مجله علمی دانشگاه علوم پزشکی کردستان
سال دوازدهم شماره 4 (پیاپی 46، زمستان 1386)

Postoperative nausea and vomiting (PONV) are common and unpleasant complications. Various drugs are used for prevention and treatment of PONV. But it stands to reason to overcome this problem by the anesthetic drug itself. In this study, the effects of propofol versus thiopental on PONV were evaluated. This was a double blind clinical trial. In a period of 8 months, ninety patients (aged between 18-50 years) who had been scheduled for elective surgery (ASA physical status I) were entered into this study and randomly divided into two comparable groups; group A received 2 mg/kg propofol IV and group B received 5 mg/kg thiopental sodium for induction of anesthesia. Each group included 45 patients. The patients were observed for 12 hours for PONV (2 hours after operation in the recovery room and 10 hours in the surgery ward. The results were processed with SPSS soft ware and analyzed by means of student t-test. The results of this study showed that in propofol group the number of episodes of nausea and vomiting was less than that of thiopental group which revealed a significant difference (p<0.05). The mean age of the patients was 29.4±9. 51.12% of the patients were female and 48.86% were male which revealed no significant difference between the two groups. Propofol is more beneficial than thiopental for the prevention of PONV and it is recommended to be used for induction of anesthesia, when PONV may be life threatening.

Diabetes mellitus is the most common endocrine disorder which can lead to hyperglycemia and hyperlipidemia. The incidence of diabetes mellitus is expected to increase in human population in the future. The present study deals with the effect of palm seed extract on the blood glucose and lipids concentration in male diabetic rats. In this experimental study, 40 adult male Wistar rats, each weighing about 240-250 gr, were divided into 4 groups: control and diabetic (received nothing) treated control and treated diabetic groups (received palm seed extract). In order to induce diabetes, stereptozotcin was injected intraperiotoneally (60mg/kg). The treated groups received (0.5mg/kg) palm seed extract intraperitoneally every day. 14 days latter, blood samples were obtained from all groups and serum levels of glucose and lipids were measured. Concentrations of glucose, cholesterol, LDL, increased significantly in diabetic group when compared with those of control group (p<0.05), while these values in the treated diabetic group showed a significant decrease compared with those of untreated diabetic group. In addition, the serum level of HDL in diabetic and treated diabetic groups was considerably less than those of control and treated control groups (p<0.05). But the concentration of triglyceride didn’t show any significant difference among various groups. Probably hypolipidemic effect of palm seed is due to the presence of oleic acid and linoleic acid and its hypoglycemic properties is due to the elements such as magnesium and zinc which stimulate the synthesis and secretion of insulin. Manganese also mimics insulin properties.

One of the basic principles of modern obstetrics is to provide adequate analgesia. An analgesic should have potent analgesic efficacy and minimal side effects to be suitable for pain relief during labour. The aim of this study was to evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine on labour pain, labour duration, apgar score of the infants and maternal complications in primiparous women. This was a triple-blind randomized control trial. 30 full term parturient women were randomly assigned to one of tramadol or pethidine groups. Inclusion criteria were full term primiparous women without high risk pregnancy in active phase of labour, with 4 cm dilatation of cervix. Lack of induction of delivery, lack of pregnancy complications and drug reactions were regarded as other inclusion criteria. In active phase of delivary vital signs of the parturient women recorded. The pain was measured by means of NRS score. Group I received 50 mg pethedine; group II, 50 mg tramadol in 200 cc Ringer solution, intravenously. The vital signs and pain were reassessed after one hour. The mothers and their fetuses were under control for potential complications. Collected data were introduced into SPSS soft ware and analyzed by means of t-test and X². p<0.05 was regarded statistically significant. There was no significant difference in relation to age, maternal weight, maternal educational status, gestational age and infant`s weight between the two groups. There was no significant difference between the decrease in the mean systolic and diastolic blood pressures in the two groups. Maternal Side effects such as nausea, vomiting and drowsiness occurred more frequently in pethidine group (p≤0.05). There was no significant difference between the durations of active phase of labour in the two groups. Mean value of the first minute apgar score in tramadol and pethidine groups were 8.87±0.516 and 8.86±0.363 respectively. The mean value of the fifth minute apgar score in tramadol and pethidine groups were 9.60±0.507 and 9.57±0.514 respectively (p>0.05). The mean values of pain reduction assessed by VAS score were 1.28±1.63 for pethidine group and 1.00±1.30 for tramadol group) p≤0.05). We conclude that pethidine has more analgesic effect than tramadol on labour pain but frequency of side effects such as nausea and vomiting was higher with pethidine administration. Both drugs can cause shortening of active phase of labour. Apgar score was not influenced by any of the two drugs.

Streptomycin and ofloxacin are synthetic antibacterial agents of aminoglycosides and fluoroquinolones groups respectively which are effective against gram-negative bacteria and urinary tract infectious diseases and used in many countries in the world. The aim of this study was to evaluate the effects of these drugs on leydig cell apoptosis by use of TUNEL assay in rats. Thirty male wistar rats were selected and randomly divided into three groups; control (n=10) and tests (n=20). The test groups received 40 mg/kg (IP) streptomycin, and 72 mg/kg (PO) ofloxacin daily for fourteen days; however the control group just received vehicle (normal saline) intraperitoneally. On the fourteenth day the testis tissue of the rats in all groups were removed, fixed in 10% formaline and prepared for light microscopic examination and the Terminal Uridine Nick End Labeling (TUNEL) technique was used to identify apoptosis. The statistical analysis was performed by ANOVA test. The number of leydig cells undergone apoptosis in streptomycin, oflaxacin and control groups were (2.15±11.14), (6.15±8.17) and (1.01±0.41) respectively which revealed a significant difference. In our study the number of apoptotic cells in streptomycin group was less than that of ofloxacin group (p<0.05). Therefore use of streptomycin carries fewer risk of producing infertility in male rats.

Sputum smear is recommended for microbiological confirmation of diagnosis of pulmonary tuberculosis. It has been reported that sputum induction is a safe and non-invasive method for confirmation of microbiological diagnosis of tuberculosis in smear negative patients. This study deals with the comparison of the value of sputum induction with that of bronchoalveolar lavage (BAL) in the diagnosis of TB. 56 patients suspected to have tuberculosis were admitted in the infectious ward of Tohid Hospital and entered into this study. Sputum induction and BAL were performed for two consecutive days according to a standard procedure. Smears obtained from induced sputum and BAL contents were stained for acid fast bacilli. Exclusion criteria were severe asthma or severe chronic obstructive pulmonary disease and pregnancy. Of 56 tuberculosis suspects with negative or absent sputum production, sputum induction led to positives smears in 8 (14.3%) patients (5 previously smear-negative, 3 unproductive) and BAL had positive results in 7 (12.5%) patients which revealed a significant difference (p=0.000). Sputum induction is safer, easier to accomplish and more sensitive than BAL technique for diagnosis of pulmonary TB. Our study suggests that sputum induction with aerosolized hypertonic saline is a useful technique for better detection of cases of tuberculosis in patients with negative smears or non-productive cough.

Acute rejection is one of the most important complications after renal transplantation which influences transplant prognosis and survival. This study was conducted to determine the prognostic value of Th1/ Th2 cytokines in acute renal rejection (AR). This was a cross-sectional study and included 60 kidney transplant recipients (40 male, mean age 38.82), who had received their transplants from live donors. Serum levels of Th-1 dependent cytokines [interleukin- (IL) 2 and interferon-gamma] and Th-2 dependent cytokines (IL-4, IL-10) were measured on the day before, 7th and 14th days post transplantation using ELISA. All the patients received Immunosupressive agents including cyclosporine, mychofenolate mofetile and prednisolon. Acute rejection was defined as a more than 50 percent rise in serum creatinin in the first 20 days after transplantation. Data were introduced into SPSS soft ware and analyzed by means of independent T-test. Among 60 patients, 40 were male. The mean age of the patients were 38.82 years. In our study we diagnosed twelve cases of AR (20% of the cases). There was no significant relation between the serum levels of IL2, IL4, IL10 and IFNδ in the patients with acute rejection of the transplant and those without. These data showed that there is no correlation between Th1/ Th2 serum cytokines profile and early AR episodes in kidney transplantation and these cytokines can not be used as prognostic factors in acute renal rejection.

Impaired glucose tolerance (IGT) and diabetes mellitus (DM) are well known complications in multitransfused beta thalassemia patients. Iron overload and chronic liver disease, viral infection and/or genetic factors may play important roles in the development of glucose intolerance. The aim of the present study is to determine the prevalence of hepatitis C and its relation with diabetes and impaired glucose tolerance. The study included 195 multitransfused β thalassemic patients, 97 females and 98 males with a mean age of 14.9±6.07 years (range 5-36 years). Diagnosis of DM and IGT was based on the criteria of ADA and WHO. Hepatitis markers were detected by use of ELISA test. Results were analyzed by means of Chi-square test. The results of ELISA test revealed forty (20.51%) patients were seropositive for HCV. After removal of confounding factors, serum ferritin level (p=0.039) and hepatitis C infection (p=0.006) were identified as independent risk factors, having significant relationship with abnormal glucose tolerance. With increasing age the number of blood transfusions increases and subsequently the possibility of iron overload and infection with hepatitis C virus increases. In our study the prevalence of diabetes in adult thalassemic patients suffering from HCV infection increased. It is probable that hemosiderosis makes the effect of HCV infection on glucose metabolism more evident clinically. Aggressive iron chelating therapy as well as prevention and treatment of hepatitis C infection are the most important measures in glucose homeostasis in transfusion dependent beta thalassemic patient.

Considering close relationship of the teachers with students and their role in promotion of mental health, recognizing children at risk of psychological disorders and referring them to obtain specialized supports, the survey of mental health among teachers seems necessary. Therefore, this study was preformed to evaluate mental health status and its related factors among high school teachers in cities of Sannandaj and Bijar. This was a cross sectional study. Sample size included 1391 individuals and sampling method was census. After referring to schools, explaining the goal of the study to the teachers, and taking their consent to participate in our survey, data were completed and gathered based on the standard questionnaire of general health (GHQ28) and a researcher-made questionnaire. Finally 60% of the subjects took part in this study. Some of the questionnaires were incomplete and only 710 teachers completed the study. Collected data were processed with SPSS software and analyzed by means of chi-square test. The prevalence of lack of mental health among the subjects was 33.5% on the whole (34% in Sannandaj and 32.9% in Bijar). Also, the rates of lack of mental health among male and female subjects were 34.7 and 32.1 respectively. Among the factors influencing mental health only the number of family members showed a significant relation with lack of mental health, most prevalent in families with 2 members (53.2%) and least prevalent in families with 4 members (27.7%). Considering high prevalence of lack of mental health among teachers in this study, it seems necessary to plan extended studies in this field all over the province in the future and take interventional measures to provide more appropriate life status with professional contentedness and security for the teachers, solve their problems and recognize their occupational stressful factors.

Strange and unfamiliar setting of the operation room and also fear of operation cause numerous problems for the patient, parents of the patient and anesthesiologist. Prescription of intravenous sedatives or opiates in addition to their side effects leads to more fear and anxiety because of venipuncture. To prevent these problems, we prescribed oral sedatives. In this controlled double blind clinical trial, sixty children, aged 1-7 year were divided randomly into two groups; group 1 received oral Ketamine but placebo was prescribed for group 2. Behavioral changes together with heart rate and respiratory rate alternations were evaluated before and 30 minutes after prescription of the medication. The results of this study showed that the children who received oral ketamin were calmer and separated from their parents easier in comparison to those who received placebo, which showed a significant statistical difference (p<0.001). Also heart and respiratory rates decreased in the patients of ketamine group which revealed a significant difference (p<0.01). It seems that prescription of oral ketamine as a premedication thirty minutes before anesthesia can produce appropriate sedation and a relative decrease in heart and respiratory rates in children, which in turn can lead to less panic, easier separation of children from their parents and facilitation of induction of anesthesia.

Zinc is essential for human health and its deficiency can lead to various biochemical disorders. The aim of this study was to determine serum zinc concentration in the middle school students of Sanandaj in 2006 and its relation with gender, body mass index (BMI) and educational status. In this cross sectional study 301 students in the middle schools of Sanandaj were selected randomly. BMI was calculated and educational status was obtained from school educational records. Serum zinc concentration was measured by use of flame-atomic absorption spectrometry. Collected data was analyzed by means of T-test, analysis of variance and Pearson's correlation coefficient statistical techniques. Regardless of gender, the mean concentration of zinc in serum was 90.1±19.1 μg/dl. The mean concentration of serum zinc levels in boys (93.6±22.6 μg/d) was significantly higher (87.4±15.4 μg/dl) than that of girls (p<0.05). In 31.2% of the students serum zinc concentration was lower than normal value. No correlation was found between serum zinc concentration, BMI and educational status of the students. More than thirty percent of middle school students in Sanandaj suffer from severe or mild zinc deficiency. Considering the importance of zinc in human health, further studies are needed to determine the prevalence of zinc deficiency in Sanandaj in order to plan for future interventions.

In most individuals, each kidney is supplied by a single renal artery and a vein, however multiple renal arteries and veins is not uncommon. In comparison to conventional angiography computed tomographic (CT) angiography is a new and less aggressive measure used for detection of normal renal vascular anatomy and diagnosis of vascular variants. To evaluate the frequency of normal vascular variants in 62 patients (124 Kidneys), underwent abdominal CT Angiography (Aortography). During a period of one year, abdominal CT angiography was performed in 62 patients, 48 male and 14 female between 7-74 years of age (Mean 25.68 years). The angiographic images were studied after being reconstituted by use of a computer. There was no complication and all patients tolerated the procedure without any reaction and/or discomfort. One forth of the patients felt some warmness during contrast injection. In 98 (79%) kidneys only one renal artery, in 20 kidneys (16.1%) two arteries, in 4 kidneys three arteries, and in two kidneys four arteries were detected. In 109 kidneys (88%) only one vein and in 15 kidneys (12%) two renal veins were detected and circum-aortic renal vein or renal collar was found only in one case. In this study the frequency of multiple renal vascular variants was less common than those of other studies. By use of spiral CT angiography and reconstitution of images by a computer, renal arteries and veins can be investigated in a short time avoiding invasive sequela or any complication for the patients.