and sometimes lead to patients mortality. According to importance of nonspecific symptoms of disease and early progression that due to patient''s life-threatening we decided to report clinical and biochemical manifestation of patient with SCHAD deficiency and with symptom of cardiac involvement. CASE: A 15 year old child with respiratory distress and loss of consciousness was admitted to the PICU. Patients had a history of intermittent vomiting and early fatigue during normal activity from 2 years ago. The development had been normal until now. Lab data revealed severe metabolic acidosis and in echocardiography hypertrophic cardiomyopathy، due to previous dilated cardiomyopathy with EF: 25-30% and severe dysfunction of both ventricles were reported. The patient was intubated on the second day of admission due to bradycardia and deteriorating the level of consciousness and he died on the third day of admission due to cardiopulmonary arrest. Finally، according to the high levels of 3-Hydroxy Butyryl Carnitine or (C4-OH) metabolic disease (SCHAD) was diagnosed. Symptoms of metabolic disease can be seen with dilatory in infant with normal development. Because of the low recognition of symptoms particularly cardiac involvement، delay in diagnosis can be life threatening.