مجله طب جنوب
سال نهم شماره 2 (اسفند 1385)

It is well established that the esophageal distention leads to gastric relaxation, partly by vago-vagal reflex but till now, the effect of esophageal distention on gastric acid secretion has not been investigated. The aim of this study was to investigate the effect of esophageal distention (ED) on basal and stimulated gastric acid secretion. Adult male Wistar rats (200-240g) were deprived of food but not water for 24 hrs before the experiments. Under urethane anesthesia (1.2 g/kg, i.p.), animals underwent tracheostomy and laparotomy. A catheter was inserted in the stomach through duodenum for gastric distention and gastric washout and the esophagus was cannulated with a distensible balloon orally to distend esophagus (0.3 ml, 10 min). Gastric acid secretion was stimulated by gastric distention, carbachol (4 µg/kg, i.p.) or histamine (5 mg/kg, s.c.). Effects of vagotomy, L-NAME (10 mg/kg, i.v.), L-arginine (500 mg/kg, i.p.) and hexamethonium were also investigated. Esophageal distention reduces basal and gastric distention, carbachol and histamine stimulated acid secretion (P<0.05, P<0.0001, P<0.01 and P<0.02, respectively). Vagotomy reduced the inhibitory effect of the esophagus distention on gastric distention-induced acid secretion (P<0.05). These results indicate that vagus nerve involves in the inhibitory effect of the esophageal distention on the basal and stimulated gastric acid secretion. Nitric oxide (NO) may also be involved.

Malaria is still one of the health problems in Iran. Resistance of Anopheles stephensi -the principal vector of the disease in the southeast of Iran- to insecticides such as DDT, malathion and dieldrin has been reported in south of the country. The present study was designed to estimate the persistence and residue of deltamethrin and cyfluthrin on different surfaces.

After testing the surface of selected locations for previous insecticides, 4 locations were sprayed with deltamethrin (25 mg/m2) and cyfluthrin (20 mg/m2). A total of 22 conical tubes were installed and fixed on surfaces of walls and ceilings made from plaster, mud and wood. In each conical tube, 10 An. stephensi were released and after half an hour exposure these mosquitoes were transmitted to sterile cups. After 24 hours, the obtained results were recorded according to the survival and mortality rate of mosquitoes. These tests were carried out from 5 days after spraying and repeated every 15 days until the mortality rate decreased to 60-65%.

Persistence and residue rate of deltamethrin 5% with the scale of 25 mg/m2 of effective substance was 3 months at most. Afterwards persistence and residue effect of this insecticide decreased on absorbent and nonabsorbent surfaces. Persistence and residue rate of deltamethrin 10% with the scale of 20 mg/m2 on absorbent and nonabsorbent surfaces in Sistan & Baluchistan province climate was estimated 2.5 months. Afterwards, its persistence and residue effect decreased significantly. In the sprayed locations with deltamethrin, there was no correlation between the An. stephensi mortality and absorbent (plaster and muddy) and nonabsorbent (wooden) surfaces (P>0.05). Also, in locations sprayed with cyfluthrin there was no significant correlation between the two types of surfaces, however, the mortality rate was significantly different between plaster and muddy surfaces (P=0.007). Moreover, from the point of residual efficacy, there was a remarkable correlation between deltamethrin and cyfluthrin (P<0.0001).

Both deltamethrin and cyfluthrin have adequate residual effect on absorbent and nonabsorbent surfaces, though deltamethrin shows a higher efficiency in comparison to cyfluthrin in control program for malaria vector.

According to World Health Organization report, chronic obstructive pulmonary disease (COPD) is the fourth cause of death which is increasing, and in the year 2015 it will be responsible for 10% of all deaths globally. Most of current researches focus on cigarette, and its association with diseases such as COPD, while many people in developing countries, including Asia, smoke tobacco using waterpipes.

A total of 245 sex -and age- matched waterpipe smokers for at least 15 years, and 245 nonsmokers, were randomly selected in Bushehr, and Tangestan districts of Bushehr Province. Salbutamol spray was used for assessing the airways reversibility. Spirometry was done three times for all subjects using a portable spirometer.

The prevalence of COPD among waterpipe smokers was 10.2% and none of the nonsmokers had COPD (P<0.001). A total of 66.6% of the cases had severe to very severe airway obstruction. Sex (male), age, smoking period, daily waterpipe runs, and job had significant correlations with COPD. Clinical symptoms such as dyspnea, cough, sputum, and cough and sputum for more than 2 years, were higher in subjects with COPD. COPD prevalence was 2.84 times higher in farmers and construction workers (95% CI: 1.06-7.63).

Chronic obstructive pulmonary disease is extremely high in waterpipe smokers. Thus, its risk for COPD should be considered as cigarette.

Palpable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. Fine needle aspiration (FNA) of palpable breast masses along with clinical and radiological findings can provide rapid distinction between benign and malignant lesions.

A total of 119 cases who had FNA biopsy and subsequent tissue biopsy in Fatemeh Zahra University Hospital of Bushehr port were included in the study. The cytological diagnoses were classified into three groups: malignant, suspicious or benign. The presence of malignancy was determined by histopathology on the corresponding surgical specimens.

Fine needle aspiration was benign in 64.7%, and malignant in 35.3% of the samples. Surgical histopathology showed malignant (38.7% 46 samples) and benign (68.3% 73 samples) masses. Thus, sensitivity and specificity of FNA in diagnosis of palpable breast masses were 78.2% and 91.78%, respectively. This method had a positive predictive value of 85.7%, negative predictive value of 87.01%, and efficacy of 93.58%.

Fine needle aspiration alone is not enough for diagnosis of breast masses.

Trauma is the most common cause of morbidity and mortality in industrialized countries and also in Iran. Anatomical imaging (AI CT and MRI) is helpful in the diagnosis of acute traumatic complications however it is not efficient in the diagnosis of disabling injury syndrome. In contrast, brain perfusion SPECT (Single Photon Emission Computed Tomography) can be more useful for evaluation of microvascular structure. This study was designed to compare these two diagnostic methods.

A total of 50 patients who had been suffering from traumatic brain injury for more than 1 year, and were followed as mild traumatic brain injury group according to “the Brain Injury Interdisciplinary Special Interest Group of the Ameri can Congress of Rehabilitation Medicine” criteria, were examined by brain perfusion SPECT and AI. The common anatomical classification of the lobes of brain was used.

The male to female ratio was 3:2. The mean age was 32.32±11.8 years and mean post-traumatic time was 1.48±0.65 years. The most common symptoms were headache (60%), agusia (36%) and anosmia (32%). Among 400 examined brain lobes in this study, brain perfusion SPECT revealed remarkable abnormality in 76 lobes (19%), but AI determined abnormalities in 38 lobes (9.5%) therefore, SPECT was twice sensitive than AI in mild traumatic brain injury (P<0.001). The correlation between SPECT and AI findings was 84%. SPECT was more sensitive than AI in demonstrating brain abnormalities in frontal lobe it was more obvious in the male group however, there was no significant difference between more and less than 30 years old groups.

According to the findings of this study, we recommend using brain perfusion SPECT for all patients with chronic complications of head trauma, particularly those who have signs and symptoms of hypofrontalism, even though with some abnormalities in AI.

Acute renal failure following aortic aneurysm surgery is a common complication and is associated with high mortality and morbidity rate. Also, acute renal failure has high mortality rate, irrespective of its cause.

In a retrospective–descriptive study, in order to identify major risk factors for acute renal failure following elective and emergent repair of abdominal aortic aneurysm, hospital records of 70 patients whom were operated by the same surgical technique (transperitoneal approach) in a university hospital in Tehran during the past 7 years were evaluated. The studied variables were major concomitant medical diseases, preoperative renal dysfunction, acute renal failure, renal ischemic time in minutes, intra operative hypotension, contrast radiologic dye use, and conditions related to the nature of aneurysm and its surgery.

A number of 53 men and 17 women with average age of 70 (range 37-90 yrs) years were studied. A total of 33% of them had chronic obstructive pulmonary disease. Baseline serum creatinine in 19% of the cases was greater than 1.5 mg/dl. One patient was dialysis-dependent and 53% of the cases had significant ischemic heart disease. The emergency operation was done in 14%. Rupture of aneurysm and aortic dissection were developed in 17% and 13% of the patients, respectively. The postoperative mortality rate for elective and emergency operation was 20% and 70%, respectively. Significant renal failure was developed in 20% with a mortality rate of 57%. Hemodialysis was done in 4 cases with a 50% mortality rate. In this study, we found significant correlation between postoperative renal failure and emergency operation (P=0.01), rupture of aneurysm (P=0.039) and postoperative mortality rate (P=0.005). There were no significant correlations between other variables.

Acute renal failure following surgery of abdominal aortic aneurysm surgery is common. It has significant correlation with emergency surgery and rupture of abdominal aortic aneurysm.

Heart disease in infants and children may often lead to rapid decompensation. Therefore, early diagnosis is essential because modern medicine and surgery can cure many heart defects. A cardiac murmur can be the first sign of a serious structural cardiac disease. Abnormal auscultatory findings, usually murmurs, are the most common reason for referral to the pediatric cardiologist. In a case series study, children and adolescents with heart murmurs, referred to or admitted at Fatemeh Zahra (S) Hospital of Bushehr University of Medical Sciences, were evaluated between 2001 and 2006. The age range of participants was from birth to 18 years old. Chest x-ray, ECG, and echocardiography were done for them in addition to history taking and physical examination. A total of 715 (56.2% male and 43.8% female) children and adolescents were included in our study (33.6% adolescents, 27.4% neonates, 22.7% infants and 16.3% children). A total of 59% of the cases had structural heart defects (organic), 27.3% had functional murmurs, and 13.7 % had acquired diseases. The most prevalent malformations were ventricular septal defects (26.2%), tetrology of Fallot (9.1%), and patent ductus arteriosus (8.7%) 23.3% of participants had growth retardation. Heart murmur may be the first sign of an underlying heart disease, and timely referral of children with a murmur for echocardiography is essential for diagnosis.

Although the majority of febrile seizures are benign, it is clinically important to understand the underlying mechanism. In this study, we investigated characteristics of febrile convulsion and factors related to its recurrence and its relapse during a hospital course.

A total of 102 patients with febrile seizure who were admitted serially at Fatemeh Zahra (S) University Hospital in Bushehr port were investigated. Demographic information and data of the history and physical examination were recorded. Children under the age of five with temperature of more than 37.8C or with history of fever accompanied by seizure entered the study those with meningitis or encephalitis according to the results of lumbar puncture or clinical diagnosis were ruled out.

Mean age of patients was 24±13.1 months, the most frequent type of convulsion was tonic-clonic (60.5%), and the least were atonic and myoclonic (each 7.9%). Focal convulsion was determined in 13.0% and complex type was observed in 32.5% of patients. Family history of febrile seizure was found in 59.0%. Female sex (RR=2.68, 95% CI: 1.20-5.99), history of previous febrile seizure (RR=2.56, 95% CI: 1.11-5.95), age at initial febrile seizure (RR=2.7, 95% CI: 1.16-6.29), and complex type of seizure (RR=3.86, 95% CI: 1-14.97) increased the risk of seizure relapses in a hospital course (P<0.05).

Gender, history of previous febrile seizure, age at initial febrile seizure, and complex type of seizure increase the risk of recurrence of febrile seizure during hospital course. Further studies for assessing the long term effects of these factors on recurrence will determine children who need more medical attention in the future.

Dermatophytosis is a prevalent mycologic skin disease which is a widespread important health problem in the world. The ecology and etiology of the disease are important issues for its control.

In a descriptive study, 341 patients with suspected dermatophytosis were examined over a period of one year (2004-2005). Skin, hair and nail samples were evaluated by to direct microscopic examination using potassium hydroxide (KOH) the specimens were cultured in sabouraud dextrose agar. In some cases, differential tests such as corn meal agar, urease and hair perforation were used for recognizing the isolated dermatophytes.

A total of 116 dermatophytes (34%) were isolated. Tinea cruris (31.9%) was the most common type of infection, followed by tinea corporis (20.7%), tinea pedis (19%), tinea unguium (11.2%), tinea faciei (7.7%), tinea manuum (5.2%), tinea capitis (4.3%). Epidermophyton floccosum was the most frequent isolated dermatophyte (32.8%). Also Dermatophytosis was more frequent in male gender.

The anthropophilic species, E. floccosum, was the most common causative dermatophyte of tinea in Qazvin and the most common clinical type of dermatophytosis was Tinea cruris.

Animal bite, particularly dog bite is a prevalent public health problem which has not been taken into consideration properly. Especially, children have less experience in handling dogs and do not consider the related dangers seriously. The aim of this study was to determine incidence and related factors of animal bite in children less than 16 years old in Bushehr.

In a prospective survey, all children (or their parents) younger than 16 years with an animal bite were interviewed from March 2001 to March 2006 in Bushehr. Some information was collected from their medical records.

A total of 240 children (mean age 9.14 years, minimum 90 days and maximum 15 years old) were identified. The annual incidence of animal bite was 0.19 per 1000 children between 0-15 years of age. Animal bite was higher in 10-15 years old patients and its rate was low in younger children. The most common animal bite was dog bite (79.6%) and in 84.2% of cases the animal was domestic. Most of the children (65%) had single lesion. The affected region in under 5 years age group and ≥5 years age group were upper limb (41.5%) and lower limb (55.3%) respectively (P=0.0001). The prevalence of cat bite injury was almost two times higher in girls than boys. Also cat and monkey bites were more frequent in urban than rural areas. Inpatient treatment was required in 3 cases (1.3%). All patients received Rabies immunoglobulin and completed courses of vaccination (3 or 5 times according to animal being captured or escaped). No significant associations were found between the number of wounds (single or multiple), degree of wounds (superficial or deep), sex and age (<5 or ≥5 years old) with the kind of animal (domestic or wild).

Dog bite in children is frequent. Since the cost of post exposure prophylaxis is very high for national health sector, preventive strategies should focus on public education, especially for children.

Cardiovascular disease remains the leading killer of women in most areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) methods. A total of 335 healthy, 25-64 years old women who had been selected by a multiple-stage stratified cluster random sampling method in Bushehr Port/I.R.Iran, were randomized into control and intervention groups. The intervention group completed an 8-week lifestyle modification program for increasing their physical activity, based on a revised form of Choose to Move program an American Heart Association Physical Activity Program for Women. Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations. Among the participants, the percentage of those who reported being active (practicing at lease 30 minutes of moderate intensity physical activity for at least 5 days a week, or at least 20 minutes of vigorous physical activity for at least three days a week) increased from 3% and 2.7% at baseline to 13.4% and 3% (P<0.0001) at the ending of the program in the intervention and control groups, respectively. The participants in the intervention group reported more minutes of physical activity per week (mean=139.81, SE=23.35) than women in the control group (mean=40.14, SE=12.65) at week 8 (P<0.0001).The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure (-10.0 mmHg) than the control group women (+2.0. mmHg). The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77, respectively (P<0.0001). An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women. The development of participatory process to support the adequate delivery of lifestyle-modification programs is a feasible and effective healthcare delivery strategy for cardiovascular community health promotion.

Homocysteine is a non essential amino acid which is derived from metabolism of the essential amino acid, metionin. It has been shown that an elevated serum homocysteine level in adults is associated with vascular diseases. In this study, we determined serum homocysteine level and its gender and age distribution in three cities of Bushehr, Genaveh and Deilam in the northern Persian Gulf. A total of 1699 inhabitants of the north region of the Persian Gulf were selected based on a multi stage stratified clustered sampling and a fasting blood sample was taken from them. We measured serum homocysteine level using enzyme immuno assay method with accuracy limit of 1 µmol/L. Hyperhomocyteinaemia was defined as homocysteine more than 14 µmol/L. Mean plasma homocysteine level was 14.63±7.08 µmol/L (17.72±6.63 µmol/L for men and 12.73±6.78 µmol/L for women). No correlation between homocysteine and age was found. The prevalence of hyperhomocysteinaemia was 51.2% (22.2% in male and 29% in female). The homocysteine level in the north region of the Persian Gulf general population is high. Further study is essential to reveal the reason of the high homocysteine serum level in the inhabitants of the northern Persian Gulf with emphasis on folic acid and vitamin B12 serum levels.