مجله دانشگاه علوم پزشکی گیلان
پیاپی 76 (زمستان 1389)

The liver played an important role in the metabolism of thyroid hormones and was involved in their conjugation, excretion and peripheral deiodination in synthesizing Thyroid Binding Globulin (TBG). Thus liver dysfunction can be influenced thyroid function. Determine the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction. Sixty Four Cirrhotic patients due to hepatitis B and C referring to Razi hospital were studied during 2007-2009 years. Data were collected by prepared questionnaire. Thyroid hormone levels were measured in a unit laboratory. Liver dysfunction was scored by MELD and child pugh scoring systems. Mann-Whitney U, chi square and kruskal wallis test were used for measuring severity of liver dysfunction. Among 64 patients, (42 patients were male and 22 patients were female). Mean age of patients was 55.03±12.05. Level of TT3 TT4 and FT3 had decreased in the majority of patients, TT3, TT4 and FT3 levels. There was a correlation between level of TT3 and severity of liver dysfunction base on Child score (p=0.0001) and MELD (p=0.02).There was a reciprocal correlation between TT3 level and probability of the history of digestive systems bleedings, Ascites and encephalopathy (P=0.01, P=0.011, P=0.009). It means that when TT3 level was low probability of this complication was high. This study showed that liver disease is accompanied by changes in thyroid hormone levels specially decrease the level of TT3, TT4, FT3 and it is indicated that TT3 level can be used as liver function index in cirrhotic patients due to hepatitis B and C.

Study of normal morphological features of the skull with precise measurement methods is named Cephalometry. The most important dimension of cephalometric is height and width of head. Occipital flattening is common among Guilanian people, so cephalometric measurements and use of cephalic index is necessary for detailed evaluation of morphological specifications of their skulls. To evaluate the probable differences of Guilanian cephalic index with other studies. In this prospective descriptive study 190 patients were selected among all Guilanian people with AP and lateral skull x-rays referring to inpatient or outpatient wards of Poorsina hospital in Rasht, Cephalic index was statistically evaluated after ruler measurement and calculation of percentage of maximal head width and maximal head length relation, in skull x-rays. Among 190 Guilanian people 151 persons were male and 39 persons were female. The mean age of them was 31.8 years. Mean of maximal head width and length were 15.358±1 and 17.752±1.1cm respectively. Mean cephalic index was 86.4±4.4 in the Brach cephalic range. Ninety percent of cases had Brach cephalic and 10% had mesocephalic skull, without any dolichocephalic skull. In this study brachycephaly is common among Guilanian adults, like other studies. There is differences between the results of this study with other world studies (the mesocephalic skulls are the prominent type), but there is no difference with studies on other areas of Iran.

Various frequencies of the mtDNA mutations have been reported from different population world wild. Three mitochondrial DNA (mtDNA) mutations including A1555G, A 3243G, and A7445G which occurred in MTRNR1, MTTL1 and MTTS1 genes were considered as the main causes of mitochondrial hearing loss in some populations. To determine the frequency of the A1555G, A3243G, and A7445G mutations in nonsyndromic sensorineural hearing loss subjects in Gilan. Forty six subjects with nonsyndromic sensorineural hearing loss were screened by provided questionnaire and audiogram from Gillan Welfare Organization. PCR-RFLP procedure was used in order to presence the MtDNA of A1555GA 3243G and A7445G mutations and was confirmed by subsequent direct sequencing. There was no MtDNA of A1555G, A3243G and A7445G mutation in the cohort study of 46 deaf individuals. Investigation of PCR-RFLP of the MTTL1 gene for existence A3243G mutation lead to identification a G3316A variant that destroyed other restriction site, in the other site of PCR fragment. Our finding indicated that possibility the association of mitochondrial mutations with deafness is very low in deaf subjects in north of Iran. According to existence the G3316A that its pathogenesis in relation to hearing loss phenotype has not stabilized, the frequency of G3316A is 1.46% that can be had highlights role of mitochondrial mutation in deafness.

Intrauterine Growth Retardation (IUGR) is defined as approximate weight of embryo being less than the ten percentile. Some of the factors contributing to the IUGR are as follow: The mother history of chronic diseases, the mothers BMI, the trends of mother weight gain at the time of pregnancy, the mother’s age at the time of pregnancy, the mothers job, various embryonic infections, placenta and uterine disorder. This cross-sectional, descriptive-analytical study was performed on pregnant women referring to the prenatal clinic of Baghiyatollah hospital at the years of 2009 and 2010. Fifty hundred four pregnant women, between the age of 18 and 35 years were examined as available, these following variable were surveyed: The mothers age at the time of delivery, the mothers BMI at early pregnancy, the mothers weight gain during pregnancy, the mother history of chronic diseases, the age of pregnancy, the mothers job and education, blood group and RH, gravid, the interval of deliveries, gender of newborn with IUGR. Data was analyzed by SPSS, chi-square and the logistic regression model.' 60.3% had normal BMI, 29.2% had BMI higher than normal, and 10.5% had BMI lower than normal. 50% had normal weight gain, 31.7% had weight gain higher than normal, 13.1% had weight again lower than normal, 10.3% had a chronic disease, 15.1% were employed and 83.3%of women were educated. There was a significant relationship among the mothers BMI at the beginning of pregnancy, the rate of mothers weight again during pregnancy, the mothers history of chronic disease, the mothers job and the newborns gender with IUGR. Probability of IUGR is higher in woman whose weight gain was lower than normal rang, female newborn and housekeeper mothers. There is a direct link between IUGR and the history of chronic disease in mothers.

The b-carbolines harmane, harmine and norharmane are the members of Harmala,s alkaloids group (Peganum harmala, Zygophillaceae). The b-carboline alkaloids adjoined to benzodiazepine site of the γ-aminobutyric acid type A (GABAA). These alkaloids also inhibited cyclooxygenase and lipoxygenase activities. These findings showed that the b-carbolines should be able to reduce writhing nociceptio induced by acetic acid- in mice. To assess the effects of acute treatment with harmane, norharmane and harmine on the writhing induced by acetic acid in mice. The experiments were carried out on male BALB/C mice (20-25g). Intraperitoneal (I.p) injection of acetic acid (0.6%) was performed in order to cause writhing behavior. This behavior was recorded by direct observation for a 30-minutes period. Decrease of writhing count is indicative of an anti-nociception. In order to avoid the possibility of a physicochemical interaction between them, Drugs were administered on opposite sides of peritoned. Intraperitoneal (I.p) injection of Harmane (5-20mg/kg) on 6-9 mice, norharmane (5-15mg/kg) on 8-9 mice and harmine (10-15mg/kg) on 8-9 mice in per group decreased the writhing behavior significantly (P<0.0001, P<0.0003 and P<0.0016, respectively). The inhibitory effects of the mentioned drugs were antagonized by flumazenil (2 mg/kg) Effects of harmane, norharmane and harmine on writhing response may be mediated through an inverse agonistic mechanism located in the benzodiazepine receptors.

One of the most important issues which affected on efficiency of academic staff members and particularly on teaching and learning process is stress. Survey the stress resources on academic staff members in Guilan University, Guilan Medical Sciences University and Islamic Azad University. Since first month of 2007 to the end of the 2008, 186 academic staff members in Guilan University, Guilan University of Medical Sciences and Islamic Azad University were selected base on kerjesy and Morgan and cluster sampling. Robbins and MacKay questionnaire were used for collecting information related to the different variables in the present research. This questionnaire consisted of two different parts which included 20 items about signals of vocational stress which was covered three months ego and 50 items which investigated vocational stress and vocational experiences in one year ego. In general, academic staff members had stress signals and resources in medium rate. But this signal in male staff is more than female. Although, in some part of the results, there was no significant difference among three mentioned universities, but there was a significant difference in other findings of individual characteristics such as gender, study and number of children with vocational stress resources in two different gender of staff members. According to the results, majority of academic staff members had stress in medium rate. There was a significant difference between male and female academic staff members, So that, male academic staffs showed more stress with respect to the type of university, study and stress resources.

Family Physicians (FPs) played a responsible role as the manager of health team for using of potentials promotion and conserve the health in their protege population. Family physicians Satisfaction can be effect on efficacy, quantity and quality of health services. To evaluate the level Satisfaction of family physicians (FPs) about effective factors on activation of FP program in medical universities in northern provinces of Iran. This cross-sectional descriptive- analytic study was performed on rural regions and towns with population under 20000 persons in the universities of Golestan, Mazandaran, Bobol and Guilan in 2008. At first 20% of health centers which applied family physician program were selected by randomized systematic selection, 160 FPs were interviewed by questionnaire in each center. Data was analyzed by Chi-square, Fishers Exact and kendalls Test in SPSS. Among 160 FPs, 92 persons (55.4%) were male, 132 persons (79.5%) were married. Mean age of them was 34.5±4.95 years, mean records of their services was 32±9.79 months. Mean of their protégé population was 4285±1338.persons. Level of FPs satisfaction was low about the function of district health center, specialists between the second level of referral system and the people with rural assurance,there was a significant difference between the mentioned universities (about these factors). But the Level of FPs satisfaction was high about the health team. According to the results the managers of district health center must promote the programs and increase the coordination between first and second levels for presentation of health services

ALuminium Phosphide (ALP) or rice tablet is one of the most commonly used pesticides in agriculture. Exposure of ALP with water, moisture and gastric acid produced phosphine gas (PH3) that caused to poisoning. Several histopathogical researches have shown edema, congestion, and leukocyte infiltration in different organs. More pathological researches are obviously required to describe the mechanism of poison affects on cells. To determine the histopathological findings in autopsy of liver, myocardium, and lungs of poisoned patients with rice tablet. This retrospective descriptive study was conducted on 80 poisoned patients with phosphine in the histopathology department of the legal medicine organization of Guilan in the years of 2001-2006. Stained sections of the liver, myocardium and lungs of poisoned patients were reviewed and histopathological findings were recorded. Data were analyzed by SPSS Ver.15 software. According to the data analysis, 60% of patients were male and the rest (40%) were female. Mean age was 31.45 years. Histopathological findings in liver were: Sinusoidal congestion (45%), fatty liver changes (20%), congestion of central vein (15%), fine cytoplasmic vacuoles (10%), PMN leukocyte clusters in Sinusoids (7%), nuclear fragmentation (2%), centri lobular necrosis (1%). Histopathological findings in myocardium were: congestion (86%), necrosis (7%) and leukocyte infiltration (7%). Histopathological findings in lungs were: edema (42%), congestion (33%), hemorrhage (11%), atelectasia (11%), capillary dilatation (2%), and thickening of alveolar septae (1%). In this study, it was discovered that the most common histopathological finding in liver of poisoned patients with phosphine were sinusoidal congestion and fatty liver changes. Meanwhile, edema and congestion were the most common in autopsy of lungs. Congestion was the mostly-observed histopathological finding of myocardium.

Obesity is one of the most common nutritional disorders in the world, clearly associated with metabolic disorder. Prevalence of children and adolescents obesity has increased due to increasing the prevalence of type two diabetes in the last decades. To determine the impaired glucose tolerance and insulin resistance of obese children and adolescents. This cross sectional study was conducted on obese children and adolescents who were referred to endocrine clinic of children hospital in Tabriz, from April 2007 till March 2008. One hundred ten obese children and adolescents were studied with BMI over than 95 percentile base on age and sex. OGTT (Oral Glucose Tolerance Test) was performed immediately, 30, 60, 90, and 120 minutes after ingestion of glucose (1.75gr/kg). Insulin resistance was examined by HOMA index. Among 110 obese children and adolescent, prevalence of impaired glucose tolerance was 9.1% and insulin resistance was 28.2% and Type2 diabetes did not observe. There was a significant difference in glucose 120min (p=0.003) and insulin 120min (p<0.001) in patients with IGT (Impaired Glucose Tolerance) as compared with other obese children and adolescents. Insulin resistance in IGT was more than other and there was a significant difference between them (p=0.03). Obesity in children and adolescents is associated with increasing the risk of IGT and insulin resistance. OGTT versus fasting glucose can be a useful predictor for them.

Today, HIV infectious and IV drug abusers have a near relationship; especially IV is an important matter in IRAN. A big number of abusers suffered from HIV and capable to psychiatric disorder. Evaluation of Depression Frequency in HIV Positive and HIV Negative among IV Drug Abusers. In a cross sectional, descriptive study, frequency of depression was evaluated between HIV positive and HIV negative among IV drug abusers. Twenty hundred seventy drug abusers (90 HIV+, 180 HIV-) were enrolled in the study. Data was collected by Beck Depression Inventory (BDI) questionnaire for depression and checklist for demographic features. Mean average age of starting injection was 38.25±7.1 years old. Frequency of depression in HIV positive individuals was 79% and 7.8% of them had major depression but in HIV negative individuals, 60% suffering from depression and 7.1% of them had major depression. Frequency of depression among HIV positive individuals is more than HIV negative individuals. So is suggested to pay more attention and better evaluation on psychiatric disorder of IV drug abusers with HIV.

Sudden deafness (SD) is one of the major complaints of patients who referred to otolaryngology or neurology clinics. Most of the cases have idiopathic etiology; but some of them have other causes that must be diagnosed by appropriate diagnostic modalities such as Magnetic Resonance Imaging (MRI). In this study, we showed the findings of MR Imaging in 32 patients with SD. Determination of MRI findings in sudden sensorineural hearing loss. We had performed gadolinium enhanced brain MRI, along Brainstem Auditory Evoked Potentials (BAEP) before treatment in 32 patients with SD referring to ENT Clinics of Kashani hospital in Isfahan and Amiralmomenin hospital in Rasht from August 2005 to September 2008 and were analyzed their results. Abnormal findings in MRI were reported in 6 cases (19.35%). In 3 cases (2 females, 1 male) were found cerebello-pontine angle tumors in the same side of suggesting 8th cranial nerve schwannoma (acoustic neurinoma). In one 45 years old male were found multiple hyperintense lesions in T2 and FLAIR that were hypo to isosignal in T1 and PD in pons, left cerebellar hemisphere and middle cerebellar peduncle that were more compatible with infectious, carcinomatous or lymphomatous processes and in 2 other cases, inflammatory process in mastoid regions, like mastoiditis were seen. Subcortical and periventricular lesions were found in one patient, compatible with migrainous changes and without any relating to SD. In one case MRI was normal but were found abnormal BAEP findings which indicatived an auditory neuropathy. In the investigation of the etiology of SD in patients, MRI is an invaluable instrument and can identify and clear up structural causes of sudden deafness.

Laryngomalcia is the most common cause of stridor between airways malacia in neonates.It can be accompanied by gastroesophageal reflux. Few cases of swallowing dysfunction were reported in neonates with no underlying disorders some of them had laryngomalacia and reflux too. All three causes can lead to neonatal or infantile FTT or recurrent hospitalization. Timely treatment decreased complications of diseases; we reported a case of a newborn that contracted severe laryngomalcia, swallowing dysfunction and gastroesophageal reflux which needed surgery, in order to attract physicians’ attention to the aspect and clinical process of these complications, from birth to discharge. Case Report: Patient was a full term baby boy who was born by normal vaginal delivery without special problem in his fetal status. His parents were not relative. His birth weight was 3100gr and he had appropriate apgar scores, he contracted mild respiratory stridor, subcostal and upper sternal retraction after birth at the delivery room and was referred to NICU. After intubation his signs eliminated, he was intubated several times during the first 2.5 months after birth. He got pneumonia repeatedly and his lung condition improved with reflux treatment. Because of disability in swallowing, milk was gavage for him. But in spite of enough intake calories, he contracted FTT. His respiratory condition improved with tracheostomy in 2.5 months, and gastrostomy was done in 3 months old. He released with a good condition in 100 days old. He was 10 months and his weight was 9kg. Although, it is impossible that laryngomalacia have got signs at birth but it should be concerned as probable cause of respiratory distress in labor room. A report of respiratory distress at birth in company with stridor, disability in milk ingestion, recurrent pneumonia and FTT (without co-existing disease) should get physiscians suspicious of coincident swallowing dysfunction and laryngomalacia. Both two disturbances can be accompanied by gasteroesophageal reflux too. If there was no response to expected medical management, surgical interventions should be necessary.