فهرست مطالب

فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال هفتم شماره 2 (پیاپی 26، تابستان 1390)

  • تاریخ انتشار: 1390/04/05
  • تعداد عناوین: 8
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  • Mina Ramezani*, Sara Ghaderi, Fard, Hamid Reza Monsef, Esfahani, Sima Nasri Pages 77-82
    Introduction
    As a result of adverse side effects caused by NSAIDs and opiates, the use of these drugs has not been successful in all cases. Therefore, new analgesic drugs lacking those effects are being searched. Due to the anti- nociceptive effects of tanan and flavonoid compounds present in Geum kokanicum, we evaluated its anti-nociceptive effects by administrating a formalin test.
    Materials And Methods
    In this research NMRI male mice were used. After determining LD50 in Geum kokanicum total extract, different doses of the extract were intraperitoneally injected into the mice and then its anti-nociceptive effect was estimated by formalin test. The mice were divided into six groups: two groups of control and positive control which received morphine 10 mg/kg and the other four groups which were given the extract in doses of 0.025, 0.05, 0.1 and 0.2 gr/kg. Also TLC chromatography was done for finding the extract constituents. The data were analyzed using one-way ANOVA followed by Tukey-kramer multiple comparison test.
    Results
    The extract LD50 used for this study was determined as 1gr/kg. The findings indicate that total extracts of 0.5, 0.1 and 0.2 gr/kg doses have particular anti-nociceptive effects, as compared with the control groups. The extract of 0.2 gr/kg was found to be the most effective although the difference with positive control was not significant. Also, TlC chromatography indicated the presence of steroid and triterpenes in this plant.
    Conclusion
    The results showed that extract of Geum kokanicum can inhibit nociceptive effects in the first and second phases of pain; i.e. acute and chronic pains, respectively. In particular, the antinociceptive effect in high doses is the same as morphine, a strong analgesic substance. This effect may be due to presence of steroid and triterpenes in this plant.
    Keywords: Antinociceptive, Chromatography, Geum kokanicum, Mice
  • Fatemeh Rangraz Jeddi, Alireza Moraveji, Fatemeh Abazari* Pages 83-94
    Introduction
    Evidence-based medicine (EBM) is the right, correct and intellectual use of the best evidence for making clinical decisions about patients’ health care. According to medical studies, the use of accredited evidence in clinical treatments are affected by physicians’ attitudes, knowledge and skills. This research study intended to survey Iranian practitioners’ attitudes towards the use of evidence-based medicine as well as the existing obstacles in Iran.
    Materials And Methods
    This research was a kind of descriptive sectional study on the research league of general practitioners including the residents and specialists of Iranians hospitals in 1390. The sample size was assigned 245 individuals. The data were collected through questionnaires, inquiring demographic information and theinformation based on the research aims. The face validity and content validity of the questionnaire were confirmed by knowledgeable professionals in the field. Its reliability was estimated as α =0.8. The data were analyzed for descriptive statistics using spss16 software.
    Results
    As for the participants’ attitudes towards the use of evidencemedicine,most of the doctors (85.3%) agree that it would improve the condition of patients’ medical cares. The majority of the surveyed physicians (71.8%) agree that this approach helps with the process of decision making and 89% of theparticipants see the use of digital library effective in applying EBM. In terms of their views about the barriers involved, 59.2% realize the lack of investment as well as the lack of financial and intellectual support for doctors as one of the most important factors. Also, to 56.3% of them, the gap for acquiring new skills in using EBM accounts for the biggest barrier in its application.
    Conclusion
    Iranian practitioners have positive attitudes about EBM but the lack of financial and intellectual encouragements for the needed investment discourages them to make the best use of EBM.
    Keywords: Applying, barriers, Attitude, Evidence based medicine
  • Afsane Lalouee, Nafise Saeedi, Mojtaba Teimoori* Pages 95-99
    Introduction
    In the recent few years endometriosis has been identified as the third common gynecologic disease among the women aged 15 to 44 years old having been discharged from the hospitals. Not only does this disease cause pains, dysmenorrheal, abnormal bleeding and infertility, but also it reduces the quality of life and produces depression leading to expending much more on thetreatment. In this study we tend to evaluate the common complaints about the disease and find out about the most engaged sites through reviewing our laparoscopic findings.
    Materials And Methods
    Our descriptive cross-sectional study was conducted prospectively. The study group were selected among the patients of Najmieh Hospital from March, 1996 to March, 2006. Those patients with the chief complaints about chronic pelvic pains, dysparonia, dysmenorrheal and infertility, as diagnosed by a surgeon, underwent the laparoscopy surgery. Then, a pathologist confirmed the diagnoses through biopsy. Those patients with only clinical diagnosis or without any pathology results recorded were excluded from the study. For each one of the subjects, data on surgical and demographical findings were collected using a questionnaire that contained questions about demographical background, the chief complaints, the engaged site and the surgeon’s findings.
    Results
    The average age of the participating patients was 28.7±6.2 with a minimum of 17 and a maximum of 49 years old. The chief complaints were recorded about: 43% primary infertility, 24% chronic pelvic pains, 14% having a cyst resistant to the treatment, 8% secondary infertility, 7% dysmenorrheal, 4% recurrent abortion and vaginal hemorrhage. The incidence of endometriosis was found to be 28% in this study. The most affected sites by endometriosis were anterior and posterior choledosac in 12 and 16 cases, respectively; the right ovary and the left one in 7 and 11 cases, respectively; and the left and right tubes were respectively affected in 10 and 6 cases.
    Conclusion
    According to the findings of this study, pelvic pains are the most prevalent incident of the clinical complications related to endometriosis. So, it is recommended here that those women complaining about pelvic pains undertake laparoscopic surgery to avoid the negative consequences on their married life as well as on the quality of their social life. Also, further studies are needed to confirm the unlikelihood of the effect of endometriosis on infertility.
    Keywords: Causes, Endometriosis, Laparoscopy
  • Leila Jamshidi*, Asghar Seif, Mahdi Moradi Pages 101-110
    Introduction
    Metabolic syndrome (M.S.) is a common health problem in the world. Consisting of multiple interrelated risk factors, M.S. increases the risk of atherosclerotic cardiovascular disease by 1.5-3 times, and raises the risk for type 2 diabetes as much as 3-5 times. It affects over 26percent of adults. Patients with M.S are known to be at high risk for heart diseases. The aim of this study was to assess the prevalence of metabolic syndrome and find out about the relationship of this syndrome with coronary heart disease in patients who referred to the Heart Center of Hamedan University in 1387 (H.SH).
    Materials And Methods
    A cross sectional study has been carried out on 1064 patients. We examined all the C.H.D patients (a total of 514) as well as 550 patients without CHD disease. The patients referred to the Heart Center over a period of three months. The patients with three or more of the following symptoms (IDF criteria) were considered to have Metabolic Syndrome: abdominal obesity (waist >102 cm for men; >88 cm for women),increased triglycerides (>150 mg/dl); low HDL-C (<40 mg/dl in men; <50 mg/dl in women), elevated blood pressure >=130/>=85 mmHg, and a raised fasting glucose (>=110 mg/dl).
    Results
    We have found significant differences between M.S. and I.H.D. The prevalence of M.S. was rated at 32.5 in patients and 21.3 in the others.. Men comprised 53.7% and women 46.3% of the patients with M.S., 13.6% of who were smokers. The findings of this study indicate that the rate of Hypertriglyceridemia was equal to or over 150 mg/dl in 39.1% of the subjects.
    Conclusion
    The prevalence of M.S. in the sample of I.H.D patients was very high. Also, the correlation between M.S and other risk factors was very significant. As a matter of fact, it can be concluded that those patients with M.S. are at the high risk of being affected by cardiovascular disorders.
    Keywords: Diabetes Melitus, Dyslipidemia, Hypertension, IHD, Metabolic Syndrome, Waist circumference
  • Shima Minaee*, Fatemeh Haghparast Pages 111-116
    Introduction
    Peripheral arterial disease (PAD) is associated with an increased risk of cardiovascular morbidity and mortality. Nevertheless, many patients are asymptomatic, and this condition frequently remains undiagnosed. An ankle-brachial index (ABI) of less than 0.9 is a nonintrusive and simple index in the diagnosis of ABI. The aim of this study was to assess the relationship between Ankle- Brachial Index and mortality in the patients affected with acute coronary symptom while they were hospitalized and six months after they were dismissed from the hospital. Also, the possible relationships between ABI and the traditional cardiovascular risk factors were examined.
    Materials And Methods
    This is a prospective, cross-sectional study that was performed on 300 patients hospitalized in Farabi and Aria hospitals. The patients were diagnosed to be suffering from acute coronary syndrome (ACS). ABI was measured in all the patients and the questionnaires were filled out to evaluate the level of hospital mortality. Then all the patients’ status regarding the possibility of mortality was followed up through telephone contact six months after their dismissal from the hospital. In this study ABI < 0.9 was considered abnormal.
    Results
    The findings of this study revealed that 71% of the patients had unstable angina and 29% of them were suffering from myocardial infarction. Abnormal ABI (i.e. < 0.9) was found in 12.7% of all the patients. The rate of hospital mortality in subjects with ABI <0.9 was 18.4% which was significantly higher than that in normal subjects (2.3%) (P = 0.0001). The rate of mortality six months after hospital dismissal was estimated 10% 73.7% of whom had identified with abnormal ABI. This finding was also significantly higher than the finding concerning the dead patients with normal ABI (0.8%). In addition, a meaningful relationship was found between ABI and having a history of hyperlipidemia and high LDL cholesterol.
    Conclusion
    Thus, hospitalized patients with coronary artery disease are likely to have Concomitant PAD and ABI should be measured in all patients with Coronary disease for prognosis purposes.
    Keywords: Acute Coronary Syndrome, Ankle, Brachial Index, Mortality, Atherosclerosis, Hypertension
  • Mohammad Shaygan, Mirnaghi Moosavi, Maryam Moosavi * Pages 117-122
    Introduction
    This study intends to determine the frequency of some atherosclerosis risk factors in retinal vein occlusion patients who referred to Mashhad University of Medical Sciences (MUMS) and Mashhad Islamic Azad University Hospitals during 1386-1388 (HS).
    Materials And Methods
    This cross–sectional study was conducted on 116 patients with central, hemiretinal and branch retinal vein occlusion who referred to the university hospitals. None of the patients had hypercoagulability or a history of anticoagalnt. The participants were evaluated for factors like sex, age, weight, hypertension (HTN), hyperlipidemia (HLP), Cardiovascular diseases (CVD), diabetes mellitus (DM), and smoking.
    Results
    This study included 116 cases of retinal vein occlusion. The mean age was 57.7 years old. As for the prevalence of HTN, HLP, CVD, DM and smoking, the rates were estimated as 59.9%, 59.9%, 23.3%, 21.7% and 12.1%, respectively.
    Conclusion
    The prevalence of HTN, HLP, CVD, DM and smoking are significantly high in patients with retinal vein occlusion. Early diagnosis and management of these risk factors may decrease the prevalence of retinal vein occlusion.
    Keywords: Atherosclerosis risk factors, Branch retinal vein occlusion, Central retinal vein occlusion, Hemi retinal vein occlusion
  • Forough Ayatollahi, Hosain Mokhtari * Pages 123-128
    Introduction
    Stethoscope is one of the most frequently-used tools in hospitals that is in direct contact with many patients and can therefore be a vector in the dissemination of bacterial infections. The aim of this study is to evaluate the rate of bacterial contamination in the stethoscopes that were used in Aria Hospital in 2009.
    Materials And Methods
    This is a cross sectional study which has been done on 70 stethoscopes used in Aria hospital in 2009. The samples were taken from the stethoscopes employed by medical students (both Externs and Interns) as well as the ones used in the other sectors of the hospital. The samples were collected from the diaphragm surface of the stethoscopes with the aid of a sterile swab, inoculated into Trypton Soy Broth media and incubated for 24 hours. Next, the samples were inoculated into blood agar and MacConkey agar where they were evaluated using gram staining and biochemical assays. Tests of sensitivity to antibiotics were also carried out using Kirby- Bauer method.
    Results
    Thirty six out of a total of 70 stethoscopes (51.42%) were contaminated, 27 (38.57%) of which were identified as infected with Coagulase negative Staphylococcus (gram positive cocci). 5 (7.14%) of them were contaminated with Enterobacter (gram negative bacilli), 2 (2.85%) with Bacillus (gram positive bacilli), 1(1.42%) with E-coli (gram negative bacilli) and 1(1.42%) with Kelebciella (gram negative bacilli). The isolatesof Coagulase negative Staphylococcus showed the highest level of susceptibility to Imipenem, Cloxacillin and Vancomycin while the most effective antibiotics for gram negative bacillus were Imipenem and Ceftriaxon.
    Conclusion
    Stethoscopes presented a high rate of contamination and their use without precautions can spread nosocomial infections. As for the suggested empirical treatments, Imipenem, Cloxacillin and Vancomycin can be used.
    Keywords: Bacterial Contamination, Stethoscope, Staphylococcus, enterobacterias, Klebsiella
  • Payman Sasannezhad*, Naghmeh Zaboli Nejad, Bahare Khalesian Pages 129-132
    Introduction
    peripheral nerve sheath tumor is a rare soft tissue tumor which originates from peripheral nerves and neurofibromatosis. This tumor has two types of low and high grade. There is a poor level of prognosis in high grade tumors. MPNST may show a variety of histology; therefore, the diagnosis of MPNST is often confused with other soft tissue tumors. The low grade has good prognosis, but the nature of these tumors has never been systematically assessed. In this article we present a low grade malignant peripheral nerve sheat tumor in a 20-year old man who presented himself with occasional pain in the antero medial surface of his right thigh (10 cm. above the knee) for several months. Neuroma was clinically suspected. He undertook a surgical operation and the complete resection of tumor resulted in a complete resolution of the symptoms.
    Keywords: Low grade, Malignant prephiral nerve sheat tumor, Soft tissue