نشریه دانشگاه علوم پزشکی بیرجند
سال هجدهم شماره 3 (پیاپی 48، پاییز 1390)

It seems that serum magnesium (Mg) plays an important role in parathyroid hormone (iPTH) secretion, with the same pathway as calcium (Ca) does. Until now the studies which have evaluated the relationship between Mg and PTH, reported different results. So, in this study, we have investigated the relationship between Mg and PTH. In this cross-sectional study, 46 patients (Male:17, Female:29) who underwent peritoneal dialysis for at least 3 months with an age of at least 15 years old and who have had stable status in the previous 2 months were enrolled. Patients with active infection or hospitalization in the last 2 months were excluded. Ca, phosphorus (P), Mg, alkaline phosphatase (Alp), albumin (Alb) and iPTH levels were measured. The serum levels of Mg, Ca, Alb, Alp and iPTH had no statistically significant difference between the males and the females but the serum level of P in the females (5.42 ± 1.16) was significantly higher than the males (4.49 ± 0.88) and there was an inverse relationship between the serum level of Mg and iPTH which was not statistically significant (r=-0.111, p=0.467). In the patients with iPTH >300 pg/ml, there was an inverse significant correlation between the serum Mg and iPTH levels (r=-0.385, p=0.036), but in iPTH <300 pg/ml there was no significant correlation. Our findings only showed an inverse significant correlation between serum Mg and iPTH in patients with peritoneal dialysis iPTH >300 pg/ml which can suggest the probable role of low serum level of Mg in development of secondary hyperparathyroidisim.

Diabetic nephropathy is the most common complication of diabetes. Oxidative stress has been suggested to play a key role in the pathogenesis of diabetic nephropathy. It has been shown that vitamin E and lovastatin delay the onset and progression of nephropathy. The purpose of this study was to determine the effects of supplementation of vitamin E and lovastatin on glomerular volume in diabetic rat kidney. Forty male Wistar rats were randomly divided into five groups. Group 1 was considered as control group and groups 2-5 as experimental groups in which diabetes was induced by intraperitoneal injection of streptozotocin (60 mg/kg). Sixty days after induction of diabetes, the rats of group 3, 4 and 5 were received lovastatin (10 mg/kg/day), vitamin E (100 IU/kg), and simultaneously lovastatin and vitamin E, respectively. After treatment, the rats were anesthetized and then the kidneys were excised and fixed. Following tissue processing and staining, glomerular and kidney volume were estimated by cavalieri method. Total glomerular volume was increased significantly in the diabetic group (group 2) in comparison with the control group (P<0.01). The lovastatin group (group 3) showed a significant decrease in total glomerular volume in comparison with the diabetic group (p<0.01). However, in the vitamin E group (group 4), total glomerular volume decreased much more than in the lovastatin group and the lovastatin and vitamin E (group 5) simultaneously (P<0.001). It is possible that administration of lovastatin and vitamin E has renal protective effects on diabetic rats and ameliorates renal function and also prevents structural changes in an experimental model of diabetic nephropathy.

Morphine is frequently used for patients suffering cancer in their end stages to relive pain. However, there are conflicting reports suggesting morphine to promote tumor growth and reduce survival rate in cancerous animal models or induce necrosis and apoptosis in the tumor cells. In the present study, we studied the effect of morphine on proliferation of human lung adenocarcinoma epithelial cell line (A549). In this experimental study, after culturing A549 line cells, a suspension of 105 cell/ml was obtained. Then a concentration of 104 cell/100µl was added to each 96 wells of the plates. The wells were then categorized into three groups including control (containing no morphine), morphine 10 (containing10µm morphine) and morphine 30 (containing 30µm morphine). After 24h of incubation, the proliferation of A549 cells were examined using WST-1 cell counting Kit and Eliza method. Morphine induced proliferation in lung tumor cells; there was a significant association between increase in dose of morphine and rate of cell proliferation. Mean absorption dose in the group recieving 30µM of morphine (1.82±0.18) was significantly different from those recieving 10µM (1.52±0.08) or no morphine (1.44±0.09) (P<0.05). Rate of cell proliferation is increased with increasing doses of morphine in lung cancer. We propose use of morphine with more caution in lung cancer patients.

Detection of women at risk of dystocia could minimize the maternal and neonatal morbidity. The objective of our study was to determine The diagnostic accuracy of the combination of maternal height and transvers diagonal of Michaelis sacral rhomboid to predict dystocia in nulliparous women who referred to Ommolbanin Hospital of Mashade between December 2008 and June 2009. In this validity study of diagnostic methods we included 447 nulliparous women with a single pregnancy in vertex presentation and with gestational age of ≥ 38 weeks. The transvers diagonal of the Michaelis sacral rhomboid area and maternal height were assessed in cervical dilatation of ≤ 5 centimeters, then labor progress was monitored and dystocia was defined as caesarean section and vacuum or forceps delivery for abnormal progress of labor (at presence of effective uterine contractions, arrest of cervical dilatation or cervical dilatation less than 1 centimeter/hour in the active phase for 2 hours and duration of second stage more 2 hours or fetal head descend less than 1cm/h). Maternal height ≤ 155 centimeters had a sensitivity of 50%, a specificity of 70/8% and an accuracy of 68/2%. The transverse diagonal of the Michaelis sacral rhomboid area ≤ 9/6 centimeter resulted in a sensitivity of 60/7%, a specificity of 84/1% and an accuracy of 81/2%. The highest sensitivity, specificity and accuracy were obtained from combination of maternal height tand transvers diagonal of Michaelis sacral and were respectively 89/4%, 90/7% and 86/2%. Transverse diagonal of the Michaelis sacral rhomboid area in comparison to maternal height was the better predictor of dystocia and its combination with maternal height results in a better indicator for prediction of dystocia. This method could predict 86/2% of cases of dystocia and normal vaginal delivery.

One of the most common complications of cancer is subsequent psychological problems including depression, reduced vital function, and increased risk of mortality. The objective of this study was to evaluate the effectiveness of cognitive-behavioral group therapy on decreasing depression among patients with cancer in Birjand city. This research was a semi-experimental study including pre-test, post-test and control group in which the statistical society consisted of patients with cancer who referred to Imam Reza hospital in Birjand. The samples included 24 patients with cancer who were selected based on DSM-IV distinctive standard and Beck depression inventory. The case group were treated by cognitive-behavioral therapy in 12 session of 1.5 hours, and the control group received no psychiatric therapy. The data were analyzed by T-Test and covariance analysis using version 15.00 of SPSS software. After treatment, depression in the case group decreased to 8.58±7.38 which was statistically significant (P<0.001); however depression in the control group (28.33±11.87) did not change. Cognitive-behavioral group therapy plays an important role in decreasing depression in patients with cancer. Psychological intervention can help patients to change their cognition by decreasing depression and enable them to have a more positive belief in controlling themselves against dependency.

Breast cancer is the most common malignancy and the first cause of cancer deaths among women in the world. The present case-control study was designed to evaluate the risk factors among the patients in South Khorasan province, Iran. In a case control study, 85 patients with breast cancer who were diagnosed during 2006 and 2008 at imam Reza hospital (birjand) were compared with 85 healthy women referred to radiology departments of Vali Asr hospital (birjand). The two groups were matched by age, job and literacy. Risk factors and demographic information were collected through a review of medical records, face to face interview and completing a questionnaire after coordination with regional health care centers. The data were analyzed using SPSS software. Positive familial history of breast cancer, smoking and addiction, neglecting breast self-examination (lack of heath awareness) and painful milk secretion during breast feeding period increased the risk of developing breast cancer. Life style changes can be considered as one of the interventions which can prevent breast cancer development. Accordingly, regular breast self-examination can help in early detection of breast cancer in people with positive family history of breast cancer.

Alopecia areata is a common skin disease that can adversely affect the quality of life (QOL) of the patients. The aim of this study was to determine QOL in patients with Alopecia areata and to compare it with QOL in healthy individuals. This study carried out on 75 patients with Alopecia areata and 150 controls. All the patients filled out two questionnaires: Short Form 36 (SF-36) and Dermatology Life Quality index (DLQI) and the controls only filled out SF-36. Then, the obtained data were analyzed by using the statistical package for the social sciences (SPSS) software (version 15) and Chi square, analysis of variance, Tukey ranged test and Pearson's correlation coefficient test. After comparing the mean score of QOL in SF-36, it was found that the mean score of the patients in the dimensions of social functioning, emotional role and general health was lower compared to the control group (p=0.04, p=0.02, p=0.01 respectively). The mean score of the DLQI in the patients with alopecia areata was 8.48 ± 5.99. There were reverse statistically significant correlations between the scores of the different dimensions of the QOL obtained from the two questionnaires (SF-36 and DLQI). The study findings showed that the QOL in patients with alopecia areata was lower than that of controls.

Vitamin D has a basic role in bone development and metabolism. Regarding high prevalence of vitamin D deficiency in Iran, we aimed to investigate its point prevalence in Arak, Iran and determine a cut-off point for vitamin D deficiency in the region. In a cross-sectional study,420 adolescents (220 girls, 200 boys) aged 10-16 years old were selected using a multistage sampling. Plasma level of vitamin D and PTH were evaluated using radio immune assay and immuno radio metric assay, respectively. The relation between vitamin D and PTH was assessed through scatter diagram and the cut-off points for vitamin D deficiency were detected accordingly. The prevalence of vitamin D deficiency in different cut-off points, as well as, the associated factors were analyzed using SPSS 15.00. Student t-test was used to compare the girls and the boys. Considering 25(OH) vit-D level <20 ng/ml as vitamin D deficiency, 84% of the students were vitamin D deficient (99.1% of girls, 66.5% of boys) (P=0.001). Scatter diagram showed three cut-off points for vitamin D deficiency as 25(OH) vit-D level < 13, 21, 33 ng/ml. Vitamin D deficiency is more prevalent among girls than boys and increases with increased weight (P=0.05). A cut-off point of 25(OH) vit-D <13 ng/ml is recommended for detecting vitamin D deficiency in Arak, Iran.

Nasal fracture is the most common facial fracture in which, incorrect diagnosis and improper treatment leads to structural and functional deficiencies. In this study we evaluated the association between nasal fracture treatment outcome and its causes in patients presenting at Farabi hospital (ENT emergency), Mashhad, Iran. In a cross-sectional study on 100 patients with nasal fracture, the necessary information was gathered through questionnaire, clinical examination and radiography imaging. After 5-7 days following the damage, the fractures were treated with closed reduction on local anesthesia using nasal cast for 7-10 days. Appropriate X-Ray imagings were taken from all patients. SPSS software (version 18) and statistical tests including chi-square and Fisher exact tests were used for statistical analysis. The age peak incidence was 10-20 (63%) with male being dominant (5/1). Accident was the main etiology in the fractures. The common presentation was external deformity, tenderness, swelling and pain. In most cases (93%) the type of treatment was closed reduction. Nasal obstruction, nasal deviation and septal deformity resulted in dissatisfaction from the treatment in most of the cases (P = 0.01). Sport and fights-related injuries end into better treatment results. Nasal obstruction and nasal bone deformity are the most prevalent problems resulting in dissatisfaction from the treatment.

Ejaculatory duct cyst causes ejaculatory duct obstruction, azoospermia and male infertility.We report a 22 years old patient with ejaculatory duct cyst that presented with low ejaculation volume and azoospermia syndrome. Transrectal ultrasound (TRUS) and magnetic resonance image (MRI) revealed a midline prostatic cystic structure. In this case, we performed transurethral incision and/or resection of ejaculatory ducts (TURED). Spermogram of this patient 3 months after TURED showed significant increase in the ejaculation volume, the sperm count and motility.