[Evaluation of clonidine premedication on hemodynamic hyperactivity in patients candidate for ERCP [endoscopic retrograde cholangio pancreatography]]

Autonomic system changes during ERCP lead to increased blood pressure [BP] and heart rate [HR] and decrease in arterial O2 saturation [SPO2]. This study was carried out with the objective of evaluating the clonidine pre-medication effects on systolic BP, HR and SPO2 during ERCP. This randomized clinical trial study was conducted on 40 ERCP candidates. Patients were classified into two groups. The first group didn't receive any premediacation. The patients of second group were given 0.2 mg clonidine 2 hours before ERCP. BP, HR and SPO2 of all patients were recorded before, during and after ERCP. The collected data were analyzed using chi-square, t-test and repeated measures ANOVA [P<0.05]. Age, sex, systolic BP, HR and SPO2 values were identical in both groups before induction [P>0.05]. Analysis of variance of systolic BP, HR and SPO2 showed that SBP and HR changes were significantly lower in the clonidine group at different times [during and after endoscopy] [in the order P<0.004, P<0.017], but no significant difference was observed in SPO2_changes in either groups. The amount of administered sodium thiopental had no significant difference in either group. On the basis of this study, clonidine as an alpha-2 agonist can inhibit BP and HR increase during ERCP by decreasing sympathic discharge but does not decrease the need for sedative drugs

Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran

The seroprevalence of hepatitis E virus infection [HEV] in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals [2.3%]. Seroprevalence increased significantly with age from 3/255 [1.2%] in children < 10 years to 8/110 [7.3%] in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas

Combination therapy with interferon and ribavirin for chronic hepatitis C infection in beta-thalassaemia major

Treatment of chronic hepatitis C virus [HCV] infection in transfusion-dependent betathalassaemia major patients is complicated by existing hepatic siderosis and the fear of ribavirinassociated haemolysis. We evaluated the efficacy and side-effects of combination interferon-alpha [INF] and ribavirin therapy for HCV-infected thalassaemia patients. A total of 17 patients were enrolled [10 nonresponders to INF monotherapy, 7 naive to treatment, mean age 23.1 years] and they received 12 months of combination therapy. The sustained virological response rate 6 months after treatment was 58.8%. Blood transfusion requirements during treatment temporarily increased by 36.6%. Combination therapy was tolerated by, and may be useful for, HCV-infected thalassaemia major patients

[Psychological aspects in young adults with beta-thalassemia major, control group]

Beta-thalassemia major [TM], a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. In the present study, the aim was to explore the nature of psychopathology according to age, sex, school performance, severity and complications of the disease in TM patients compared with demographically matched healthy persons. A controlled anterograde cohort study was conducted at the Thalassemia Unit of Boo-Ali Hospital from June 2003 to November 2005 in Sari, Iran. Psychological aspects were evaluated by the Persian version of symptoms checklist-90-revised questionnaire. Information on relevant demographic characteristics, school performance, severity and complications of the disease was collected by one of the investigators who had created the questionnaire. 125 persons with TM completed the questionnaires and were compared with 125 controls and 250 totally. The mean age of the participants was 18.51 +/- 2.0 years and with a range of 15-25 years. 132 [52.8%] were female with equal family status, social and economic status. Patients group reported a significantly lower level of marital status [P<0.01], education level [P<0.0001], school performance [P<0.0001]. TM patients were found to have significantly more psychiatric disorders than the control subjects with GSI: 1.16 +/- 0.47 vs. 1.01 +/- 0.6; [P<0.03], PSD: 54.99 +/- 12.59 vs. 46.42 +/- 18.76 [P<0.0001], and PSDI 2.02 +/- 1.02 vs 2.45 +/- 2.22 [P<0.05]. We recorded significant changes in the mean scores of somatization [P<0.0001], interpersonal sensitivity [P<0.0001], depression [P<0.003], anxiety [P<0.05] and psychoticism [P<0.03] in the TM patients as compared to the control subjects. These findings show that beta-thalassemia major patients are at risk for psychiatric symptomatology and need appropriate psychiatric consultation

[ effect of esophagectomy and cervical esophagogastrostomy with or without of pyloromyotomy on emptying of intrathoracic stomach]

A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure. The aim of this study was to determine the emptying of the intrathoracic stomach after esophagectomy and cervical esophagogastrostomy with or without pyloromyotomy. Between January 2003 and April 2006, in a randomized controlled trial, 30 patients with esophageal carcinoma were randomized to have with or without pyloromyotomy as a gastric emptying procedure for the gastric conduit used for esophageal replacement. Patterns of gastric emptying in the vagotomized intrathoracic stomach were studied using radioisotope techniques. Gastric emptying [GE] was evaluated 8 weeks after the operation. Patients were available for 6 months follow-up. A total of 30 patients were enrolled in this study. Sixty percent [18] were male, and 40% [12] were female. Twenty three patients [76.7%] had squamous cell carcinoma and 7 [23.3%] had adenocarcinoma. Delayed GE was reported in 11 [73.3%] and normal GE in 4 [26.7%] of patients with Pyloromyotomy. Delayed GE was reported in 9 [60%] and normal GE in 6 [40%] of patients without Pyloromyotomy. There were not any significant differences between complications of post surgery in both groups. These findings were showed that esophageal surgery can be don't add a pyloric drainage procedure in esophagectomy and cervical esophagogastrostomy and that very few patients actually need it

Study of Psychiatrists' knowledge, attitude, and practice toward compulsory admission of psychiatric patients and its related laws in Iran in 2006

The aim of this study was to investigate the Iranian psychiatrist's knowledge, attitude and practice about compulsory admission and its related laws. The target group of this descriptive prospective study was the entire Iranian psychiatrists whose addresses were available in Iranian psychiatry association. Assessment was performed through a self-report questionnaire, which contained 52 evaluating questions. Questionnaires were mailed to psychiatrists and assessed after they returned the answers. We obtained responses from 116 psychiatrists. Twelve and a half percent of them had been complained against due to compulsory admission. More than 50% of them had studied literature crowing psychiatric health laws, and 12.1% of them had a poor knowledge regarding this literature. About 70% of them believed that the present law is not befitting with current needs. Majority of them reported that they hospitalize their patients involuntarily and they prefer their opinion on compulsory admission rather than other resources in most situations. These findings suggest that the present law about compulsory admission of psychiatric patients is deficient and not befitting with current needs. Furthermore, lack of education in this view is obvious and prominent

[Comparison of the adequacy of specimens provided by fine needle aspiration, fine needle non - aspiration sampling and combined technique in thyroid nodules]

Thyroid dysfunctions are one of the most important diseases in endocrinology. Fine needle aspiration [FNA] is currently the first line diagnostic tool for the evaluation of thyroid nodules. The adequacy of specimens provided by this method is also very important. FNA puncture in thyroid causes intra- parenchyma hemorrhage, which may distribute the quality of tissue specimens. Fine needle non-aspiration [FNNA], may provide better specimens without this problem. The aim of this study was to evaluate the adequacy of thyroid nodules specimens provided by fine needle aspiration and fine needle non - aspiration sampling in Imam Hospital. This descriptive study was performed on 200 patients with thyroid nodules in Imam Hospital, Sari, Iran. After a detailed clinical history, systemic examination and thyroid sonography, FNA and FNNA sampling were performed in all patients. The adequacy of specimens was evaluated by Mair scoring system in both techniques. All data, including demographic data and sonographic results and background blood, amount of cellular material, degree of cellular degeneration, degree of cellular trauma and retention of appropriate architecture were recorded. Results were analyzed by means of SPSS [11] software and Wilcoxon Signed Rank Test. The P.value less than 0.05 were considered to be significant statistically. 200 patients, 189 [94.5%] females and 11 [5.5%] males, with mean age of 43.36 +/- 12.3 years were studied. Cytological findings showed that in FNA technique, 26[13%] of specimens were unsuitable for diagnosis, 97[48.5%] were diagnostic/adequate, while 77[38.5%] were diagnostic/superior for diagnosis. In FNNA technique, 32[16%] of specimens were unsuitable, 96 [48%] were diagnostic/ adequate, while 72 [36%] were diagnostic/superior for diagnosis. In the combined application of FNA and FNNA, 9 [4.5%] of specimens were not diagnostible and 191 [95.5%] were diagnostic. Mean of total score in FNA was 5.82 +/- 2.3, while in FNNA was 5.70 +/- 2.4, with the difference was not statistically significant. Furthermore, there was no statistically significant difference between other parameters. Our study demonstrates that there is no difference between FNA and FNNA sampling, however, applying the combination of these two techniques, may improve the diagnostic quality

[Frequency of hepatitis A virus antibodies in patients with hepatitis B and hepatitis C in Iran]

Superinfection of hepatitis A in chronic hepatitis B and C may worsen the course of disease. This study attempted to study frequency of hepatitis A virus antibodies in patients with hepatitis B and hepatitis C. 115 hepatitis C and 56 hepatitis B patients who visited the Hepatitis Association of Hamedan province during 2004-2005 were enrolled. Hepatitis A virus antibodies [IgM, IgG] by ELISA, WBC, hemoglobin, platelet, AST and ALT were evaluated. 32 patients with hepatitis B and 39 patients with hepatitis C refused the study. In 71 [85.5%] patients with hepatitis B, IgG-HAV-Ab and in one patient IgM-HAV-Ab was detected. 36 [92.3%] patients with hepatitis C had IgG-anti-HAV. Due to high frequency of HAV Ab, it is preferable to evaluate patients with hepatitis B and C for HAV-Ab instead of vaccination of all patients

Measles seroepidemiology among adolescents and young adults: response to revaccination

We evaluated the seroprevalence of measles antibody and response to measles re-immunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti- measles IgM and IgG titres were assessed again 2- 4 weeks after revaccination in 144 [105 seronegative, 39 seropositive] individuals: 75 seronegative participants responded to revaccination anamnestically [P < 0.001] and developed immunity 11 also showed IgM response [probably primary vaccine failure immunity]; 38 seropositive participants, remained seroprotected without significant increase in antibody titre [P = 0.577]. Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected

Measles seroepidemiology among adolescents and young adults: Response to revaccination [SARI; 2003]

Despite a high coverage with measles vaccine, outbreaks of measles occur with an increasing proportion in older children and adults who have been vaccinated. The aim of this study was to determine the anti- measles seroepidemiology in adolescents and young adults, and the responses of subjects to revaccination. Five hundred and ninty adolescents and young adults 15 to 25 years old previously received one or two doses of measles vaccine [15-19 years old subjects; 2 doses at 9 and 15 months of age and 20-25 years old subjects; one dose after 12 months of age] with no history of physician diagnosed measles were redcruited to determine the seroprevalence of IgG measles antibody. Two to six weeks after revaccination, anti measles IgM and IgG antibodies titers were assessed by ELISA methods, to differentiate between the primary and secondary vaccine failure. The results were compared and analyzed. From 590 subjects, 263 were serologically negative or susceptible. Of 105 susceptible revaccinated subjects 75 showed anamnestic IgG and 11 of them also showed IgM responses [probably primary vaccine failure]. No significant responses were observed in 39 seroprotected subjects to revaccination except one subject. The results showed that 44.6% of vaccinated adolescents and young adults were serologically susceptible to measles. The rates of primary and secondary vaccine failure, herd immunity with 95% coverage were 4.7%, 27.1% and 83%, respectively. The study showed that vaccination- induced anti-measles antibody decline overtime especially in the absence of natural boosting. Catch-up vaccination or third dose of measles vaccination is recommended

[Comparison of polydioxanone [PDS] and polyamid [nylon] sutures complications in abdominal midline repair [laparotomy surgery]]

Despite progresss in the techniques of surgery, there is still a lot of controversy about selection of the best technique and suture material. Many post operation complications such as infection, wound dehiscence, pain and sinus formation are related to the type of the suture used. In this study we compared the complications due to the absorbent suture [PDS] with a non absorbent suture [nylon] in laparotomy operation. This clinical trial was performed on 120 patients referring to Imam Khomeini hospital, Sari, 2003-2005 for laparotomy. They were randomly divided in tow groups of equal number. The incision was repaired with PDS sutures in case and with nylon suture in control group. All patients under study were followed up for one year. Data about chronic pain,wound dehiscence, infection, hernia and sinus formation were recorded and analyzed using SPSS software and Chi- square test. In this study 120 patients [60 in case and 60 in control groups] were enrolled. After laparotomy, the incidence of chronic pain and sinus formation in case group was significantly less than the control group. There were no significant differences between the rate of infection, hernia and wound dehiscence in the two groups. No significant differences in the rate of infection, hernia and wound dehiscence between two types of suture materials were observed. However, application of PDS leads to less pain and sinus formation. Therefore, it can be a better choice in surgical incisions

[Comparison of the effectiveness of weekly and daily iron supplementation in pregnant women in rural health centers of Mazandaran province, 1383]

Iron deficiency and its related anemia is a common Iranian pregnant women problem. This study evaluated the efficacy of daily and weekly ferrous sulfate supplementation in pregnant women. 150 pregnant women enrolled into this randomized controlled field trial. They were received 50 mg elemental iron daily in control group and 100 mg elemental iron weekly in other group for 12 weeks duration. Serum ferritin and serum hemoglobin was measured at the start and immediately after 12 weeks of the study. Collected data were analyzed with SPSS10 software. After 12 weeks of Iron supplementation, no significant differences were observed in serum hemoglobin [gr/dl] and serum ferritin [g/dl] levels in daily and weekly groups [p>0.05]. Also the frequency of anemia after 12 weeks in two groups was not significantly different [p>0.05]. According to the results and tendency of pregnant women to the weekly regime and less consumption of ferrous sulfate pills in this group, weekly regime is reccomended for suplementation

Rapid reinfection by Giardia lamblia after treatment in a hyperendemic area: the case against treatment

We selected 405 children aged 1-10 years with Giardia lamblia infection but without abdominal or gastrointestinal complaints for the previous month. For 5 days, 204 received metronidazole 15 mg/kg/day and 201 received B-complex syrup. Stool samples were examined 2-3 weeks and 3 months after treatment and results were tested with chi-squared. Weight and height 6 months after treatment were compared with primary weight and height by Z-score and Student t-test. Metronidazole efficacy at 2-3 weeks was 85.3%. Three months after treatment, 60 were reinfected [34.5%] and 71 had spontaneously cleared [35.3%]. Because of high reinfection, spontaneous clearing and treatment failure rates, and the lack of effect on nutritional status or growth, we do not recommend treatment for children with asymptomatic giardia infection

[Fungal keratitis at Boo Ali Sina Hospital, Sari, Iran]

To report the prevalence of fungal keratitis as a cause of corneal ulcer in patients referred to Boo-Ali Sina Hospital in Sari and identify the predisposing factors. This prospective study was conducted on patients who presented with corneal ulcers to the ophthalmology ward at Boo-Ali Sina Hospital in Sari, 2004-2005. Using standard techniques, a corneal scraping was performed by an ophthalmologist. Material obtained from the scraping was hydroxide [KOH] with or without calcofluor white [KOH + CFW] stain for fungal keratitis. Specimens were inoculated directly onto blood agar, Sabouraud's dextrose agar, and potato dextrose agar in C-shaped streaks. A total of 22 patients were examined including 10 female [45.5%] and 12 male [54.5%] subjects. Average age was 61.5 +/- 17.7 years [range: 15-83 years]. Branching septate hyphae were identified in 7 patients [31.8%] including five male and 2 female subjects; two of these specimens fungal keratitis was 60.4 +/- 12.1 years [range: 39 to 73 years]. Three patients with fungal keratitis were farmers. The mean interval between onset of symptoms and diagnosis was 26.4 days with a keratitis. Five cases of fungal keratits had received topical antibiotics. Analyses using KOH + CFW as the golden standard revealed individual sensitivities for detection of fungi to be 71.4% and 42.9% for KOH and Gram stain, respectively. Infections of the cornea due to filamentous fungi are frequent cause of corneal damage and should always be kept in mind. Direct microscopy is an essential tool in the diagnosis of fungal keratitis. Mounts with KOH+CFW or KOH alone can be relied upon as the single most important method for rapid diagnosis of fungal corneal ulcer

[Serological levels of Zinc and Iron elements among Giardia lamblia infected children under 12 years old]

Giardiasis is one of the most prevalent human intestinal parasites, especially among children aged between 2 to 12 years old. In this study, the effects of giardiasis on serological levels of zinc and Iron elements were determined. A total of 100 children aged under 12 years who were admitted to the Pediatric departments of hospitals affiliated to Mazandaran University with gastrointestinal complain, and diagnosed as having giardiasis by stool examination [direct and formalin -ether technique and trichrome stain] in the parasitology department, were enrolled as the case group. The control group consisted of 100 age - matched healthy children. A questionaire including age, physical growth status and clinical symptoms was completed. Serological levels of Zinc and Iron were measured by atomic absorption spectrophotometer in all samples in Shilat of Mazandaran. In this study, serum Iron levels were 67 +/- 25 microg/dL and 77 +/- 23 microg/dL and Zinc levels were 64 +/- 20 microg/dL and 96 +/- 23 microg/dL in case and control group, respectively. Statistical analysis showed significant differences between the serological levels of these elements, which was much higher in serum Iron level [P<0.05]. These results revealed those serological levels of Zinc and Iron decreased during giardiasis due to malabsorption

[Relationship of neurologic signs with Schizophrenia]

Background and Objective: Schizophrenia is one of the most prevalent diseases in psychiatry. A lot of efforts have been made to find out the biologic and organic causes of this disease. One of the cases, which more attract the attention of researchers, is soft neurologic signs and their relationship with Schizophrenia. The objective of this study was to compare the prevalence of soft neurologic signs between Schizophrenia patients and their sisters and brothers, and normal group

Methods: 30 Schizophrenia patients, 30 persons of their sisters and brothers, and 30 persons of normal group were chosen and evaluated in view of soft neurologic signs. Then a total score was obtained in view of signs for each case. Finally these groups were compared with each other

Findings: The average of soft neurologic signs in Schizophrenia patients was more than in their sisters and brothers and in normal group. The average of scores of soft neurologic signs in these patients' sisters and brothers was also more than in the normal group. There was also a significant relationship between the total score of the soft neurologic signs and the family history of Schizophrenia in Schizophrenia patients [P=0.034], it means that the patients having a family history for Schizophrenia, had a higher total score than other patients in view of soft neurologic signs. There was no relationship between age, sex and the average of total score of these signs

Conclusion: This findings that neurologic signs in Schizophrenia patients were more than in the 2 other groups confirms the biologic and organic view about the etiology of Schizophrenia, these signs can be raised as a strong biologic marker of Schizophrenia. Considering the early beginning of treatment by anti-psychotic drugs, these signs can influence the outcome of this disease