مجله علمی دانشگاه علوم پزشکی کردستان
سال سیزدهم شماره 2 (پیاپی 48، تابستان 1387)

Cardiac complications due to Iron overload are the most common cause of death in -thalassemic patients. Although regular blood transfusions in thalassemia major(TM) patients have improved the quality of life of the patients but the most important complication of such transfusions is iron overload in cardiac tissues. In spite of iron overload in untransfused thalassemia intermedia (TI) patients, the intestinal absorption of iron increases in these patients because of ineffective erythropoesis. The aim of this study was to evaluate cardiac status in thalassemia major and intermedia patients and the investigation of the possible effect of iron overload in the heart of ß-thalassemic patients. 46 patients entered into this study. 26 patients had thalassemia major with regular blood and also chelator transfusions and 20 patients with thalassemia intermedia who had not received regular transfusions. The age of the patients in the 2 groups were similar. The results of clinical evaluation and echocardiographies of the patients of the 2 groups were compared with each other. Collected data were analyzed by means of X2 and man whitney U tests. Heart failure occurred in two patients with TM (9.52%) and one patient with TI (4.76%). Considerable pulmonary hypertension (systolic tricuspid gradient >35mmHg) was only present in 3 patients with TI (14.28%). But systolic dysfunction of left ventricle (ejection fraction<55% or shortening fraction<35%) occurred in 5 patients with TM (23.8%). In the patients without apparent heart disease, cardiac dimensions, LV mass, LV shortening and ejection fractions, cardiac output and valvular involvement were significantly more in patients with TI. But the maximum speed of systolic flow out of mitral valve in primary phase was higher significantly in TM patients than TI patients. Regular lifelong transfusion and chelation therapy in TM patients prevents premature heart disease and pulmonary hypertension, but LV dysfunction can occur and lead to heart failure. In contrast in TI patients left ventricular function is normal but pulmonary hypertension occurs which may lead to heart failure. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain the serum ferritin concentration at <1000 ng/ml.

Disadvantages of intravenous regional anesthesia (IVRA) include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of addition of nitroglycerine (NTG) to lidocaine for improvement of IVRA. Forty six patients (20-50 yrs) were randomly assigned into 2 equal groups. Under identical conditions, the control group received 3 mg/kg of lidocaine 0.5% diluted with saline, and the study group received an additional 200 µg NTG. Vital signs and tourniquet pain were measured on the basis of VAS score and recorded before applying tourniquet and 5, 10, 15, 20, and 30 min after administration of anesthetic solution. The onset of sensory and motor block was measured and recorded for all patients. Severity of pain was measured at 5 min, 2, 4, 6, 12, 24, hours after deflation of tourniquet and the total dosage of pethidin injected in the first 24 hours after operation was calculated. Sensory and motor block began more rapidly in study group than control group (2.61 vs. 5.09 and 4.22 vs. 7.04 min., respectively) (p<0.05). Recovery from sensory and motor block and onset of tourniquet pain were delayed (7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65min., respectively) (p<0.05). Duration of analgesia after tourniquet deflation was more prolonged and tourniquet pain intensity was lower in study group (p<0.05). Fentanyl requirement during operation and meperidine used during first postoperative day and pain intensity at 4, 6, 12 and 24hr postoperatively were lower in study group) p<0.05). No significant side effect was noted in the patients of both groups. Addition of NTG to lidocaine in intravenous regional anesthesia accelerates the onset of anesthesia and decreases the tourniquet and postoperative pain, without any side effect.

Substance abuse is one of the most prevalent problems in young adults. The aim of this study was to assess the prevalence rate of substance abuse among Kurdistan university students. This was a cross sectional and descriptive analytic study. The sampling method was census and sample size included all students of Kurdistan University (1186 student) in 2007. The data were collected and recorded in a questionnaire for each subject. Data were introduced into SPSS software and analyzed by mean of x2 test. The results of this study indicated the percentage of students who reported usage of substance one or more times in their lives as following: alcohol 17.1, cannabis 4.7%, opium 4.8%, heroin 0.7%, ecstasy 2.7, and other substances 5.2. Ongoing abuse of different substances was assessed as following: alcohol 1.1%, cannabis 0.1%, opium 0.1%, heroin 0.1 %, ecstasy 0.1%, other substances 0.2. There was a correlation between substance abuse and male gender (p<0.001), age (p<0.001), living with friends (p<0.001), and being medical student (p<0.01). There was no correlation between substance abuse and marriage and father education. All substances, except for opium, had been offered to the medical students for the first time by their friends. Curiosity was the most common motivation for cannabis and opium use and pleasure was the most common reason for alcohol, heroin and ecstasy use. The mean age of first use for different substances was 18.6, 18.3, 19.5, 20.3, and 20.2 years for alcohol, opium, heroin, ecstasy, and cannabis. Substance use among Kurdistan university students was similar to other universities of Iran. Although substance abuse by female students was much lower than male ones in Kurdistan University, it was higher in comparison to the results of studies in other universities.

Melissa officinalis (MO) grows in the different parts of Iran abundantly. In previous studies, the extract of MO has been reported to have antinociceptive and anticonvulsive effects in rats. This study was designed to evaluate the effect of different doses of the aqueous decoction extracts of MO on withdrawal syndrome in rats. 40 male albino rats (25-30 gr) were selected for this study. Morphine was used to produce drug dependency by Marshall method (injection of 10 doses of drug in four days). 30 min before injection of naloxone (2 mg/kg), different doses of the extract (5, 10, 25 mg/kg) were injected intraperitoneally and saline (10ml/kg IP) was injected into the rats of control group. Assessment of classic withdrawal syndrome was based on the number of jumps and the weight of the fecal material for every rat. The results of this study indicated that injection of doses of 10, 25 mg/kg of the extract led to a significant decrease in the number of Jumps (p=0.005) and also in the weight of feces of the rats (p=0.01). We conclude the aqueous extract of MO can have an important role in the reduction of the severity of withdrawal syndrome in rats.

Cytomegalovirus (CMV) and toxoplasmosis are the most common and serious opportunistic infections in AIDS patients. Despite recent advances in the treatment of these infections, they still remain as challenging problems for physicians. The aim of this study was to determine the frequency of cytomegalovirus and toxoplasma infections in HIV-positive patients in HIV/AIDS counseling and care center in Kurdistan in 1385. This was a cross-sectional descriptive, analytic study. The sample size included all accessible patients referring to Sanandaj behavioral and STD diseases consultation center (64 participants). ELISA test was performed for all individuals, IgM and IgG anti CMV and Toxoplasma titers were determined. Data were introduced into SPSS 13 Soft ware and analyzed by one way ANOVA test. This study included 64 patients, 98/4% of them were male. The mean age of the patients was 32.1±6.73 years. Anti cytomegalovirus IgM was negative and anti cytomegalovirus IgG was positive in all of the patients (100%). Anti Toxoplasma IgM and anti Toxoplasma IgG were positive in 10.9% and 46.9% of the patients respectively. There was no significant relationship between the level of IgG and mean time duration of being HIV positive, age and CD4 cell count. But a significant relationship was noticed between the level of CMV and toxoplasma IgM and CD4 cell count (p<0.05). There was a significant relation between positive toxoplasmosis IgM and history of keeping a pet in house (p=0.019). In this study 100% of HIV positive participants were negative for anti cytomegalovirus IgM which can be explained by presence of CD4 cell count above 100 in all of the patients. But 53% of HIV positive participants had negative anti toxoplasma antibody who will be at risk of acute toxoplasmosis in their clinical course. Educational plans and regular follow up of theses patients are recommended for proper prophylaxis and treatment.

Pyrethroids are commonly used as insecticides for both household and agricultural purposes, and recently have been shown to have detrimental effects on endocrine system. Permethrin is a type I pyrethroid which is used widely in Iran. In the present study the effects of permethrin on sexual behaviour and plasma level of PG (pituitary-gonadal) hormones of adult male mice were investigated. Mice received daily Intra peritoneal injection of permethrin (10, 15, 20 mg/kg) for 5 weeks. Using receptive females, permethrin-treated male mice exhibited reduced sexual behavior (i.e. decrease in the number of sniffing, following, mounting and mating). The concentrations of plasma testosterone, LH and FSH were measured by means of ELISA method. Serum testosterone levels were reduced significantly (p<0.05) in the experimental group versus control group, whereas FSH and LH values were not altered significantly. The results of this study indicate permethrin can have detrimental effects on plasma testosterone level and sexual behavior. In regard to considerable use of this insecticide in Iran, it’s necessary to restrain its use and extent of human contact to prevent hazards of this insecticide on human body tissues.

Determination of prevalence rate of idiopathic hypercalciuria(IH) in primary school students in Sanandaj. This was a descriptive-analytic study and included 506 primary school students. First we measured the ratio of urine calcium to urine creatinine (UCa/UCr) as screening test then 24 hour urine calcium of the patients who had UCa/UCr ratio more than 0.2 mg/mg (31patients) was measured. Those with 24 hours urine calcium of more than 4 mg/kg were regarded hypercalciuric, (3 boys and 12 girls). Data were introduced into SPSS win soft ware, represented in the form of frequency distribution table and analyzed by means of X2 and T-tests. 248 patients were female and 258 were male. 32 patients (6.32%), 11 boys and 21 girls had UCa/UCr ratio more than 0.2 mg/mg, but 15 patients (3 boys and 12 girls) had excretion of more than 4mg/kg/day calcium in urine which encompassed 3% of the students (1.2% boys, 4.8% girls). The results of this study indicated the Incidence of hypercalciuria among student girls was more than that of boys. 95th percentile for urine Ca/Cr is 0.198 for boys and 0.253 for girls. Considering the effect of hypercalciuria on bone density and growth which has more importance in girls, it is recommended to evaluate such effect in a more comprehensive study.

Domestic violence against women is now widely recognized as an important public health problem. Research works are necessary to clarify the relationship between the different forms of domestic violence and mental health outcomes, especially in the developing countries where relatively little research is available. The aim of this study was to evaluate the relationship between domestic violence in pregnancy and postnatal depression in pregnant women referring to the health care centers in Marivan, in 1386. This study was a prospective cohort study. Sample size included 251 women at the last month of pregnancy who were questioned about domestic violence during pregnancy and assigned into 2 groups: abused and non-abused groups. Each group included 120 patients. 11 patients were lost to follow up. Then the subjects filled out the Edinburg Postnatal Depression Scale questionnaire within 4-6 weeks after delivery. P<0/05 considered statistically significant. The mean age of the subjects was 26.02±5.53 years and most of them had elementary education. The prevalence rate of depression among the patients was 34.2%. %15.8 of the women in the abused group and %52.5 of the women in the non- abused group had scores of more than 10 on the basis of Edinburg Postnatal Depression Scale. There was a significant relation ship between domestic violence and postnatal depression (p<0.001). The relative risk of depression RR=3.3 with a confidenc interval of 95% was between 2.1 and 5.1. Since the detrimental impacts of domestic violence during pregnancy have been clarified in this research and other studies, it is recommended to screen such cases routinely in order to recognize abused cases for counseling.

Several studies have shown that cardiac tolerance of ischemia, before maturation is greater in the newborn than adults and it decreases gradually in the rest of life. Most studies on cardiac tolerance before maturation have shown this tolerance gradually decreases before maturation. But a few studies have not confirmed such results. In regard to its clinical importance this study was designed to determine the change in the pattern of tolerance of ischemia before maturation. Hearts of 2, 3, 6 and 8 week-old rabbits were isolated and perfused under constant pressure according to langendorff method. Coronary flow (CF) and functional parameters including heart rate (HR) and fluctuations in the left ventricular developed pressure (LVDP) were measured and the product of (HR × LVDP) (RPP) was calculated. Steps of the experiment included baseline period (20 min), ischemia (35 min) at temperature of 37C and reperfusion for 45 minutes. Cardiac parameters including RPP were evaluated 45 minute after reperfusion and at the baseline period. ANOVA test was used for data analysis. Recovery of the heart function in 3 week old rabbits (85.81 ± 4.36) (mean ± SE) was significantly greater than those of 2, 6 and 8 week old rabbits (67.57 ± 3.27), (61.19 ± 2.83) and (52.03 ± 5.09) respectively (P<0.05). It can be concluded that tolerance of ischemia in rabbit before maturation doesn’t decrease and reaches its maximum between birth and maturation.

The pollution of water resources with arsenic (As) is considered as a serious problem and there are several reports about pollution of superficial and underground water with arsenic, in particular arsenate and arsenite in our country specially in some areas of Kurdistan province. There are various methods for removal of arsenic from drinking water which are generally costly. In this study, granular ferric hydroxide (GFH) was used as a synthetic adsorbent for removal of arsenate and arsenite with concentrations of 0.5, 1.0 and 2.0 mg/L. The effects of changing contact time, pH and concentrations of competitive anions, concentration of iron added to water during removal of arsenic and the effect of sulfate and chloride ions on removal of arsenic and compatibility of adsorption with Ferundlinch and Langmuir equations were evaluated. Excel soft ware was used for data analysis. According to this study, GFH showed removal efficiencies of 95, 86.5 and 83.75 for arsenate and 91, 83.5 and 80 percent for arsenite (in initial concentrations of 0.5, 1 and 2 mg/L and at a PH of 7.5). The dosage of adsorbent for this treatment was 0.5 g/L and 30 minutes was required for contact time. SO42- and Cl- revealed no significant effect on removal of arsenic. Adsorbability of both arsenate and arsenite by GFH followed Ferundlich isotherm with R2=0.96, whereas arsenate adsorption (with R2 value of more than 0.94) complied more with Langmuir isotherm in comparison to arsenite adsorption (with R2 value of more than 0.92). Results of our study also indicated that the amount of iron added to water was much more than the standard value of 0.3mg/L used for dinking water. The results of our study showed GFH is highly efficient in removal of arsenate and arsenite after modification of water PH, but it has disadvantages of addition of iron to water, need of import of GFH and high cost. The problem of addition of iron to water can be managed by traditional methods.