مجله دانشگاه علوم پزشکی گیلان
پیاپی 83 (پاییز 1391)

Oxidation of low-density lipoprotein (LDL) has been strongly implicated in the pathogenesis of atherosclerosis. The use of antioxidant compounds in dietary food stuffs including vitamin E and rosmarinic acid may lead to the inhibition of production of oxidized LDL and may decrease both the development and the progression of atherosclerosis. The present work investigated the effects of Rosmarinic Acid (RA) on LDL oxidation induced-CuSO4 quantitatively in vitro. Fasting blood samples from normal people after an overnight fasting were collected and then LDL was isolated. LDL was incubated without CuSO4 as control and incubated with CuSO4 and several concentrations of RA (50، 100 and 200 µM); and measured the formation of conjugated dienes and Malondialdehyde (MDA). Inhibition of this Cu-induced oxidation was studied in the presence of several concentrations of RA (50، 100 and 200 µM). It was demonstrated that RA is able to decrease CuSO4-induced LDL oxidation. Rosmarinic acid showed a decrease in the formation of (MDA). Rates of 31. 8%، 36. 7% and 50. 3% were seen at concentrations ranging from 50، 100 and 200 µM، respectively، against oxidation in vitro. The inhibitory effects of the RA on LDL oxidation were dose-dependent at concentrations ranging from 50 to 200 µM. This study showed that RA at concentrations (50، 100 and 200 µM) prevented the oxidation of LDL in vitro and it may suggest that they have the similar effect in vivo.

Recovery following Coronary Artery Bypass Graft surgery is a multifactorial process and extraordinary important for patient''s later life. However، psychological، physiologic factors، demographic and clinical characteristics are important for the recovery following Coronary Artery Bypass Graft surgery. However، such factors are not yet studied in integrative and interactive manner in Iran. Investigating the predictive role of psychological، physiologic factors، demographic and clinical characteristics for the recovery following Coronary Artery Bypass Graft surgery. In a retrospective cross-sectional survey، 292 patients 2 months following Coronary Artery Bypass Graft surgery were selected by convenience sampling in Tehran Heart Center Rehabilitation Clinic. Data were collected by demographic and clinical information questionnaire and Type D personality measure، Multidimensional Health Locus of Control Scale (form A) and Depression Anxiety Stress Scales (DASS). Then، data were analyzed by Chi square، T test and enter binary Logistic Regression. Smoking، BMI، diet، Type D personality، blood pressure، Angina، age، Illness duration، Depression، Internal Locus of Control and external Locus of Control were significantly able to differentiate patients with recovery from those without recovery (P<0. 001). Sex factor was not significantly able to differentiate between the two groups (P>0. 05). According to the total regression model، 92/5% of the sample was classified correctly. Psychological factors، physiological factors، demographic and clinical characteristics all together seem to be important in the recovery following Coronary Artery Bypass Graft surgery. It is important to pay attention to such factors in Planning and administrating the promotion programs for the recovery following Coronary Artery Bypass Graft surgery.

Physical violence against women in the family is the most common form of physical violence usually committed by family members especially by husbands. It is also one of the most important concerns for general health in any society which progressed rapidly. In this study، we aim to find out the features of individual violence and her partner. This is a cross-sectional study which surveyed physical violence against women by their partners in the years 2008 till 2009 who were referred to forensic medicine center of Rasht. We collected the demographic features of the women and their partners and other data such as addiction، cause of physical violence، economic status، using a questionnaire. Then، data were analyzed by SPSS (ver. 16) software. The mean ages of women and their partners were 31. 5±8. 4 and 36. 3±8. 8، respectively. Most of the women had precollege education and were housewives but most of their partners had diploma of high school and were simple worker and actually not addict. In total، 80. 3% of these families lived in urban areas. Most physical violence against the wives occurred in the first years of marriage. Echimosis was the most frequent sign of women when referred. Although some differences were found among other reports in Iran، these show that the phenomenon of physical violence does actually exist and requires more money and time to prevent it.

Low birth weight is considered as one of the world''s most serious health problems that put tremendous pressure on health care system and family. Poor diet and poor weight gain during pregnancy affect negatively on maternal health and infant birth weight. To determine the relationship between nutritional status and maternal weight gain during pregnancy with low birth weight term infants. This study is a historical cohort one conducted on the subjects consisting of 1177 mothers referred to the health-care centers or posts for postpartum care or their children''s vaccinations for two months and all have had health records. The mothers، based on their newborns’ birth weights، were classified into two groups: mothers of underweight infants (2500 grams or less) and mothers of infants with normal weight (more than 2500- 4000 grams). Data were collected from maternal health records and organized interview with mothers. For data analysis، descriptive statistics، chi-square، Fisher، Mann-Whitney U and logistic regression models were used. The results showed a significant relationship between maternal nutritional status (p<0. 008) and weight gain (p<0. 002) during pregnancy with low birth weight. Low intake of dairy products 2/57 times (P<0. 018، OR=2. 57)، low consumption of fruits 3/75 times (slightly significant P<0. 069، OR=3. 75)، not taking iron supplements، multivitamins and folic acid 13/16 times (P<0. 001، OR=13. 16) during pregnancy seem to have increased the chances of the low birth weight. Considering the dietary factors associated with low birth weight، the role of hygienic personnel in promoting public awareness about proper nutritional status and weight gain during pregnancy is important.

Foot dropis a common and distressing problem that can lead to falls and injury. Considering the respective Patients and physicians’ concerns regarding the prognosis of this condition، relative improvement in some cases and no complete study about this problem in our country despite various treatments attempted، a closer study to assess prognosis in these patients seems necessary. The aim of this study is to investigate the associated factors in foot drop improvement including age، gender، site، cause and type of injury، time between the incidence and referral، and type of treatment. The present study is a cross- sectional one carried out with the patients referred to electordiagnosis department of Pursina hospital of Rasht in 2010-11. After entering the patient into study، demographic information، cause and damage started time were recorded. All the patients after a complete neurological examination were assessed by a neurologist experienced in EMG-NCV. Afterwards، the vulnerable patients were treated routinely. No intervention was done in the process of treatment and recorded the type of treatment. Patients had monthly visits، with improvement and changes in treatment recorded. If a patient withdrew he was excluded. Six months later، based on the age، gender، site، cause and type of injury time between the incidence and referral and type of treatment، all the patients were compared in terms of recovery. Totally، 105 patients (61 males and 44 females) with mean age of 45±17. 3 years participated in this study. 56. 2% of them were cured. The improvement in the root was (44. 1%)، sciatic nerve (75%)، common peroneal nerve (75%)، deep peroneal nerve (88. 9%)، which was statistically significant (P< 0. 005). The recovery rate of axonal lesion (53. 5%) and Demyelinating lesion (100%) which were statistically significant (P<0. 028). The recovery rate of foot drop in trauma was (75. 6%)، radiculopathy (38. 6%) and local compression was (85. 7%) which was also statistically significant (P<0. 0001). The recovery rate of foot drop according to type of treatment was not statistically significant in 95% of improved patients، the average age was 35-43 years (P<0. 0001) and time between the incidence and referral in 95% of improved patient، were within 0. 8 to 2 months، which was statistically significant (P<0. 0001) Predictive factors of recovery were age of the patient and time between the incidence and referral.

ADHD is a common disorder in children and adolescents. The children and adolescents with ADHD are at a high risk for cigarette smoking and substance abuse. Studies show earlier age of the onset of cigarette smoking in these groups of children and adolescents. This study was performed to determine the attitude towards cigarette smoking in attention deficit- hyperactive children from 7 to 12 years of age compared to that among their normal siblings and control group. This was a comparative cross sectional study performed on three groups of 7 to 12 years old children. The first group was the patients referred to Shafa Hospital with the diagnosis of ADHD based on clinical interview of child and adolescent psychiatrist and semi-structured K- SADS (Kiddie Schedule for Affective Disorders and Schizophrenia for school age children) interview. The second group was siblings of the first group and the third group was the patients referred to dentistry clinic of Guilan University، that were not ADHD by clinical interview and K- SADS. Attitude toward cigarette smoking and demographic data also were gathered by another questionnaire. Our study shows negative attitude of ADHD group towards cigarette smoking and there was no difference between different groups، and between boys and girls. But there was a negative correlation between age and attitude toward cigarette smoking (r= -0. 618). There was a significant difference between ADHD group’s attitude towards smoking as a relaxing act and other groups. Negative attitude toward cigarette smoking in the above-mentioned groups shows that the age of changing attitude toward cigarette smoking in the adolescents would be higher. The attitude of being relaxed by cigarette smoking in ADHD adolescents show motor and mind restlessness، which is so important that treatment is essential. The results of this study could be a preliminary step for performing more studies to determine target groups for preventive education of adolescents about cigarette smoking.

Traditionally، the central library of any university is the main source of scientific data retrieval for respective faculty members. Exploration of rate and pattern of such usage makes it possible to promote the quantity and quality of library services and increasing the efficacy of faculty members'' activities. To determine the rate of usage of central library resources among the faculty members in Guilan University of Medical Sciences and their satisfaction in this respect. This descriptive-analytical study was carried out on 139 faculty members of Guilan University of Medical Sciences who were selected on a stratified-random sampling manner. Data were collected using a two–section questionnaire containing items about demographic data and likert-scaled questions proposed to explore the amount of use and satisfaction of central library services. The normality of data was confirmed through Kolmogorov–Smirnov test. The most usage (%61. 2) of library resources was related to Persian books and least usage (%0) to the theses. Frequency of Persian journal use and Latin journal use were %52. 5 and %27. 3، respectively. Also، the most satisfaction was related to books (%37. 4) and the least to the electronic resources. The most common cause of avoidance of library resources usage (%35. 5) was using other resources and lack of suitable physical space was the least cause (%0) in this respect. The frequency of Persian resources (books and Journals) usage shows the need to the adoption of strategies for using Latin resources، as they are assumed to be source of updated data. Also، the faculty members'' satisfaction with non-electronic resources and their mild dissatisfaction in this issue shows the need for providing electronic infrastructures for using electronic resources.

Post-partum hemorrhage (PPH) is one the major causes of maternal mortality globally. Prediction and diagnosis of severe PPH remains challenging and most deaths due to severe PPH involve delayed in the diagnosis and management of hemorrhage. This delay may result from an underestimation of blood loss at delivery. Many studies indicate that assessment of post-partum blood loss following a vaginal delivery is difficult and visual estimation of blood loss is frequently inaccurate and it underestimates the amount of blood loss in around 45% of cases. A collector transparent plastic bag after delivery is a quantitative and objective method of measuring blood loss. The aim of this study was to assess sensitivity، specificity، positive predictive value (PPV)، negative predictive value (NPV) of a collector bag. The correlation between bag’s volume and hemoglobin (Hb) and hematocrit (Ht) variation was also examined. This study was carried out with 100 women referred for admission to labor ward in 2007. After measuring serum Hb and Ht in admission، a collecting bag in size 84×28 cm and thickness of 70 micron was to be placed under the pelvis of the mother as soon as the baby was born and was weighed after delivery. Hb and Ht were assessed before and 8 hr after delivery. Each 500 ml blood loss accounts for approximately a 3% change in the Ht level or a falling in Hb of 1 g/dl. Statistical analyses were performed using Chi square and T tests. Sensitivity، specificity، PPV and NPV indices of collecting bag were compared to laboratory tests (Hb، Ht). Post-partum hemorrhage was defined by a blood loss ˃500 ml or a fall of Ht˃ 3%، or by a fall of Hb˃1g/dL. Collector bag had Sensitivity=88. 9%، Specificity=91. 8%، PPV =80% and NPV= 95. 7% to detect the PPH. For Hb=1 the calculated bag volume was 500 ml. With this cut off، we noted Sensitivity=80%، Specificity=95. 7%، PPV= 88. 9% and NPV= 91. 8%. The collector pelvic bag is a rapid and precise instrument to diagnose post partum hemorrhage in delivery room. It also enables a visual، quantitative and objective estimation of blood loss.

Understanding the effect of different factors on the utilization of physician services is of great importance for policy making processes in health sector. Identification of such factors will improve the process of planning and policy making in health sector. To examine the effect of accessibility، income and out- of- pocket payments for visit and medicine on the utilization of specialist doctors'' services (visits)، in the population covered by Social Security Organization (SSO). Managerial data bases throughout the SSO were used to measure the effect of assumed variables on the utilization of specialist doctors'' services (visits) in a thirty-million population covered by SSO. The data were collected from 1998 to 2009 and then adjusted for the purpose of the study. A bilogarithmic regression model with panel data، using fixed effect model was estimated. The study results showed that 1% increase in the geographic accessibility and medicine costs would increase the utilization of specialist doctors'' services by 23% and 17%، respectively. As well، out-of-pocket payments for specialists'' visits and the insureds'' incomes have no significant effect on the utilization of these services. Visiting specialists in private sector showed no responsiveness to out-of- pocket payments، but more for geographic accessibility. Social Security Organization can regulate and control the utilization of these services through considering the flexibility of different provinces to different factors.

The Valvular mechanism and associated intra-articular lesions has shifted therapeutic approach for Baker’s cyst towards arthroscopic technique.

The aims of this study include determining the frequency of accompanying intra-articular lesions as well as comparing the outcomes of treating popliteal cyst with arthroscopy and open surgery.

This is a prospective study on 45 patients referred with symptoms of pain، swelling، and limited range of motion in knees and underwent arthroscopy with a diagnosis of Baker’s cyst confirmed by clinical examination and sonography. The accompanying intra-articular lesions were documented and treated and، whenever possible، the cyst’s valve was removed (26 cases). Otherwise، the cyst would be excised by open surgery (19 cases). On arthroscopy، we used the anterolateral and anteromedial portals to treat accompanying lesions، and the additional posteromedial portal for removing cyst’s valve. We recorded and analyzed the patients’ demographic characteristics، associated lesions and rate of reduction of symptoms (using Rauschning and Lindgren scale) before and three months after surgery. One year after surgery، recurrence was studied through sonography.

The arthroscopic group consisted of 11 women and 15 men (mean age: 48. 27±8. 27years) and 8 women and 11 men (mean age: 48. 63±9. 15 years) were in open surgery group. They all had at least one intra-articular lesion. The most frequent associated lesion was medial meniscus tear (75. 6%)، followed by sinovitis and chondral lesions. In both groups، the patients recovered considerably after three months (p<0. 0001); in both modes of therapy symptoms were reduced almost equally (P=0. 74) and no case of recurrence after one year was found.

The results suggest that arthroscopic treatment of intra-articular pathologies may result in lower rate of recurrence for popliteal cyst. In case the valve is found and removed and the cyst is extracted through its entry into the knee، it is then not necessary to excise the cyst by open surgery.

Pain control is one of the most important issues of post operation. Uncontrolled pain can be due to the complications such as rise of myocardial oxygen consumption، hypercoagulative state and suppression of respiratory system. There are several methods to control post operative pain، among which peripheral methods، due to fewer associated complications than others، (such as opioids and noroagsial methods) is more fruitful. The aim of this study was to compare efficacy of marcaine 0. 25% with that of lidocaine 2% for controlling the pain after cesarean section. In a double blind clinical trial، we selected 90 women with gravid one and term pregnancy. They were randomized into three groups. Patients underwent spinal anaesthesia. Following the surgery، we injected marcaine 0. 25% in dose of 0. 5 mg/kg with 20 cc distilled water، in 3 layers of abdomen (peritoneum، muscle، sub derm) in group 1، lidocaie 2%، 4mg/kg with 20 cc distilled water in group 2 and 30cc normal saline in group 3. The severity of pain was measured by VAS in 1، 2،3،4،8 and 12 hours after surgery. Also، the first dose administration time and mean consumption of diclofenac were assessed and compared among the three groups. We used SPSS، One Way ANOVA and Repeated Measure for analysis. (P. value less than 0. 05 was considered significant) The mean values of VAS in hours of 1،2،3،4 in group of marcaine were (3. 33،3. 6،3. 46،3. 33)، respectively، in lidocaine group were (3. 56،4. 16،4. 8،4. 43) and in normal saline group were (4. 06،5. 3،5. 66،5. 43). The mean time of the first dose administration of diclofenac in marcaine group was 2. 56، in lidocaine group was 2. 53 and in normal saline group was 1. 53. The local infiltration of marcaine 0. 25 % in puncture of cesarean seems to be more effective than lidocaine 2% for pain control and decreases analgesic consumption in early hours after cesarean section.

Strongyloides stercoralis is a common intestinal nematode that affects 30–100 million people worldwide. It is endemic in Guilan province، northern Iran and especially strikes the rural population. Case Report: We report the case of a 65-year-old woman living in Guilan province of Iran with a history of diabetes mellitus who was treated with high-dose prednisolone for temporal arteritis. Undiagnosed infestation by this nematode led to disseminated strongyloidiasis and Gram-negative sepsis. Fortunately، early diagnosis and prompt therapy with a proper anthelmintic drug as well as supportive care resulted in an acceptable outcome. All the patients who are candidates for immunosuppressive therapy or planned to receive steroid should be evaluated for strongyloidiasis. Although a stool test is the first and simplest test for this purpose، it may be negative for the parasite despite a large parasitic burden. Thus، physician’s awareness should be emphasized and a high index of suspicion required to diagnose this ominous condition by further evaluation (serology، evaluation of duodenal aspirate، endoscopy with biopsy and stool exam with proper culture by an expert، at index laboratories.)