Journal of Arak University of Medical Sciences

A Study of Effect of Metimazole-Levothyroxine Combined Therapy Compared With Metimazole Alone in Prolonged Remission of Graves Disesase

Ali Fani

Introduction: Graves disease is the most prevalent form of thyroxicosis (60-80%), which is caused by an autoimmune reaction. Treating with antithyroid drugs usually lead to prolonged remission in 30%-40% of cases. Paradoxically it is assumed that adding thyroid hormones to the therapy would give more bebefits because of preventing the feedback of TSh to further stimulate the thyroid gland after using antithyroid drug. In this study we compared the effect of adding levothyroxine to the routine therapy in reducing the relapse of thyrotoxicosis.
Material and Method: This was a clinical-trial study in which we compared the two regimens of metimazole plus levothrixine (regimen A), with metimazole alone(regima B), in reducing the graves diseases relapses.
Results: In this 7 years study, 262 patients finished the trial. 137 were assign as group A and 125 cases were assigned to group B. randomely. Graves was most prevalent in 3^rd to 5^th decades. 52.3% of disease had grade II Goiter. The rate of relapse was 36.4% in group A and 61.6% in group B. during 3 years after discontinuation of therapy.
Conclusion: The peak age of prevalence was found out to be lower than eastern reports (3-5 in comparison to 5-6 decades). Clinical manifestations was not significantly different from other studies. The two regimen results were compared by Or method and calculating Or, in grade I goiter was 0.27 and in grade II was 0.29, grade III was 0.32, which has a meaningful difference and implies regimen A is effective in reducing the prolonged rate of relapse but in garde Iv goiter, there is not significant difference in relapsing in two group.

Genetic Polymorphism GSTMI by PCR and Susceptibility to Stomach Cancer

Mandana Yadollahi

Introduction: Glutatathion s-transferases (GST) are enzyme encoded by a multigene family and have important roles in detoxification of some strong carcinogens. Human GSTs are categorized into four groups. Namely π، μ، α، θ GSTM! Is a member of GST m previous studies revealed that absence of GSTM1 protein associates with increased risk of development of several malignancies.
Material and Method: In the current study, the relationship between GSTM1 genetic polymorphism and the susceptibility for being involved by gastric carcinoma was explored. Forthy patients with gastric carcinoma and 80 normal individuals (control group) were studied. GSTM1 genetic polymorphism between exons 5 and 6 was explored using a PCR technique. For each patient a questionair including gender, age, cigarette smoking, habit, and history of neoplasia in first-degree relatives was completed.
Results: The relative frequencies of null genotype in the control group and gastric cancer were 31.25 and 60% respectively. There was a statistically significant (x2=9.21; p<0.05) assessment between GSTM! Null genotype and development of gastric carcinoma.
Conclusion: Not mentioning the GSTM1 genotype, cigarette smoking and a positive family history had significant correlations with development of stomach malignancy.

Diagnostic Value of Reticulocyte Count Test in Dissociation of Iron Deficiency Anemia and Minor B Thalassemia

Kamran Moshfeghi

Introduction: Iron deficiency anemia is the most common type of anemia in the world and the most important disease which has overlapping diagnosis with it is & thalassemia minor. For diagnosis of theses two diseases, serum ferritin measurement and hemoglobin laboratories throughout the country now, finding some tests which are easier. More available and cheaper for different of these two mentioned diseases, are useful. Therefore in this article, reticulocyte counting test, after a short period of iron consumption, was evaluated.
Material and Method: This study is descriptive and cross-sectional. The sample population consists of 69 patient with hypochromic microcytic anemia which serum ferritin measurement, reticulocyte counting and hemoglobin electrophoresis for each of there were done. After 7 days treatment with oral iron tablet, reticulocyte counting test for each of them was done. If reticulocyte counting test had increased, the patient was considered as iron deficiency anemia, on the other hand, the results of reticulocyte count test was compared with serum ferritin test and hemoglobin electrophoresis results and then, sensitivity as well as specificity of mentioned test, were analysised.
Results: Sensitivity and specificity of mentioned test for iron deficiency anemia were 82 and 67 percent and in B thalassemia minor were 64 and 78 percent, respectively. These results show high sensitivity of this test for iron deficiency anemia and high specificity for B thalassemia minor.
Conclusion: It seems that, in circumstance which serum ferritin measurement and hemoglobin electrophoresis aren’t available, applying reticulocyte count test for deferenciation of these two diseases, is helpful.

The Prevalence of Giardia Infection in Student In Arak, of Iran 1999

Safar Ali Talari

Introduction: Giardiasis is one of the intestinal parasite infection in various regions in Iran. Giardia can lead to different personal and social problems and due to the broad spectrum of its clinical manifestation, this study was performed in order to define the prevalence of giardiasis in 6 to 14 years old student of Arak in 1999.
Materials and Methods: A cross sectional descriptive study was performed in 948 students aged 6 to 14 years old to school by random sampling. Three stool specimens were collected from each student at three days intervals. Using formalin ether method, the specimens were examined by a parasitologist. Demographic characterisitics and clinical manifestations of the affected individuals were evaluated and recorded in the questionaires. Then the results were statistically analyzed.
Results: 948 students were enrolled into this study. 145 of them (15.3%) were infestated with giardiasis. Infestation was most commonly observed in the primary students 27.6% and 79% of the affected individuals were symptomatic and the remainder were asymptomatic. The most common clinical manifestation was abdominal pain (64.7%) and the least common was vomiting and diarrhea (4.2%).
Conclusion: Considering the relatively high prevalence of this infestation, further research to find out the predisposing factors recommended.

A Prospective Clinical Study for Evaluation of Three Methods (Acupressure, Interavenous Metoclopramide and Placebo) for Prevention of Post Operative Nausea and Vomitinga Prospective Clinical Study for Evaluation of Three Methods (Acupressure, Interavenous Metoclopramide and Placebo) for Prevention of Post Operative Nausea and Vomiting

Alireza Susanabadi

Introduction: Nausea and vomiting is a common manifestation in anatomic as and Functional disorders, and these are current complications after general anesthesia and are unpleasant and with secondary complications. Nausea and vomiting are the most common complications after general abesthesia.
Materials and Methods: In this study we compared three methods which one of them is acupressure (non invasive and non medical and is one of subtype of acupuncture) with other methods consisting of IV metoclopramide and placebo. This controlled study was done in teaching Vali-Asr hospital. Total number of patients was 420, type of sampling was random. Type of operation was laparotomy and all of them had general anesthesia. We divided them in three equal groups (acupressure group, metoclopramide group, and placebo group). In this study we used from history and examination and we finished puzzles and we use from statistician.
Results: we concluded that there is no valuable difference between metoclopramide and acupressure group ( with considering odds-Ratio and 0.6). we resulted that with using from acupressure and IV metoclopramide there will be lesser nausea and vomiting when comparing these two groups with placebo.
Conclusion: We compared these data we find that acupressure is a suggestive and valuable method and also noninvasive and inexpensive and also effective method in preventing post operative nausea and vomiting.

Assessment of Clinical Signs, Laboratory Findings and Predisposing Factors in Diabetic Ketoacidosis Patients in Arak Vali Asr Hospital

Mohamad Reza Rezvanfar

Introduction: Diabetic ketoacidosis is an acute complication of insulin dependent diabetes mellitus with high mortality rate. The aim of present study was evaluation of clinical signs, laboratory findings and predisposing factors of DKA in Arak Vali-asr hospital.
Materials and Methods: This investigation is a descriptive, cross-sectional study during 2 years on 30 patients with DKA with passion sampling method.
Results: Twenty percent of patients were male and eighty percent were female. Majority of patients were on insulin (83.3%) but DKA was first presenting sign of diabetes in 16.6% of patients. Most common signs were fatigue and weakness (100%) and then gastrointestinal and pulmonary signs (96.6%) and decreased level of consciousness in 60%. Hyperkalemia was seen in 20% and hypokalemia only in 30.3%.
Conclusion: Trying for patient education and giving a wareness about primary and common sign of DKA will have an important role in decreasing mortality. Nobody had hypernatremia and only one patient had hyponatremia and only on one patient had hyponatremia.

Survey Effect of Rhythmic Breathing on the Intensity of Pain in the Post Orthopedic Surgery Patients

Reza Borzou

Introduction: Rhythmic breathing is a method which distracts the acute pains. But there is not any research effect of rhythmic breathing on the intensity of pain in the post orthopedic surgery in our study which is a semi-experimental clinical trial study, we found the effect of rhythmic breathing on the intensity of pain and also the amount of analgesis taken by the post orthopedic surgery patients.
Materials and Methods: In this study 68 orthopedic surgery patients were randomely divided in the two experimental (34) and control (34) groups. Both groups were studied in the first 24 hours after the surgery. The intensity of pain in patients were measured according to the visual analogue intensity pain scale (VAS) which is a 10 of parts scale amount of analgesic taken by the patients.
Results: Statistical analysis of our findings shows that there is a significant difference between two experimental and control groups (p<0.001) this means that experimental group has taken less analgesic in comparison to the control group (p<0.001).
Conclusion: As the result according to our information rhythmic breathing can reduce the intensity of pain and also the amount of analgesic taken by the post orthopedic surgery patients.

Survey of Knowledge, Attitude and Practice of Nursing Staff About Nosocomial Infection Control in Bushehr

Maryam Farokhifar

Introduction: Nosocomial infection is responsible of over 20.000 mortality in year and about 60% admission in hospital cause nosocomial infection. Thus it is necessary to evaluate attitude, knowledge and practice of nursing staff about prevention of it.
Materials and Methods: In this study, 100 nursing staff of teaching hospitals in Bushehr were selected in a multistaging random sampling. A questionnaire used for determination of attitude, knowledge subjects and practice was assessed by check list which reliability and validity of it assessed by pilot study. The questioner had 15 questions of attitude based on likret scale. In data analysis of attitude scores aet in rang of 15-75, the high scores indicate positive attitude and the lowest scores indicate negative attitude. The results divided in to three group: negative, positive and no idea and showed that most staff had positive attitude(85.5%) about infection control. In analysis of knowledge and practice scores, score 100 consider the highest level and below 50 no acceptance.
Results: Showed that 44% nursing staff had optimal knowledge related to nosocomial infection and most of them practice poor inprocedures such as change dressing (84%), tracheal suctioning (81%), bladder catheterization (83%) and change venous site (78%. There was seen statistical relationship between knowledge and academic degree, position, and years in practice. The last variable had negative relationship (p<0.01, r=-0.276). In addition there was seen relationship between practice and experience in critical care unit, family history of infection disease and participation in teaching session (p<0.01)
Conclusion: This study results showed poor knowledge and practice of nursing staff nosocomial infection control in study society and must be attention to it in this group and similar societies.