مجله مطالعات علوم پزشکی
سال بیست و چهارم شماره 6 (شهریور 1392)

The aim of present research was to study the prediction of physical and mental aspects of quality of life in multiple sclerosis patients. The current study was important to pave the way for further investigation aimed for managing believes and perception in order to increase the quality of life in MS patients. This non-experimental research was descriptive and correlative and was conducted on 100 members of MS patients that were selected by accessible sampling in Tehran MS Association. Clinical and demographic information were collected and the participants completed a range of questionnaire s. The data were analyzed by Pearson correlation and multivariate regression metod. According to the results illness perception can predict the physical and mental aspects of quality of life in multiple sclerosis patients. Illness perception is effective on quality of life in multiple sclerosis patients. Further interventional study are necessary to improve the quality of life in MS patients.

Incidence of cardiovascular disease and stroke can be due to decreased mobility or non-suitable life style. Exercise induces changes in blood lipids, cortisol. The aim of this study was to evaluate response of serum cortisol and lipid profile to a moderately intensive aerobic exercise in non-active middle-aged men. Thirty middle-aged men with an age range of 40-50 years were volunteered in this study. The exercise group performed an aerobic exercise training on the treadmill up to 65% of maximum heart rate (HRmax) for 30 minutes. Blood samples were obtained from the two groups before, immediately after, and 12 hours after the exercise. Cortisol, triglyceride, cholesterol, and VLDL levels immediately after exercise in the exercise group showed a significant increase comparing to control subjects (p<0.05). There were not any significant changes in the cortisol and lipid profiles in the recovery state (p>0.05). The difference between the immediately after exercise values with that of the base values of cortisol and lipids concentrations was significant, and it increased in the exercise group comparing with the control group (p<0.05). There were significant increase in cortisol, cholesterol, VLDL and LDL levels in the exercise group immediately after exercise comparing with the recovery condition (p<0.05). Moderately-intensive aerobic exercise, with stimulation of cortisol, increases the blood lipid concentrations in order to increase their metabolism, and it provides a desirable condition to reduce the cardiovascular risk factors.

Quality control is the most common function to test and measure material and product. Quality control of active ingredients in drug formulation is to control the quality of the products of a company and evaluate their stability. The purpose of this study was to determine the amount of dextromethorphan available in drug market of Iran. For this purpose different pharmaceutical formulations of dextromethorphan with different serial number preparations were purchased from the market. Based on their standard methods of extraction (USP Pharmacopeia) the active ingredient dextromethorphan was extracted and determined by using HPLC Colum. The method utilize fluorescence detector. The results of this project on 40 commercial products were as follow: The respective forms of pharmaceutical tablets were 104-124%; drops 87-92%; simple syrup 91-119%; and syrup mixture 109-120% of labeled. The assay results obtained from forty commercially available formulations of tablet and syrup were more than the amounts declared which agree with the tolerances indicated by the USP pharmacopeia while the assay results for drops were less than the declared values.

Giardia lamblia is one of the most prevalent intestinal flagellate protozoan that infects a wide range of vertebrate hosts. Giardia is one of the most common intestinal pathogens in children causing sever intestinal disorder and growth retardation. This study was performed to determine subspecies of Giardia lamblia by the PCR-RFLP method, targeting the glutamate dehydrogenase(gdh) locus, in hospitalized children at the Urmia Mutahhari hospital, West Azarbaijan Province, Iran In this study, thirty four stool specimen were collected from the hospitalized children in Urmia Motahhari hospital and dgiardia cysts were detected using microscopy. Cysts were partially purified by the sucrose density gradient method and then washed with sterile distilled water to effectively remove the PCR inhibitors. Genomic DNA of G.lamblia isolates was extracted by freeze-thaw cycles followed by phenol/ chloroform/isoamyl alcohol method. A single step PCR-RFLP assay was used to differentiate the assemblages A and B which been found in humans. In this method, 432 bp expected size were amplified and then for detection sub species were used of specific restriction RsaI and BspLI enzymes. From 720 examined samples, totally 34 samples were positive in term of giardia cyst so the parasite spread rate was reported 4.72%. Analysis of PCR-RFLP on these samples revealed that 28 samples (93.3%) had the genotype BIII and two samples (6.7%) belonged to the subgroup BIV. PCR-RFLP is a rapid and reliable method that enables us to effective genotype discrimination within Giardia assemblages using glutamate dehydrogenase gene, and makes it possible to identify the presence of mixed genotypes. In the base results, an animal source of infection is suggested.

About 60% of term infants and 80% of preterm infants are affected by jaundice in the neonatal period which 5-10 % of them require phototherapy. Phototherapy causes the separation of mother and infant, interfering with breastfeeding and there are also some concerns regarding to destruction of the genetic materials. Methods which might reduce the rate of photo would be useful. In this study, we compare the results of continuous and intermittent phototherapy methods on bilirubin levels of infants with hyperbilirubinemia. This study was a randomized clinical trial study which has been undertaken on 100 newborn infants, those who hospitalized in Bandar-Abbas hospital. Using simple Randomization technique, infants were divided into two groups. First groups were 39 newborn infants who were undertaken in intermittent phototherapy (phototherapy was one hour on and one hour off) and the rest (45 infants) were in continuous phototheraphy (phototherapy was on for two hours and 45 minutes, and off for 15 minutes). After starting phototherapy, the total billirubin was measured every 12 hours. Demographic data, feeding method, and incidence of complications were gathered. Mean of age, weight, feeding type and gender distribution did not have any significant difference between two groups. The levels of bilirubin reduced significantly for both groups (p<0.001). The reduction rate of bilirubin were higher in continuous than intermittent group (p<0.01). There were not any significant differences in duration of phototherapy and incidence of side effects in two groups who were under phototherapy. The level of bilirubin reduction was higher in the continuous phototherapy group than intermittent phototherapy and duration of phototherapy for reducing hyperbilirubinemia was similar in two groups of full-term infants.

Eotaxin is an important chemokine in asthma prevalence and adiponectin, with anti-inflammatory properties, acts as an agent that can decrease the risk of diabetes and cardiovascular diseases. The purpose of this study was to examine the effect of eight weeks of interval endurance training on plasma eotaxin, adiponectin levels, insulin resistance, serum lipid profile, and body composition in overweight and obese adolescents

In this semi-experimental study, 36 healthy overweight and obese male adolescents were randomly assigned to training (N=18) and control group (N=18). The training group underwent eight weeks of interval endurance training program (40 min/d, 4 d/wk). Adiposity, insulin resistance, lipid profile, eotaxin, and adiponectin were measured before and after the completion of exercise training. To evaluate the results, Paired T-test, Pearson correlation coefficient, and Stepwise multiple regression analysis were used.

The results showed that eight weeks of interval endurance training decreased the body weight, body fat percent, BMI, Insulin resistance, waist circumference, and triglycerides levels in training group (p<0.05), without changes in eotaxine and adiponectin levels (p>0.05).also there was a significant and positive relationship between eotaxine with cholesterol and LDL levels following training (p<0.05). Moreover, stepwise multiple regression analysis show that there was a significant relationship between eotaxin and insulin resistance (p<0.05).

After eight weeks of interval endurance training, without changes in eotaxine and adiponectin levels decreased triglyceride, insulin resistance and central obesity in overweight and obese adolescents

At least two third of neonatal morbidity and mortality are due to preterm labor. Transvaginalultrasonography has an important role in diagnosis of cervical incompetency and prediction of preterm labor. T he aim of this study was to determine the value of ultrasonographically measured cervical length between 16-24 weeks gestation in the prediction of spontaneous preterm delivery. A prospective cohort study examined cervical length by transvaginal ultrasonography between 16-24 weeks gestation. A total of 75 women who referred to prenatal clinic of imam Khomeini and Razi educational hospitals in Ahvaz and met inclusion criteria after measuring cervical length (c l) by transvaginal ultrasonography (TVS). They included two groups (36 cases with c l =26-30 m and 40 cases with cl=30-35mm. Then they followed until delivery. The incidence of preterm labor in c l=26-30 mm was 38% and in group with c l=30-35 mm was 50%. Respectively, in the multivariate analysis, age, parity, job, education, and cl. There was a statistically sign ificant relation between cl and preterm birth. (p<0.01) Mechanical and chemical factors can effect on the cl and cause preterm labor. A short cervix seen on 16-24 weeks gestation was a strong predictor of preterm birth.

Superior Mesenteric Artery Syndrome (SMAS) is a rare cause of upper intestinal obstruction manifested by retching or vomiting. Thanks to the difficulties arising in its diagnosis, it is usually done by elimination of other causes. We tried to report on the radiological manifestation of this rare syndrome aiming to find reliable predictable signs in imaging. The findings obtained from abdominal MDCT and barium meal of 50 adult patients with clinical symptoms suspected for SMAS. Our study showed two radiographic signs for diagnosis of SMAS: which are dilatation of descending duodenum because of D3 compression and decreased aorto-mesenteric angle. Multi-Detector-Computerized-Tomography (MDCT) was preferable to obtain the exact angle range between SMA and aorta. There was a significant correlation between D3 diameter and aorto-mesenteric angle (p<0.01). 3 cases were diagnosed as SMAS, among 50 cases enrolled in this study. The mean angle was 17±1 degree and the mean D3 diameter was 0.46±0.024 cm. MDCT is preferable imaging modality compared to barium study where we can exclude other simulating causes with different symptoms. It can provide the exact angle between SMA and aorta which is a essential imaging sign for diagnosis

Errors in the Health and Medical Systems has multi-dimensional parameters. Human parameters, system, equipment are the error making factors and by managing these parameters such errors can be reduced. The aim of this study was to survey the path of information and errors within the HIS system. T his study was based on analytic al method in which the hospital information system of Urmia Imam Khomeini Medical Education center were analyzed; in doing so the technical errors also the human errors in the path of information from deferens parts of the hospital in the HIS system were found using a prepared che c klist. Finely t he algorithm of errors or in other words the path in which there was a high technical and human error were reported. According to t he finding s there wa s a great gap between the human errors and the education level of operators (p =0/000). In contrast there was a signatures difference between the human errors and different working times (p >0/05). Also there was no significant difference between the human errors and various parts of the hospital working with HIS (P<0/05). By analyzing the path of information in the system of HIS, it was seen that maximum error occurs in the time shifts of nights and holidays and the clinical wards up to 40% and 33.33%, Respectively. By paying attention to the changes in the needs of the h ealth area as time goes on, the information system should adapt itself to the changes; these changes should be in parallel with the changes in the structure and the missions so that it would fulfill the needs of operators and prevent errors.

Kennedy's Disease (KD) Bulbar and spinal muscular atrophy (BSMA) is an adult onset, X-linked, recessive disorder caused by expansion of a polymorphic CAG tandem repeat. Because Kennedy’s clinical symptoms overlap with some other neuromuscular disorders such as amyotrophic lateral sclerosis (ALS) or spinal muscular atrophies, KD sometimes is misdiagnosed or left unnoticed. Here we describe a case of Kennedy’s disease confirmed by genetic testing who had been diagnosed and treated with ALS for three years. We describe a 56-year-old man presented with progressive onset of lower limbs muscular atrophy, weakness, and fasciculations since five years ago. He also complained of instability and fatigue when walking. Since three years ago, he had difficulty in swallowing and talking. He denied any sensory symptoms and sphincter disturbances. On examination at disease beginning he had normal mental status, bilateral facial palsy, tongue atrophy and fasciculation. The patient had lower limb muscle atrophy with mild weakness. The deep tendon reflexes all were depressed and the plantar responses were abolished. There were no sensory and cerebellar signs. Neuroimaging didnt show any significant pathology. Electrodiagnostic examination (EDX) revealed neurogenic pattern with low compound muscle action potentials (CMAP) and acute and chronic denervation pattern in tested muscles, so the patient diagnosed with ALS and treatment started with Riluzole, six months ago we visited him again with new onset sensory symptoms of face and limb parenthesis. Sensory examination revealed mild impairment of pinprick and thermal senses at limbs although senses of vibration and joint position were normal. He had also perioral and facial fasciculations. Since patient's signs and symptoms progression was gradual with developing of sensory findings we questioned the initial diagnosis and reevaluate it later on, EDX study showed decreased lower extremities CMAP with absent F-wave and H-reflects. All sensory parameters were near absent. Genetic studies revealed an increased CAG repeat number (50 normal up to 34), confirming the diagnosis of Kennedy disease. KD is the most common disease which is confused with ALS and recognition of KD is important because its prognosis, natural history, family testing, and management is different from ALS so it is necessary to rule out KD in suspected male cases of ALS.

Axillary artery originate from subclavian artery and feed axilla walls and after inferior border of teres major, this artery continues its route as brachial artery and several branches originate from it. So far some various variation of axillary artery and its branches are reported. Since axillary artery feeds the upper limb, it seems essential to be aware of its branches and variations. In this case we observed variation in axillary artery and its branches: thoracodorsal artery which is resumption of subscapular artery in normal situation, originates from lateral thorasic. subscapular artery which derived from the third part of the axillary artery is sandwiched between two roots of median nerve at its origin and anterior and posterior circumflex humeral arteries originated from subscapular. profunda brachii (a branch of brachial artery in normal situation) was resumption of subscapular artery. noticing the possibility of existence of these variations in the upper limb can be valuable and help surgeons to reduce the potential of mistakes and side effects in surgery