مجله علمی دانشگاه علوم پزشکی کردستان
سال چهاردهم شماره 3 (پیاپی 53، پاییز 1388)

In this study, the functional recovery of female rats with contusive spinal cord injury (SCI) model was evaluated after administration of (-)-deprenyl. A total of 18 Sprague Dawley female rats were selected for the study and randomly allocated into equal groups (n=6); control, sham and (-)-deprenyl-treated groups. All animals were laminectomized at T13 level. Based on the weight dropping technique contusion was induced in both control and (-)-deprenyl-treated groups. (-)-deprenyl group received daily injections of 0.1 mg/kg (-)-deprenyl and other group received intra peritoneal (IP) injection of equal amount of normal saline for 14 days. BBB test was carried out in all groups at the first day and at the end of each week after induction of injury for eighth weeks. Spared tissue volume and the number of motoneurons at the site of lesion were measured and compared by means of frozen sections of spinal cord. In contrast to control group, (-)-deprenyl-treated group showed a significant increase in motor ability at all times except for the first day (P <0.05). In the (-)-deprenyl-treated group the mean volume of spared spinal cord and the mean number of motor neurons were more than those of control group significantly (P<0.05). The results of this study indicated that (-)-deprenyl probably protected motor neurons and spinal cord white matter; hence, it caused motor recovery in contusive SCI model in female rats.

Preterm delivery is a major cause of prenatal mortality and morbidity in the world and results in increased obstetric and pediatric care costs. The purpose of this study was to evaluate the effects of prophylactic vaginal progesterone in decreasing the rate of preterm delivery and its complications in high risk women. This study included 150 asymptomatic women with high risk singleton pregnancies. The subjects were assigned randomly into two similar groups. One group received 100 mg of prophylactic vaginal progesterone therapy (n=75) daily between the 24th and 34th week of gestation and the other group received no treatment (n=75). The two groups were similar regarding maternal age and preterm delivery risk factors. Uterine contractions were monitored by external tocodynamometer for 60 minutes and in case of true contractions, routine tocolytic drugs were started for the subjects. In some patients, in spite of receiving tocolytic drugs, delivery progressed and the related data were collected. Data were introduced into SPSS software and analyzed by means of chi square, exact Fischer, ManWitney U, and t tests. The results were reported with a confidence level of 95%. The mean gestational age at the time of delivery was higher in the interventional group (38.62 2.08 week vs. 35.88 3.5 week) (P=0.001). Preterm delivery before the 37th week of gestation occurred in 11.6% and 31.9% of the subjects in the progesterone and control groups respectively (P=0.004) and preterm deliveries before the 34th week occurred in 22.2% and 2.9% of the women in the control and progesterone groups respectively (p=0.001). Moreover respiratory distress syndrome, low birth weight, birth weight, need for oxygen, infant apgar,need for mechanical ventilator, and hospitalization in NICU were significantly different between the two groups (P<0.01). prophylactic vaginal progesterone reduced the frequency of uterine contractions which led to decreased rate of preterm delivery in women with high risk factors for preterm delivery.

Menstrual disorders cause a lot of problems for the women. Sometimes diagnosis and treatment of these problems seems very sophisticated. Early diagnosis and treatment of menstrual disorders together with its clinical complications, recognition of their underlying causes and their relation with one another, are essential for treatment of these disorders. The aim of this study was to determine the incidence of menstrual disorders and some of its potential causes in 17 and 18 year old high school female students in Sanandaj in 2005. This was a descriptive-analytic cross sectional study and included 511 high school female students at the age of 17 and 18 years. After obtaining primary information, in case of any menstrual disorder, the subjects were referred to a gynecologist for confirmation of the diagnosis. After confirmation of diagnosis sonographic and hormonal studies were performed. Using SPSS software, the data were analyzed by means of descriptive statistics and x2 test. The incidence of menstrual disorders in the study population was 43.25%. Hypermenorrhea was the most and hypomenorrhea was the least common disorders (13.9% and 3.13% respectively). Polymenorrhea was detected in 13.31% of the cases. The incidence rates of dysmenorrhea, premenstrual syndrome (PMS), and spotting were 78.1%, 72.4% and 8.2% respectively. Menstrual disorders and its symptoms showed no significant relationship with presence of any evidence of PCO in sonoghraphy (P>0.05). High incidence of menstrual disorders in high school students should be taken into consideration and necessary instructions should be given to these students to decrease their stress. In case of persistence of the menstrual disorder, hormonal and sonographic examinations should be performed to detect the underlying cause of menstrual disorder.

Thyroid carcinoma is the most common endocrine malignancy. Considering highly heterogenous nature of tumoral and non-tumoral thyroid nodules from pathological point of view and also in regard to absence of appropriate molecular markers, extensive efforts have been made to find a molecular tumor marker for specific diagnosis of thyroid tumors. Recent attention has been paid to Survivin, a new member of the Inhibitor of Apoptosis Protein Family (IAP), as a new molecular marker in cancer. Studies have been demonstrated that Survivin and its splice variants have different expressions in cancerous tissues compared to normal tissues. In this study the expression of Survivin-2α splice, one of the newest Survivin variants, was evaluated in thyroid cancer as a molecular marker. Tissue samples were collected from 77 thyroid specimens including 49 tumoral, 14 nontumoral and 14 tumor margin samples. The expression of Survivin-2α was studied by Hemi-Nested RT-PCR method. Expression of Survivin-2α splice was the highest in surgical margin samples compared to non-tumoral and tumoral samples. The lowest expression was that of tumoral samples. Our data demonstrated the expression of Survivin-2α in thyroid tumors. Although the expression of surviving-2α splice variant in tumoral cells was lower than that of tumor margins, it did not show a significant difference. Therefore it seems likely that it does not have a special role in the progression of tumor and development of abnormal nature of the cells. According to the results of this study, it can be concluded that the different expressions of 2α in these groups can not be an appropriate criterion for distinguishing tumors from non-tumoral lesions of thyroid gland.

This study was conducted to compare the sonographic (gray scale) findings with those of Doppler sonography in patients with rejection of kidney transplant. This was a cross-sectional study performed in Hasheminejhad Educational and Therapeutic Center in Tehran. Sonography and then Doppler sonography were performed and primary creatinin level and if needed sequential creatinin levels, were checked. We used a scanner (AU4 mod) with 3.5 and 7.5 MHz probes. The most common morphologic signs in sonography were increased antro-posterior diameter of allografts in 19 cases (31.4%). Other common morphologic signs consisted of increased cortical echogenicity in 18cases (30%), increased prominanance of the renal pyramid or hypoechogenicity of pyramid in 12 cases (20%), decreased echogenicity of rejected kidney sinus in 7cases (11/7%). The rarest morphologic sign was focal cortical hypoechogenicity in 2cases (3/4%). Thirty one patients (51.7%) had positive sonographic findings, 47 patients (78/3%) had Resistive Index (RI) ≥0.8 and 13 patients (21/7%) had Resistive Index≥0.9. Those with age range of 51-65 years had the highest frequency among all the patients and revealed positive findings in both methods of sonography. In 23.4% of the patients creatinin level was normal. 46 patients (76.6%) had early and fourteen other patients had late onset rejection of the transplant. Doppler sonography (RI) is the best and most sensitive non invasive method for precise and early diagnosis of renal allograft rejection. RI≥.0.8 has eliminated need of taking biopsy. Findings of sonography were less sensitive than those of Doppler sonography.

Considering increasing rate of cesarean section (C/S) and post operative infection as its consequence, we presumed that manual removal of placenta is associated with increased rate of infection. The aim of this prospective study was to investigate the effect of placental removal methods on the amount of bleeding and development of post operative fever. In this study six hundred patients who needed C/S were assigned randomly into two groups, one group had spontaneous placental delivery (300 patients) and in the other group manual placental removal delivery (300 patients) was performed. All of caesarean sections were done by the same surgeon and after delivery of the neonate and clamping of umbilical cord placenta was either removed manually or spontaneously while massaging uterus and pulling umbilical cord slightly. The amount of bleeding during operation was estimated by measuring blood suctioned and weight of sponges before and after operation. Hct was measured 24 and 48 hours after operation and a 3% decrease of Hct was considered significant. Temperature of each patient was checked orally every four hours after operation. Diagnosis of endometritis was made based on two high temperatures higher than 38 centigrade degree, presence of suprapubic tenderness and alterations in the quality and quantity of lochia. Using SPSS software version 11, sstatistical analysis was performed by means of T test and chi square test. Mean age of the patients was 24.56±5.56 years. Two groups were evaluated and compared for decrease of Hct (>3%) during 24 and 48 hours after surgery which revealed a significant difference (P<0.001). Fever was detected in 27 patients with spontaneous placental delivery (9%) and 44 patients with manual placental delivery (14.7%). The difference between two groups was significant (P<0.05). Comparison of the mean amount of bleeding during operation, measured based on the minimum and maximum weight of sponges and suctioned bloody amniotic fluid, showed a significant difference between two groups (P<0.001). Duration of C/S in two groups showed no significant difference. Considering increased incidence rate of bleeding and development of fever after manual placental delivery compared to spontaneous placental delivery in S/C, we recommend spontaneous placental delivery in C/S in order to lower the incidence of above mentioned complications.

Thalassemia is one of the most prevalent heamoglobinopathies in the world in particular in Iran. Major thalassemia patients need blood transfusion and desferrioxamin injections throughout their life. Regarding improved life quality of thalassemic patients, new clinical problems, such as hearing loss, need more attention. This study was done to determine the frequency of hearing loss and otolaryngeal disorders together with their related factors in major beta thalassemic patients. This was a descriptive analytic study and 84 beta thalassemia patients were examined and evaluated for hearing loss by an otolaryngologist. Standard pure tone audiometry was performed for the patients. Serum ferritin level was measured. Considering blood transfusion the patients were divided into two groups: those with suitable transfusions and those with unsuitable transfusions. Also in regard to desferrioxamin injections again the patients were divided into two groups: those with regular injections and those with irregular injections. Among 84 beta thalassemic patients (40 M, 44 F) with mean age of 12.8±5.7 years, 10 (11.9%) had sensorineural hearing loss, 8 (9.5%) had conductive hearing loss, while 8 (9.5%) showed mixed hearing loss. There was no relationship between hearing loss and age, sex, ferritin level, but hearing loss had a significant relationship with doses and duration of desferrioxamine therapy (P<0.01). Also hearing loss had no significant relationship with regular and irregular blood transfusions and desferrioxamine injections (P<0.01). The results of this study implicated that high dose desferrioxamine was the main factor in the pathogenesis of ototoxicity in thalassemic patients. For management of these patients it is necessary to use proper doses of desferoxamine. Also blood transfusions should be proportional to body iron burden and hemoglobin. In addition, regular periodic otolaryngologic and audiometric follow up examinations are required for early diagnosis of hearing disorders in prevention of permanent hearing loss.

Global initiative for Chronic Obstructive Pulmonary Disease (Gold) has defined COPD as a disease characterized by airflow limitation that is not fully reversible. COPD is a subset of obstructive lung diseases which also includes cystic fibrosis, bronchitis and asthma. Adenosine deaminase (ADA, E.C.3.5.4.4) converts adenosine to inosine. ADA has two isoenzymes; ADA1 and ADA2. In COPD patients the serum level of ADA increases which can be regarded as a result of reduction in ADA activity. In this study we evaluated the level of ADA and its isoenzymes in COPD patients and healthy subjects. Martial and This was a case control study. ADA activity in 30 COPD patients with age range of 20-60 years whose disease had been confirmed by a pulmonologist in Ekbatan Hospital, was compared to the activity of the same enzyme in 60 healthy subjects consisting of 30 non smoker and 30 smoker subjects as control groups. Data were introduced into SPSS version.13 software and analyzed by Kruskall-Wallis and two-way ANOVA tests. ADA activity in the COPD and smoker control groups was significantly lower than that of non smoker group (18.99±7 and 22.99±6.7 U/L, respectively). Regarding ADA2 serum level, the difference between patient group and non smoker control group was significant (P<0.05). Activity of ADA1 isoenzyme in the study groups did not show any significant differences. In general ADA activity was decreased in COPD patients. Decreased ADA activity together with increased adenosine level may play an important role in producing pulmonary damage in COPD patients

Children with cancer develop depression which can lead to several problems in the course of treatment. The aim of play therapy was to reduce depression and produce positive results in the health status of these children. This was an experimental study and included all 6-15 years old children with cancer in Mahak center in 2007. After calculating the depression score by means of Child Depression Scale-A (CDS-A), 24 patients who were depressed and had scores of more than 84, were randomly assigned into experimental and control groups. Play therapy was performed for seven 2-hour sessions for experimental group. The groups were assessed for depression again after one week. Data were introduced into SPSS software and analyzed by means of Manwitny-U and Wilcoxon, and Kruskal-Wallis tests. The results of this study showed that the mean values of depression scores in experimental and control groups were 95.21 and 91.75 before play therapy, and 74.33, and 94.08 after play therapy respectively, which was statistically significant (p= 0.002). The results indicated that play therapy led to significant improvement of depression and may be an effective intervention for children with cancer. Play therapy can be an effective intervention to help the hospitalized children in order to prepare them for painful therapeutic procedures and stress of hospitalization.

This study was conducted to compare the differences of contamination rates between operating room boots in sterile and semi-sterile parts of the operating room and the necessity of replacing boots in the distance between these parts in Tohid Hospital in Sanandaj city. The study sample included all boots used in the operating room of Tohid Hospital. Sampling method was census. Sample cultures were taken from the boots at the end of four consecutive days. A total of 160 samples were obtained from sterile and 160 samples from the semi-sterile parts. The culture media were examined after 24 hour and colonies grown on them were counted. Independent t-test and chi square test were used for data analysis. 73.7% of the boots in the sterile and 74.9% of boots in the semi-sterile parts were contaminated. The mean number of colonies grown in sterile and semi sterile parts were 22543.97 (SD 41865.67) and 29494.36 (SD 45614.32) respectively which showed no significant differences (P>0.05). There was a significant difference in the severity of contamination between the two parts (p<0.05). Considering the high contamination rate of the boots in both sterile and semi sterile parts, washing style and/or the detergents solution used for washing lack considerable disinfectant efficacy which should be replaced properly. There were not significant differences between the mean numbers of the colonies grown in the two parts. The severity of contamination between the two parts showed a significant difference, therefore it can be concluded that replacing boots in the distance between the two parts has no effect on prevention of spreading contamination in the environment.

This is a report of pulmonary edema following cesarean section under spinal anesthesia in a patient with valvular heart disease. Case report: The patient was a 38-yr old multigravida woman without history of cardiac disease. She was operated under spinal anesthesia and remained haemodynamically stable throughout the procedure. But she developed respiratory distress at the end of operation in the recovery room. The only finding in ECG of the patients was sinus tachycardia and chest X-ray revealed bilateral pulmonary edema. The result of echocardiography was suggestive of moderate to severe mitral stenosis. Diagnosis of pulmonary emboli was excluded by perfusion scan. The patient was treated with diagnosis of pulmonary edema and after two hours the patient showed some improvement. Result of the echocardiography on the next day, confirmed the diagnosis. Physical examination should be performed carefully in order to determine the proper method of anesthesia. Spinal anesthesia in patients with mitral stenosis, in particular in pregnancy may not be well tolerated and should be performed cautiously.