مجله دانشگاه علوم پزشکی گرگان
سال پانزدهم شماره 3 (پیاپی 47، پاییز 1392)

Antibiotical resistance to Helicobacter pylori reduced the eradication rates. This study was done to compare the sequential comparison of sequential and routine four drugs therapeutic regiments in Helicobacter pylori eradication.

In this double blind clinical trial study 160 chronic dyspepsia patients randomly divided into 2 groups of sequential and routine four drugs therapeutic regiments. We performed invasive tests for H. pylori in patients who underwent gastroduodenoscopy. 160 patients who were diagnosed as H. pylori-positive by histological evaluation were selected for the trial. A 14-day sequential regimen (Omeprazole، Amoxicillin، each administered twice daily for the first 5 days، followed by Omprazole، Clarithromycin and Urazolidon، each administered twice daily for the remaining 9 days. 14-day 4 drug therapy، Omprazole، Clarithromycin، Amoxicillin and Bismoot each administered twice daily. 5 weeks after treatment urease breath test (UBT) was preformed.

The recovery was seen in 50. 9% and 49. 1% in sequential and routine four drugs theraputical treatment، respectively. The recovery of patient with severe H. pylori infection was non-significantly higher in sequential regiment (64. 7%) than four drugs regiment (41. 2%). In comparison to four drugs، sequential therapy was significantly more effective in patients with sever gastritis (87. 5% vs. 25%، p<0. 05).

The eradication of H. pylori infection particularly in severe gastritis is preferred by sequential theraputical regiment.

Coronary angiography is a routine and gold standard cardiac diagnostic procedure. Patients are restricted to bed rest after the procedure due to potential vascular complications using a femoral approach. Many patients are required to remain on bed rest for up to 24 hours after the procedure. The aim of this study was to assess the effect of changing position and early ambulation on the amount of bleeding، hematoma and urinary retention in patients with coronary angiography. In this clinical trial study 140 patients، which referred to coronary angiography center in Dezfoul-Iran، were randomly divided into four 35-individual groups. The patients in the control group were in supine position for 6 hours without movement. Position change was applied to the first interventional group based on a specific protocol، early discharge was applied to the second interventional group and both early discharge and position changes were applied to the third interventional group. The level of bleeding، hematoma and urinary retention were measured at zero، 1، 2، 4، 6 and 24 hours after angiography. The findings were collected using the individual data questionnaire and Kristin Swain’s checklist in order to evaluate the level of bleeding and hematoma. There were no significant differences between the four groups in terms of occurrence of vascular hematoma and bleeding. The incidence of urinary retention was non significantly higher in the control group in compare to others. Changing position following angiography speed up patient discharge from hospital.

Estradiol plays an important role in folliculogenesis and its developmental stages of embryo. This study was done to determine the quantitative assessment of mouse embryo development yielded from in vitro fertilization of ovulated mature oocytes after ovarian stimulation using human menopausal gonadotropin (HMG) and Estradiol valerate (E2). In this experimental study، 40 female NMRI mice were allocated into two groups. Control and treatment groups received HMG alone (10 IU/mouse) and a combination of HMG and E2 (1μg/mouse) in single dose manner، respectively. Following the induction of ovulation by HCG، the oocytes collected and morphologically evaluated. MΙΙ oocytes for in vitro fertilization (IVF) were transferred into medium containing capacitated and incubated sperm derived from male NMRI mice. The yielded embryos subsequently transferred into developmental medium for reaching to the blastocyst stage. The difference between the mean percentage of yielded oocytes and healthy MII oocytes in the control and treatment groups was not significant. The percentages of the fertilized oocytes reached to two-cells was 34. 22±21. 87 and 36. 83±20. 68 in control and treatment groups، respectively. The percentages of the blastocys stages of embryos was 49. 41±26. 5 and 62. 02±30. 11 in control and treatment groups، respectively. The addition of estradiol to HMG as an ovarian stimulator can not increase the rates of yielded MII oocytes and embryonic development.

Many studies have showed malformation of low frequency of electromagnetic fields (EMF) on different tissues. This study was carried out to evaluate the effect of low frequency electromagnetic fields on the heart of white-leghorn chicken embryo. In this experimental study، 90 healthy، fresh and fertilized eggs were allocated into 6 groups including control، sham، and four preincubated experimental groups. Experimental groups I، II، III and IV (1. 33، 2. 66، 5. 52 and 7. 32 mT) were located in the electromagnetic device، sham group was located into the same coil with no exposure for 24h before incubation. Control، sham and experimental groups incubated (37±0. 5 ºC، 60% humidity) for 14 days. Disassembling cell regulation in experimental group I، dense nucleus of myocytes and increase of intercellular spaces in experimental group II، necrosis and bleeding in the heart tissue in experimental groups III and IV were seen in compare to control and sham groups. There was a significant increase in the level of activity of alkaline phosphatase in the heart of experimental groups in compare to control and sham groups. Low frequency of electromagnetic fields caused alternations in cardiac tissue and elevation of Alkaline phosphatase activity in chicken embryos.

Breast cancer is one of the most frequent malignancies among women. This study was done to determine the BRCA1 gene expression in 7،12-Dimethylbenz (a) anthracene (DMBA) induced breast cancer in rats. In this experimental study، the breast cancer was induced by DMBA in Sprague dawley rats. After tumors arise، cell cultures were prepared and G-banding staining was performed on metaphase chromosomal smear. According to databases، genes in the affected area were collected and after comparing genome of the rats and human in changed chromosomal segments، a gene list was prepared. FISH technique was performed on BRCA1 gene to prove accuracy of chromosomal banding results. Structural changes such as deletion occurred in chromosomes 10، which BRCA1 is located on. 24. 7% of cells showed evidence of physical deletion in both copy of BRCA1 gene and 23. 8% of cells showed deletion in one copy. Induced DMBA Breast cancer cells showed deletion in BRCA1 copy numbers. This gene may be involved in animal breast tumor model.

Antiepileptic drugs can partiality control or achieve the convulsion. There are controversial issues about the use and effect of ethanol to control epileptic convulsion seizers. This study was done to determine the effect of ethanol on microvascular alterations in the brain cortex of epileptic mice treated by valporic acid (VPA). In this experimental study، 36 BALB/c mice were allocated randomly into six groups including: 1-PTZ (Pentylenetetrazol)، 2- Ethanol، 3- VPA+ PTZ، 4- ethanol + PTZ، 5-ethanol+ VPA+ PTZ and control groups. The animal brains were excluded and stained by Hematoxilin and eosin. Thirty-six optical microscopic field from each group were selected and microvascular count were determined. Immunohistochemical method was used for detection of injuries in the vascular brain tissue. Mean number of brain microvascular cortex significantly increaed in PTZ+ethanol and PTZ+ethanol+VPA groups in compare to controls (P<0. 05). Infiltration and thrombophlebitis were observed in vessels and cortical brain tissues in mice which received ethanol and PTZ. Proliferations in endothelial vascular cells were seen in PTZ and VPA+ethanol groups. Immunohistochemical method showed the endothelial cells of PTZ+ethanol groups were more stained in compare to the other experimental groups. Ethanol + PTZ cause cellular infiltration and damage to the cortical brain vessels although VPA reduces histological altheretions.

Oxidative damage associated with the presence of Lead in the brain has been proposed as one possible molecular mechanism involved in Lead toxicity. Aerobic exercise is known to protect the brain through a cascade of molecular and cellular processes. The purpose of this study was to investigate the effect of 8 week aerobic training on the brain-derived neurotrophic factor (BDNF) and malondialdehyde (MDA) levels in rat''s cerebellum exposed to Lead acetate. In this experimental study، 40 Male Wistar rats were randomly allocated into four groups: sedentary base، sham (30 mg/kg of ethyloleate)، Lead and exercise+Lead (20 mg/kg Lead acetate، intraperitoneally). The exercise program consisted of progressive running training on the treadmill for 15 to 22 m/min، 25 to 64 min/day، and 5 days/week for 8 weeks. BDNF and MDA levels were measured by ELISA and TBARS methods، respectively. Chronic Lead acetate administration enhanced significantly (P<0. 05) cerebellar MDA levels in rats compare to base and sham groups but had no effect on BDNF levels. Cerebellar MDA significantly was reduced and BDNF non significantly was increased in Lead acetate+ training group. Regular aerobic exercise with moderate intense may exert role neuroprotective against Lead-induced cerebellar injury by down-regulating oxidative stress and promotes brain health through increases in BDNF.

Irreversible electroporation is a new treatment modality for skin tumors ablation. In order to successful treatment، all of tumoral tissues must be exposed to intense electric field. In addition، the heat that produced during the surgery has adverse effect on recovery procedure. This study was done to evaluate the thermal distribution in ablation of squamous cell carcinoma skin tumors using irreversible electroporation. In this study numerical modeling by finite element was used for determination of electrical and thermal distribution in healthy and tumoral tissues. Three-Dimensional Model was done using MR imaging of patient with squamous cell carcinoma in FEMLAB v3. 5a software. Electric field distribution determined using Laplace equation and distribution of thermal damage calculated using bioheat equation and Arrhenius equation. This calculation was done for different geometry parameters of needle and plate electrodes. Thermal damage of first-degree burn was not observed in any cases. However in high voltage، volume with temperature above 43˚C reach to 10% of tumoral tissue and 3% of healthy tissue. The study show that the voltage applied to the electrodes and the distance between the electrodes can have the greatest impact on the thermal and electrical distributions. Although needle electrode showed better electric coverage in tumoral area. This study showed that it can be possible to select optimized electric and geometric parameter to select electrode for complete tumor ablation، control of thermal damage in tumoral and healthy tissues.

Degeneration of neurons in the central nervous system occurs during aging. Transplantation of neural stem cells (NSCs) can be preventing the degeneration of neurons. In addition to neuronal replacement، with the production of neurotrophic factors، increased survival and proliferation of endogenous cells. This study was done to compare the cell proliferation، neurotrophic factors expression and features of NSCs harvested from different areas of the central nervous system in vitro. In this laboratory study NSCs have been harvested from subgranular zone (SGZ)، subventricular zone (SVZ) and central canal of spinal cord from adult Wistar rats with mechanical، enzymatical digestion and subsequently was cultured in α-MEM medium supplemented with serum as monolayer or adherent conditions and passaged for 13 times. Immunocytochemistry was used to determine expression of the nestin and GFAP markers. Semi-quantitative RT–PCR was used to confirm genes expression (NGF، CNTF، NT3، NT4/5، GDNF and BDNF). Morphological features of stem cells extracted from different regions of the central nervous system were similar in the culture. Doubling time NSCs in the SVZ (37. 45 hr) is shorter than in the SGZ (44. 04 hr) and central canal of spinal cord (57. 22 hr). The culture conditions as well as monolayer neural stem cells are capable of producing neurospheres. Also، nestin and GFAP markers، expressed by NSCs. Neurotrophic gene expression pattern profiles were similar to each other in stem cells extracted from the SGZ، SVZ and central canal of spinal cord. Neurotrophic gene expression in stem cells extracted from different regions of the central nervous system were similar، but proliferation capacity was higher in NSCs، which have been harvested from the SVZ.

Androgens are among the causative factors in preeclampsia. This study was done to compare the serum androgens and progesterone in preeclampsia and normal pregnancy. This case-control study was done on 30 preeclamptic and 30 healthy pregnant women in Gorgan، Iran. Higher or equal to 140/90 mmHg and proteinuria equal or more than +1 in dip stick test in the third trimester of pregnancy were considered as the diagnostic criteria of preeclampsia. Progesterone، free and total testosterone، and dehydroepiandrosterone sulphate (DHEA) were measured by ELISA method. Total testosterone level was 1. 8±0. 3 ng/ml and 1. 3±0. 9 ng/ml in cases and controls، respectively. This difference was not significant. Progesterone was lower in cases (95±46. 9 ng/ml) than in controls (165. 4±75 ng/ml) (P<0. 01). Free testosterone and DHEA were 5. 6±2. 3 ng/ml and 1±0. 5 ng/ml in cases، respectively which was significantly higher than the controls (3. 2±1. 5 ng/ml and 0. 7±0. 4 ng/ml، respectively) (P<0. 045). Serum level of free testosterone، DHEA and progesterone increased and reduced respectivley in preeclampsia.

Attention deficit / hyperactivity disorder (ADHD) is a neurodevelopment abnormality. Inattentive behavior is considered a core and pervasive feature of ADHD. This study was done to compare the executive function and working memory in attention deficit / hyperactivity disorder and healthy children. This case – control study was done on 50 children with ADHD as cases and 40 healthy children as controls. The disorder was diagnosed by applying Kanerz teacher test and confirmed by a psychiatrist. Stroop test، Wisconsin Card Sorting Test (WCST)، Continuous Performance Test (CPT) and n-back test were used to assess the executive function and working memory. There was a significant difference between case and control groups in regard to executive function and working memory (P<0. 05). Error omission was 16. 98±8. 157 and 7. 3±3. 824 in cases and controls، respectively (P<0. 05). Attention deficit / hyperactivity disorder reduces executive function and working memory in children.

Klebsiella species are gram-negative bacteria with positive voges proskauer (VP) reaction. Klebsiella species are found as commensal in human digestive and respiratory system. This group of organisms can create a serious health hazards in hospitalized patients، and their ability to drug resistance is a major health problems. This study was done to evaluate the efficacy of Ciprofloxacin، Ceftizoxims and Carbenicillin on Klebsiella species isolated from hospital specimens. In this laboratory study، 1200 clinical samples were isolated from patients in Imam Khomeini hospital، Tehran، Iran. The identification Klebsiella species were carried out according to conventional biochemical tests. The minimum inhibitory concentration (MIC) of carbenicillin، ceftizoxime، and ciprofloxacin antibiotics were determined using Macrodilution broth test. Out of 1200 isolated samples، 25% were identified as Klebsiella species. 73% of identified Klebsiella were obtained from urine samples. Klebsiella. peumoniae with rate of 94% was the most abundant among other species. The results of MIC and minimum bactericidal concentration by using standard microdilution method showed drug resistance range of 16-1024 μg/ml، 4-256 μg/ml and 0. 25-16 μg/ml for carbenicillin، ceftizoxime، and ciprofloxacin، respectivley. In general، 94%، 6% and 1% of species were resistance to carbenicillin، ceftizoxime and ciprofloxacin، respectively. Ciprofloxacin and Ceftizoxime are suitable for the treatment of infections due to Klebsiella species.

Nitric oxide synthase (NOS) paly a role in nitric oxide (NO) generation. Despite the beneficial effects of NO on different body systems its overproduction of produce reactive nitrogen species (RNS) and nitrosilation of proteins. This study was done to evaluate the effect of asymmetric dimethylarginine (ADMA) and NG-Monomethyl-L-arginine methyl ester (L-NMMA) on inhibition of nitric oxide synthase activity. In this laboratory study، Nitric oxide synthase was extracted from 500 grams of sheep kidney by homogenization، ammonium sulphate precipitation and column chromatography on DEAE-32 Cellulose and 2''، 5''-ADP-agarose. During purification، protein content was measured according to the Bradford and enzyme activity was assayed using the Griess reactions the inhibitory effects of 25 μΜ concentrations of ADMA and L-NMMA on purified enzyme were determined. Specific activity and yield of NOS were 0. 6 units/mg protein and 0. 9%، respectively. Molecular weight of purified enzyme was 54 KD with SDS-PAGE. ADMA and L-NMMA in 25 μΜ concentrations reduced enzyme activity by 76 and 61. 2%، respectively. Km values for NOS in absence and in presence of ADMA and L-NMMA were 5. 32 μM، 31. 25 μM (P<0. 05) and 14. 29 μM (P<0. 05)، respectively. Vmax for NOS in absence and presence of inhibitors was not changed. ADMA and L-NMMA have competitive inhibitory effect on NOS activity and ADMA have higher inhibitory effect than L-NMMA.

Rheumatoid arthritis (RA) is a systemic and chronic disease. Anticitrulinated anticyclic antibody (Anti-CCP) and rheumatoid factor (RF) are applied for the diagnosis of rheumatoid arthritis. This study was designed to evaluate the diagnostic value of anticitrulinated cyclic antibody and rheumatoid factor in rheumatoid arthritis patients. This laboratory study was done on 238 affected RF patients and 152 RF symptom free subjects in Gorgan، Iran. Anti-CCP and RF were measured by ELISA and Latex agglutination. Out of 238 patients with rheumatoid arthritis Anti-CCP test was positive in 196 patients، and the sensivity was 82%. In control group، Anti-CCP was positive in 5 cases، and the specificity for RA was 96%. RF test was positive in 206 patients and sensitivity for RF in rheumatoid factor was 86%. In control group، RF was positive in 28 cases and specificity was 81%. Positive RF and Anti-CCP (simultaneously) showed sensitivity as 89%. The specificity of CCP is higher than RF and therefore can be substituted as diagnosis of rheumatoid factor.

Treatment of scaphoid fractures is studied extensively due to the specific anatomic shape and position، blood flow and its performance. In recent years، several treatment methods have been devised which are associated with various findings. This study was done to evaluate the short-term results of limited dorsal approach in treatment of scaphoid fracture. In this descriptive study، 14 male patients with scaphoid fracture were gone under limited dorsal approach in treatment of scaphoid fracture in 5th Azar teaching hospital in Gorgan، Iran. Patients were followed up for 12 weeks and the onset of infection، screw breakage and joint degenerative changes were evaluated. 64% of scaphoid fractures were in waist of the bone. The mean time to union was 10. 5 weeks. 64% of patients returned to work after 12 weeks. In none of the patients، infection، wound breakdown and joint destruction were seen. There were two-delayed union (> 12 weeks) and two screw head prominency in the scaphotrapezial joint but patients did not complain and their hand movements had no problem. During procedures، two guide pin failures occurred with no adverse effect in fixations. Complications were minor and wrist movements were nearly normal. Limited posterior approach in the treatment of scaphoid fractures is an easier، faster and better union rate. Despite the short duration of follow-up study، this method is recommended in the treatment of scaphoid fractures.

Occurrence of nursing error is important issue in patients safety. This study was done to determine the role of workload، sleep، mental health and individual factors in occurrence of nursing errors. This descriptive study was done on 268 nurses who employed in hospitals of Tehran University during 2011. Data were collected by demographical information questionnaire along with work environment conditions، Global Sleep Assessment Questionnaire (GSAQ)، Pittsburgh Sleep Symptom Questionnaire (PSSQ) and Mental Health Inventory (MHI-28). Sleep distruptions (OR=3. 260، P<0. 002)، sleep behaviors (OR=2. 946، P<0. 003)، psychological distress (OR=2. 530، P<0. 006)، psychological well-being (OR=0. 775، P<0. 002)، and work overload (OR=5. 240، P<0. 009) significantly able to predict occurrence of nursing errors (P<0. 05). Work overload، sleep distruptions، sleep behaviors، psychological distress and psychological well-being cooperatively were resulting in occurrence of nursing errors.

Otalgia is a complaint triggered from either ear disorders or adjacent structures due to common innervations between ear and adjust organs. This study was done to explore the causes of primary otalgia. This descriptive study was done on 770 patients with otalgia in Gorgan، Iran during 2009-10. After clinical examination age، gender، patient complaint and signs were recorded for each patient. 668 patients (86. 8%) had primary otalgia including 39. 9% left، 41. 3% right and 18. 8% bilaterally. 63. 9% were female and 36. 1% were males. External otitis was the most common causes of primary otalgia with 64. 8%. Other causes consist of acute otitis media (14. 5%)، serumen (14. 1%)، chronic otitis media (5. 8%)، foreign body (4%) and trauma (3%)، respectively. The most common cause of primary otalgia was external otitis.

Congenital malformations are among important causes of morbidity and mortality in newborns. This study was done to determine the prevalence and pattern of congenital malformations in newborn. This descriptive study was done on 6089 newborns in maternity center in Rafsanjan، Iran during 2007-08. The newborns were examined by pediatricians and based on clinical examination; the type of obvious of either minor or major malformations were recorded. The 179 cases had at least a major or minor malformations. Over all the prevalence of malformations was 2. 93%. The highest prevalence of obvious malformations was seen in the musculo-skeletal (43. 5%)، followed by genitourinary (22. 9%) and cardiovascular systems (15. 08%). There was significant relation between congenital malformations، gestational age and medicine used by mothers (P<0. 05). The highest prevalence of obvious malformations was seen in the musculo-skeletal system.

Papillon-Lefevre Syndrome is a rare autosomal recessive disorder. This syndrome accompanied by palmoplantar hyperkeratosis and severe periodontal destruction of primary and permanent teeth. The teeth erupt normally but due to the severe alveolar bone loss both in deciduous as well as permanent dentitions، these teeth are exfoliated within two or three years after eruptions and by the age of 15 or 17. Patients are usually edentulous. Due to periodontal disease، the dentists are often the first ones who diagnose the syndrome. A 15-year-old girl was referred to dental clinic complaining of permanent teeth mobility. All patient’s teeth except 13، 14، 17، 23، 27، 37، 43، 44 and 47 had been extracted. The third molars were impacted. Patient has advanced periodontal disease and all teeth have mobility. There was hyperkeratosis at the palms and soles. The teeth were extracted and treated with complete denture. Early diagnosis of the papillon-lefevre syndrome can help to preserve teeth. Dental treatment included extraction of all deciduous teeth، professional prophylaxis، conventional periodontal therapy، systemic antibiotics، oral retinoid، complete dentures and implants.

Anomalous coronary artery origin is a rare clinical entity with varied clinical outcomes ranging from asymptomatic to sudden cardiac death. The incidence of anomalous origin of left coronary artery arising from the right coronary cusp is 0. 3-1%. CT angiography is the choice method for coronary anomalies، but often coronary angiography in RAO (right anterior oblique) view shows the coronary course. We present a case that referred to our hospital with post myocardial infarction angina for coronary angiography. A resting 12-lead electrocardiogram showed ST-segment elevation in leads v2، v3، v4. A transthoracic echocardiogram indicated LVEF 25% (Left ventricular ejection fraction)، septal akinesia and apical dyskinesia. Coronary Angiography showed an anomalous origin of the left coronary artery from the right coronary cusp and significant stenosis in LAD (left anterior descending) and LCX (left circumflex) arteries with poor run off.