1 1728-6506 Yasuj University Of Medical Sciences 658 Special Effect of Small-dose of Ephedrine Administered Prior to Induction of Anesthesia on the Onset Time of Succinylcholine Atashkhoyi S Negargar S 1 10 2007 12 3 1 9 01 06 2015 01 06 2015 Introduction & Objective: Onset of action of relaxants is influenced by cardiac output and muscle blood flow. Ephedrine increases blood flow to muscles and may shorten the onset of action of succinylcholine. The aim of this study was to evaluate the effect of small-dose of ephedrine administered prior to rapid-sequence induction of anesthesia on the onset time of succinylcholine for endotracheal intubation. Materials & Methods: In this randomized clinical trial, 60 patients scheduled for elective gynecologic surgeries in Alzahra hospital in Tabriz 1385, were selected. In these patients ephedrine, 70 µg/kg (study group, n=30), or saline (placebo group, n=30) was administered 3 minutes before induction of anesthesia with thiopentone/fentanyl. Succinylcholine, 0.6 mg/kg, was administrated to facilitate the tracheal intubation. Onset of succinylcholine, intubating conditions and hemodynamic variables were recorded in the subjects. Results: Fasciculation was absent in 60% (36) of the patients. No significant differences were found between the onsets of fasciculation between two groups. Moreover, the difference in duration of fasciculation in two groups was not significant. Onset time of succinylcholine was significantly shorter in study group (19.53±3.91 second), compared with placebo group (25.87±7.11 second) (p<0.0001). Patients in study group were intubated in 47.07±4.51 seconds compared with 58.73±9.04 seconds in placebo group (p<0.0001). Intubation conditions were similar in both groups. Heart rate was slightly increased in study patients in the first and 3rd minutes after ephedrine administration, but there was no significant difference in systolic blood pressure values compared with the baseline value between two groups. Conclusion: The onset time of succinylcholine is shortened with small-dose of ephedrine pretreatment without significant adverse heamodynamic effects.
659 Special Comparative efficacy of Combination of Propofol or Thiopental with Remifentanil on Tracheal Intubation without Muscle Relaxants Naseri k Shami S Taibi Arasteh M Farhadifar F 1 10 2007 12 3 11 23 01 06 2015 01 06 2015 Introduction & Objective: In some medical situations administration of muscle relaxants after intravenous anesthetics for tracheal intubation may be unnecessary or sometimes could be hazardous. In such situations, replacing an alternative drug for the facilitation of tracheal intubation is obvious. Remifentanil is a short acting opioid drug which may be useful in solving this problem. The aim of this study was to compare the effects of propofol or thiopental in combination with remifentanil in the absence of muscle relaxants on larengoscopy and intubation conditions in general anesthesia. Materials & Methods: This is a randomized double-blind clinical trial which was performed in 1386 in Be’sat hospital of Sanandaj. Forty two ASA 1 and 2 patients recruited to receive propofol, 2 Mg/Kg, or thiopental, 5Mg/K. All patients received lidocaine, 1.5 Mg/Kg, and remifentanil, 2.5 µg/Kg, 30 seconds before anesthetics administration. larengoscopy and tracheal intubation were done 90 seconds after induction of anesthesia. On the basis of mask ventilation, jaw relaxation, vocal cords position and patient's response to intubations and endotracheal tube cuff inflation the intubation conditions were assessed and recorded as excellent, good ,acceptable or poor. The mean arterial pressure and heart rate were measured before and after anesthetics administration and also 45 seconds and two and five minutes after intubations. Data were analyzed by X2, fisher exact test ant student T-test using SPSS software. Results: Excellent or good larengoscopy and intubation conditions were observed in 9 (%42.9) of thiopental patients and 20 (%95.2) of propofol patients (p<0.05). Mean arterial pressure and heart rate decreased more significantly in propofol group in comparison with the thiopental group (p<0.05). Conclusion: Combination of remifentanil and propofol or thiopental could facilitate ventilation via face mask in all patients. Although combination of propofol and remifentanil is better than thiopental and remifentanil for tracheal intubation without muscle relaxants, it induces more homodynamic changes. 662 Special Differentiation of Exudates from Transudate Pleural Effusion by Measuring Cholesterol and Bilirubin Ataei B Araghy A Fasihi Dastjerdi M Farajzadegan Z 1 10 2007 12 3 25 36 01 06 2015 01 06 2015 Introduction & Objective: Differentiating exudates from transudate is the first step in examining pleural effusion. Moreover, it is a guide for determination of pathologic trend of background diseases and differential diagnosis. Although Light’s criteria are considered as standard in differentiating exudates from transudate, in some studies pleural fluid cholesterol, ratio of pleural fluid cholesterol to serum and ratio of pleural fluid bilirubin to serum have been considered. This study was performed to investigate the diagnostic efficacy of cholesterol and bilirubin of pleural fluid in differentiating exudates from transudate pleural effusion. Materials & Methods: This cross-sectional study was performed in Al-Zahra Hospital, Isfahan in 1384, where 86 cases of pleural effusion were assessed by easy and consecutive sampling method. After differentiation of patients with exudates from transudate pleural effusion, based on light’s criteria, related parameters were measured. Using ROC (Receiver Operative Characteristics) curves, area under the curve was determined following by determination of sensitivity, specificity and positive and negative predictive values. Results were analyzed by MC Nemar test. Results: From 86 studied patients, 59 cases were exudates and 27 cases were transudates. Considering the pleural cholesterol above 43 mg/dl as cut off, a sensitivity of 73.8% and specificity of 92% were obtained for the method. Decreasing the cut off level to 35.5 mg/dl, the sensitivity was increased and reached to 81.4%. Ratio of pleural fluid cholesterol to serum more than 0.3 had a sensitivity of 65%, 88% specificity and 85% efficiency for differentiation of pleural effusion while ratio of pleural fluid bilirubin to serum more than 0.6 had 76.3% sensitivity, 74.1% specificity and 75.6% efficacy. Conclusion: The criterion on 3 g/dl protein had the highest sensitivity and specificity in differentiating exudates from transudate pleural effusion and can be used as the best determinant alone. Also pleural fluid cholesterol more than 35.5 mg/dl has suitable sensitivity and specificity and the combination of pleural fluid protein and cholesterol can be used as the best practical determinant. The criterion of pleural fluid cholesterol to serum ratio more than 0.3 has low sensitivity and with reduction of this ratio to 0.14, its sensitivity increases but its specificity will decrease. 663 Special Evaluation of Immunogenicity of Divalent DNA Vaccine Encoding Brucella melitensis Omp31 and P39 Genes in Balb/c Mice Doosti A Javadi GR Sardari S Shokrgozar MA Ghassemi-Dehkordi P 1 10 2007 12 3 36 45 01 06 2015 01 06 2015 Introduction & Objective: Brucella is a facultative intracellular pathogen and one of the etiologic agents of brucellosis that can infect humans and domestic animals. Attenuated strains such as B. melitensis Rve1 and B. abortus S19 and Rb51 are being used to control brucellosis in domestic animals. However, no safe and effective vaccine is available for human use. This study was designed to evaluate the immunogenicity and the protective efficacy of a divalent fusion DNA vaccine encoding both the B. melitensis Omp31 protein and P39 protein, designated pCDNA3 recombinant vector. Materials & Methods: This experimental study was performed in Biotechnology Research Center of Islamic Azad University, Shahrekord branch in summer, 1386. Construction of pCDNA3 recombinant vector containing Omp31 and P39 genes of B. melitensis was completed. Then, 12 Balb/c mice were immunized intramuscularly with 100 mg per 50 micro liters of this DNA vaccine. Control mice, 12 Balb/c mice, were simultaneously injected with PBS. During the 1st, 7th, 15th and 30th days the mice received the injections. Afterwards, the ELISA cytokine assay was performed and data were analyzed by SPSS software. Results: Intramuscular injection of the divalent DNA vaccine elicited cellular immune responses in Balb/c mice. The ELISA cytokine assay with serum of vaccinated mice showed high level of IFN-γ and low changes of IL-4 in compare with control mice. Conclusion: Use of divalent genetic vaccine based on the Omp31 and P39 genes can elicit a strong cellular immune response against Brucellosis. 665 Special Biofilm Formation of Listeria monocytogenes on Various Surfaces Mahdavi M Jalali M Kasra kermanshahi R 1 10 2007 12 3 47 57 01 06 2015 01 06 2015 Introduction & Objective: Listeria monocytogenes is considered as a ubiquitous foodborne pathogen which can lead to serious infections, especially in newborns, elderly, pregnant, and immunocompromised people. The organism has been isolated from many foods and may cause meningitis, septicemia and abortion in pregnant women. Also L. monocytogenes forms biofilms on many food contact surface materials and medical devices. Development of biofilms on many surfaces is a potential source of contamination of foods that may lead to spoilage or transmission of foodborne pathogens. Materials & Methods: Biofilm formation of L. monocytogenes (RITCC 1293 serotype 4a) was investigated. Hydrophobicity of L. monocytogenes was measured by MATH method. Then biofilm formation of the organism was assessed at 2, 4, 8, 16 and 20 hours on stainless steel (type 304 no 2B), polyethylene and glass by drop plate method. Results: Results indicated that L. monocytogenes with 85% of hydrophobicity formed biofilm on each of three surfaces. Biofilm formation on stainless steel surfaces was significantly more than other surfaces (p<0.05). Conclusion: The ability of biofilm formation of L. monocytogenes on medical devices and food containers is very important as far as hygiene and disease outbreaks are concerned. 666 Special Perceived Severity and Susceptibility of Diabetes Complications and its Relation to Self-care Behaviors among Diabetic Patients Morowaty Sharifabad MA Rouhani Tonekaboni N 1 10 2007 12 3 59 68 01 06 2015 01 06 2015 Introduction & Objective: Diabetes is a disease with long cardiovascular, renal, eye and neural complications. It is prevalent all around the world including Iran and especially in Yazd province and its prevalence is increasing. Higher perceived severity and susceptibility of its complications may cause a higher level of self care behaviors in these patients. The aim of this study was to determine the constructs’ status and their related factors in diabetic patients. Materials & Methods: This analytical study was carried out on 120 diabetic patients referred to Yazd Diabetes Research Center which were recruited with a sampling method. A questionnaire was used for data collection which measured the perceived severity and susceptibility and self care behaviors. Subjects’ demographic variables such as age, sex, education level, job, history of diabetes duration and type of diabetes were also recorded. Results: The subjects reported 86.72, 55.72 and 62.79% of receivable scores of perceived severity, perceived susceptibility and self care score, respectively. Deteriorating eyesight was perceived at the highest level of severity and circulatory problems in the feet were at the lowest level. Deteriorating eyesight and aching legs and blurred vision was at the highest level of perceived susceptibility while high and low sugar coma was at the lowest level. Men had a higher level of perceived severity than women. There was a significant correlation between history of diabetes duration and perceived susceptibility and severity × susceptibility. Perceived susceptibility and severity, and severity × susceptibility and self care behaviors had a significant correlation with each other at 0.01 level. Perceived susceptibility and severity predicted 12.1% of variances in self care behaviors while severity × susceptibility predicted 12% of variances in self care behaviors. Conclusion: Despite the fact that perceived severity of diabetes complications among subjects was at favorable level, their perceived susceptibility was low. Diabetic foot complications are more important and in general, increasing perceived susceptibility and severity may induce an increas in self care behaviors among diabetic patients. 669 Special Comparison Efficacy of Interferential Currents and Desmopressin in Primary Enuresis Children of 5-15 Years Old Yazdanpanah P Mehrabi S Rabani M Mehrabi S Ghaffarian Shirazi HR Sadat SM 1 10 2007 12 3 69 78 01 06 2015 01 06 2015 Introduction & Objective: Nocturnal enuresis as a common disorder in children can create many problems. A variety of modalities has been used for its treatment but applying new and effective modalities can be of much interest. In this study efficacy of interferential currents (IFC), as a new modality, has been compared with nasal spray of desmopressin in treatment of primary nocturnal enuresis in 5-15 year old children. Materials & Methods: This is a prospective, randomized, clinical trial in which 39 patients received desmopressin (20µg/day) for 3 weeks and left off gradually in six months, if it was responsive. The other 36 patients received IFC therapy (5 times/week, 20 minutes each session, up to 15 sessions). Efficacy of treatment was evaluated after completion of therapeutic sessions and recurrence rate was calculated one month later. Results: About 66.7% of patients were 5-10 and 33.3% were 11-15 years old. Of all subjects, 58.7% were male and 41.3% were female. In those patients who received IFC, complete response was observed in 25%, partial response in 36.1% and 38.9% had no response while in desmopressin group, complete response was achieved in 61.5%, and partial response in 25.6% of cases and 12.8% had no response to the treatment. The recurrence rate in IFC and desmopressin groups were 16.7 % and 23.1%, respectively. In 11-15 year old children, response rate was better than those for 5-10 years old. Male patients had the most rate of recurrence. Therapeutic side effects were not observed in any of the patients in both groups. Conclusion: Desmopressin and IFC are effective and safe modalities for treatment of primary nocturnal enuresis of children with less recurrence in females. Moreover, desmopressin had better efficacy while IFC had less recurrence rate. In addition, desmopressin showed better efficacy in females. IFC can be recommended as an effective and safe modality for treatment of primary nocturnal enuresis, with less recurrence rate. 670 Special Comparison of Sleep Disorder in Myocardial Infarction Patients with Their Healthy Relatives Javan AR Mohamadi A Kharamin SHA Mohebi S 1 10 2007 12 3 79 86 01 06 2015 01 06 2015 Introduction & Objective: Cardiovascular diseases are among the most common causes of mortality and sleep disturbances are common in today society. The purpose of the present study is to determine relationship between wide spectrum of sleep disorders including dyssomnias and parasomnias and occurrence of myocardial infarction. Materials & Methods: This is a prospective case control study which was performed on 65 patients with acute myocardial infarction and 65 cases of their healthy relatives. Data were collected by Epworth sleepiness scale and analyzed with SPSS software and using chi square, t-test and variance analysis. Results: For dyssomnias, frequency of early awakening in the morning, sleep duration at night, difficulty in falling asleep, sleep disruption and restless leg syndrome in case group were significantly higher than control group. For parasomnias, frequency of sleep paralysis, nightmare and sleep walking in case group were significantly higher than control group. Conclusion: Sleep disorders are more frequent among patients with myocardial infraction and can be considered as a risk factor for this disorder. 673 Special Study of the Effect of Dexamethasone and Normal Saline in Reducing Headache after Spinal Anesthesia in Cesarean Section Tavakol K Ghaffari P Hassanzadeh A 1 10 2007 12 3 87 94 01 06 2015 01 06 2015 Introduction & Objective: Post dural puncture headache (PDPH) is a bothersome complication of spinal anesthesia specially in young parturient women after cesarean, which causes not only psychotic and somatic problems, but also increases hospital costs due to delay in patients discharge from hospital. The purpose of this study was to determine the effect of dexamethasone in improvement of complications of PDPH after spinal anesthesia in cesarean section. Materials & Methods: This is a randomised clinical trial in which 35 cases of parturient women, aged 21-44 years, who developed pain in head (PDPH), lumbar, shoulder, or more than one site due to spinal anesthesia after cesarean section in spite of consumption of NSAID drug, opoid, bed rest, rehydration. They received intravenously drip dexamethasone 0.2mg/kg (maximum 16mg) in one liter of normal saline for 2 hours. Visual analogue scale (0=no pain, 10=most unbearable pain) for patients before and after dexamethasone therapy was used and recorded. Results: The most common complaints of patients were headache (87.5%), low back pain (56.2%), shoulder and neck pain (25%). Results showed that mean of VAS pain score before tretment was 6.5±1.8 and decreased to 1.6±1.2 after treatment indicating a decrease of 77% in pain among the subjects. Conclusion: The advantage of dexamethasone therapy in comparisn with routine supportive therapy is the greater rapidity in pain relief and earlier release of patients from hospital. 675 Special Using Human Umbilical Cord Matrix Cells (HUCM) for Culturing Toxoplasma gondii for Serological and Molecular Assays Raeghi S Lateifpor M Zia-Ali N Sadighi S 1 10 2007 12 3 95 103 01 06 2015 01 06 2015 Introduction & Objective: Toxoplasma gondii is an intracellular parasite and one of the most common parasites between human and animals. Nowadays the molecular methods are being used for the diagnosis. Many molecular and drug assays have been performed on this parasite. Many serological and molecular methods are available for detection of this parasite. The aim of this study was to use human umbilical cord matrix cells for propagation of Toxoplasma gondii for serological and molecular assays. Materials & Methods: In this experimental study, performed in Kerman Medical University, RH strain of tachyzoite of Toxoplasma gondii was isolated from mice and cultured in HUMC, A549 and Hep2 media. The growth and generation conditions of cultured parasite in different times were studied. DMEM medium was used to compare the viability of parasite. The obtained data were analyzed by variance analysis using SPSS software. Results: Parasite entry to cell line was observed in the fist 48 hours of culturing in all media. In day 3-6, propagation of parasites in HUMC cell line was better than other cultures. In the late 6th day volume of cultivated parasites in virulence was acceptable. Conclusion: Use of human umbilical cord matrix cells is a suitable and inexpensive method for proliferation of Toxoplasma gondii. Using these cell lines are useful in providing live parasite for research purposes, drug assays or making laboratory kits. 677 Special Prevalence of Cryptosporidium and Risk Factors Related to Cryptosporidiosis in Hospitalized Children under 5 Years of Age Due to Diarrhea (Shahrekord- 2005) Khalili B Shahabi GH Khayeri S Sarkari B Khalili M Samadzadeh M 1 10 2007 12 3 105 115 01 06 2015 01 06 2015 ; Objective: Cryptosporidium is a cosmopolitan protozoan parasite which is recently known as one of the main causes of diarrhea in children and immunocompromised cases. Majority of studies on this parasite in the last 3 decades focusing on immunocompromised cases has been reported from developed countries and no comprehensive study has evaluated the prevalence and risk factors related to cryptosporidiosis in Iran. This study aimed at investigating the prevalence of Cryptosporidium and risk factors related to cryptosporidiosis in hospitalized children under 5 years of age due to diarrhea in Hajar Hospital, Shahrekord. Materials & Methods: This is a cross–sectional and descriptive - analytical study. One hundred and seventy one stool samples were obtained from hospitalized children under 5 years of age due to diarrhea in Hajar Hospital. They were examined by ELISA method to detect Cryptosporidium Surface Antigen (CSA). Data were collected by standard questionnaire and analyzed using statistical tests by Epiinfo2002 software. Results: Out of 171 stool samples, 8 (5%) cases were positive for CSA. The highest frequency of infection, 6 cases (6%), was seen in children under 1 year followed by 13-24 months children with 2 cases (4%). There was a statistically significant correlation between infection with Cryptosporidium and gender. The frequency of infection was statistically higher in boys than in girls (p<0.05). Also a statistically significant relationship was observed between infection with Cryptosporidium and non-breast fed children and low birth weight (p<0.05). Conclusion: These results showed that prevalence of cryptosporidiosis in hospitalized children under 5 years due to diarrhea in Shahrekord is similar to other parts of Iran and factors like being masculine, having a low birth weight and non-breast feeding are risk factors increasing the chance of cryptosporidiosis. 678 Special A Study of Factors Influencing Low Deliveries at Maternity Facility Centers in Kohgilouyeh and Boyerahmad Province in 2007 Karimi A Chaman R Pourmahmoudi A 1 10 2007 12 3 117 125 01 06 2015 01 06 2015 Introduction & Objective: The Ministry of Health and Medical Education of Iran established maternity facilities in order to provide a safe delivery and reduce deliveries at home in rural areas. However, a few of deliveries in Kohgilouyeh and Boyerahmad province took place in these centers. Therefore, the aim of this study was to determine the delivery status and factors influencing the pregnant women’s tendency to choose the place of delivery. Materials & Methods: This descriptive study was carried out on 747 participants in the rural areas that were covered by maternity facilities in the first three months of 1384. Data were collected by a self-structured questionnaire whose validity and reliability had been determined previously. Data of age, education level, parietal status, antenatal cares, decision-maker for the place of delivery, geographical access to maternity facility centers and the cause of avoidance of referring to the centers were determined asking the women. Data were analyzed by SPSS software and using X2 statistical test. Results: The results showed that overall 31% (230 cases) of deliveries took place at home and 51% (384 cases) at hospital, but only 18% (133 cases) of deliveries took place at maternity facility centers. There was a significant difference in antenatal education by midwives between women who delivered at home and those that delivered at maternity facility centers, showing that more educated women have managed to deliver at the maternity facility centers (p < 0.001). 58% of mothers had selected their delivery place by themselves, but in others the delivery place was selected by their mothers, mothers-in-law, their husbands, etc. Almost 79% (181cases) of mothers who delivered at home announced that geographical access (long distance) to the maternity facility was major problem. In addition, there was a significant association between literacy, living place and the number of previous pregnancies with selection of delivery place (p< 0.005). Conclusion: Findings showed that the most important cause of avoidance of referring to maternity facility centers, from women’s point view, was geographical access to maternity facility centers as well as antenatal education by midwives. 680 Special Human Cystic Echinococcosis in Yasuj: A Survey of Ten Year Hospital Records Sarkari B Naghmachi M Azimi S Vaezi M Ebrahimi S 1 10 2007 12 3 127 134 01 06 2015 01 06 2015 Introduction & Objective: Cystic echinococcosis (CE) is a zoonotic infection of humans and domestic animals caused by larvae of the cestode Echinococcus granulosus. Echinococcosis has a world-wide geographic distribution and occurs in all continents. CE is one of the most important zoonotic diseases prevalent in different parts of Iran and human cases are repeatedly reported from medical centers in different regions of Iran. This study was conducted to survey the hospital records of hydatidosis between 1996 and 2006 in Yasuj, southwest of Iran. Materials & Methods: Hospital records of CE patients from 1996-2006 in three hospitals in Yasuj were carefully studied. Data such as age, sex, occupation, place of residence, number of cyst, cyst location, clinical signs and other related features were recorded in a predestined information sheet. Collected data were statistically analyzed. Results: Results of this study showed that during 1996 to 2006 (10 years) 105 cases of hydatidosis have been admitted in Yasuj hospitals, out of which 70 cases (66.7%) were women and 35 cases (33.3%) were men. Considering the age of patients, the highest rate of infection was recorded in 31-40 year old patients. Female housekeepers with 66.7% of cases were found to be the main victims of the disease. Hepatic cyst was recorded in 81% of cases where nephrotic cyst was the second most prevalent one. Most of the patients (87.8%) had only one cyst, though 11.4% of the patients had 2 cysts and in one case 18 cysts have been isolated from the patient. Recurrence of the disease, based of number of patient's operation, was noted in 14.3% of cases and in one case five times of surgery for removing of hydatid cyst were noted. Conclusion: Results of this study indicate that CE is an endemic disease in the studied area. Data also suggest that the trend and number of CE cases remained unchanged during the 10 years in this area. Therefore, effective steps should be taken to control the disease in this hydatid cyst endemic district.