Journal of Babol University of Medical Sciences

COMPARISON OF MUSCLE ENERGY TECHNIQUES WITH ULTRASOUND THERAPY IN MYOFASCIAL TRIGGER POINT TREATMENT IN UPPER TRAPEZIUS

F Ghiasi,

BACKGROUND AND OBJECTIVE: Various treatments of electrotherapy and manual therapy were suggested for management of trigger points, but there were not randomized controlled trials to compare these two methods. The purpose of this study was to compare the treatment effect of muscle energy technique and ultrasound therapy on myofascial trigger points in upper trapezius.
METHODS: In this randomized controlled trial 45 patients with trigger points in upper trapezius were randomly assigned to one of three groups: ultrasound group (N=15), muscle energy group (N=15) and control group (N=15). In ultrasound group, frequency of ultrasound 1 MHz, continuous mode, intensity 1.5 W/cm² and duration 4.5 min was selected. In muscle energy group, Jandas approach (post-isometric relaxation with stretching) was used, and control group did not receive any treatment. A 10 session treatment program which lasted 2 weeks was performed for interventional groups, and follow-up was done 3 months after treatment. Outcome was based on self–reported pain (neck disability index (0-50 scores) and shoulder pain and disability questionnaire (0-130 scores)) (ordinal), range of motion (degrees) and muscles strength (kg) were measured immediately before, after and three months after intervention. Data were analyzed using one-way ANOVA and repeated measurement tests.
FINDINGS: Neck disability index scale was decreased from 19.1±7.3 to 7.8±4.6 (ordinal) in ultrasound group (p<0.05), and from 17.2±8.4 to 6.8±3.2 (ordinal) in muscle energy group (p<0.05), and in control group neck disability index scale was decreased from 21.2±5.1 to 20.4±5.5 (ordinal) that was not seen significant decrease. Results of follow-up showed that significant difference was not seen in score of neck and disability index in ultrasound group, but shoulder disability score was increased in ultrasound group after three months of treatment.
CONCLUSION: The results of this study support the effectiveness of ultrasound and muscle energy technique to reduce disability and pain in the short term in patients with myofascial trigger points. However, muscle energy therapy had more long benefit effect than ultrasound therapy therefore this method for treatment of trigger point was suggested.

EFFECT OF HONEY FROM NORTH OF IRAN ON CANDIDA ALBICANS

S Mahdavi Omran,

BACKGROUND AND OBJECTIVE: According to the increasing resistance of Candida species to anticandidal drugs in some patients, several researches were led to find out new antifungal agents from natural sources. The aim of this study was to evaluate the anticandidal activity of honey experimentally.
METHODS: In the present study, physical, biochemical and microbial characterization of four types of honey from North of Iran were determined. Different dilution (15-75%) of honey, amphotericin B (0.008-16µg/ml) and fluconazole (0.06-128µg/ml) were used on two species of candida albicans and one species of candida dubliniensis. Micro plates were incubated at 25 °C and 37°C for 48 hours with shaking (150 rpm). 10µl of transparent wells were plated onto sabouraud dextrose agar plates and calculated minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). The anti-candida activity of honey and drugs were analyzed by using t-Student, Mann-Whitney and ANOVA tests.
FINDINGS: It was not grown any organisms on honey cultures. Different dilution of honey in 20-25% and 15-30% can inhibit candidal growth at 25 °C and 37 °C (MIC50). MFC for honey at 25 °C and 37 °C were 40-70% and 45-70%, respectively. The differences between anticandidal effects of honey were not statistically significant. Candidal growth was inhibited (50%) by amphotericin B in 0.03-0.125µg/ml and 0.03-0.06µg/ml at 25 °C and 37 °C, respectively. MFC for this drug and temperature above mentioned were 0.5 and 0.125 µg/mg, respectively. MIC for fluconazole at 25 °C and 37 °C were 2-4 µg/ml and 0.25-0.5 µg/ml, respectively fluconazole inhibited candida growth, totally (MFC) at 25 °C and 37 °C in 32-64 µg/ml and 16-32µg/ml, respectively.
CONCLUSION: With regard to the anticandidal effects on honey, specially unheated old honey on candida dubliniensis at 37 °C, so honey could be considered as antifungal component in the treatment of experimental infections.

KI67 AND P53 PROTEINS IN ODONTOGENIC KERATOCYST

S Seifi

BACKGROUND AND OBJECTIVE: Ki67 is proliferation marker in proliferative cells and P53 is a tumor suppressor gene. Meanwhile the cause of high recurrence of keratocyst is unknown. The purpose of this study was to evaluate immunostaining reaction of Ki67 (proliferation marker) and P53 (tumor suppressor gene) in different and all layers of odontogenic keratocyst (OKC).
METHODS: This descriptive study was performed on 20 paraffinized blocks. From parafinized blocks, 3-µm section was cutted and then IHC was done for Ki67, P53 markers with anti Ki67 antibody and anti P53 antibody. Nucleus of epithelial cells was immunostained in different layers of OKC in 1000 epithelial cells, in 10 HPF (high power field) were counted and compared to each other.
FINDINGS: Immunostained nucleus of epithelial cells with Ki67 in basal, intermediate and surface layers and all lining epithelium of OKC were 14.3±4.4%, 41.4±12.8%, 0, 18.5±6.1%, respectively. Mean of nucleus immunoreactive epithelial cells with P53 in basal, intermediate, surface layers and all lining epithelium of OKC were 11.7±3.2%, 23.9±7.6%, 0, 11.8±3.6%, respectively. Mean of immunostained nucleus of epithelial cells with Ki67 and P53 markers was statistically significant in different layers of epithelium of OKC (p<0.0001). There was a significant relationship between mean of nucleus immunoreactive epithelial cells with Ki67 and P53 in intermediate layer of OKC.
CONCLUSION: According to the results, high immunoreactivity with Ki67 and P53 markers in intermediate layers compared to basal, surface and in all lining epithelium of OKC showed exclusion of epithelial cells from normal cell cycle and tendency to recurrence and aggressive behavior in OKC. Also, high expression of Ki67 and P53 in intermediate layers could be used to differentiate aggressive of odontogenic cysts from other odontogenic cysts.

EFFECT OF LEAD APRONS ON DECREASING THE DOSE REICEIVED BY PERSONNEL IN NUCLEAR MEDICINE DEPARTMENTS

K Ghazi Khanlou Sani,

BACKGROUND AND OBJECTIVE: In the nuclear medicine departments, personnel exposure to radiation is inevitable during patient positioning and radiotracer preparation. There is controversy regarding usage of usual lead aprons with respect to penetrating gamma rays used in nuclear medicine departments as well as production of characteristic lead x-ray from aprons .This study was performed to evaluate the effect of 0.5 mm lead apron on dose reduction during patient positioning and radiotracer preparation.
METHODS: In this experimental study, three point sources of usual radioisotopes used in nuclear medicine departments (^99mTc, ²⁰¹Tl and ¹³¹I) were used. The sources were in liquid form and low volumes. The sources once were fixed in air (imagery of working in hot lab) and then in water filled skull phantom (imagery of patients positioning). Single head LFOV gamma camera (GE- SMV, DSX) was used for counting purposes. As the source was fixed at certain distance, count rating was done by gamma camera with and without a lead apron with thickness of 0.5 mmPb.
FINDINGS: The measurement showed that count rates were reduced about 83.2%, 83.7% and 53.7% for 99mTc, 201Tl and 131I, respectively. Evaluation of the area of K-edge, X-rays show reduction in count rating of all sources in this area even with lead apron.
CONCLUSION: This study showed that 0.5 mm lead aprons significantly decrease count rate. Also this effect is significant for low energy radioisotopes.

EFFECT OF LAUGHTER THERAPY ON BLOOD PRESSURE PATIENTS WITH ESSENTIAL HYPERTENSION

SF Jalali,

BACKGROUND AND OBJECTIVE: Using humor to decrease stress, diminish pain and improve quality of life has recently become a popular topic. Job and life stress were effective factor on incidence, stability and severity of hypertension in some patients so it was decided to survey the effect of laugh in these patients. The aim of this study was to determine the effect of laughter therapy on patients with essential hypertension.
METHODS: This semi-experimental study was performed on 40 patients with essential hypertension. Clinical and paraclinical evaluation was performed to exclude the secondary cause of hypertension. Patients participated in laughter clinic once a week for 2 months in Shahid Beheshti hospital. The time of these classes was 1-1.5 hours. In this clinic we tried to laugh patients with use of famous comedy films and a few inspectors attended in the meetings for supervision of virtue in performance and active cooperation of patients. Systolic and diastolic blood pressure was evaluated by mercury manometer (ALPK2) before and after every session and 24-hour blood pressure holter monitoring performed before and after study for patients that participated in all classes. Finally 35 patients participated in all sessions. Patients have been recommended for repeat of humor during week in family.
FINDINGS: The mean age of patients was 55.1±10.7 years. Mean (±SD) systolic (142.9±24.1 vs. 131.1±19.8 mm/hg) and diastolic (88.4±12 vs. 81.6±10 mm/hg) blood pressure decreased significantly after every session of laughter clinic (p<0.05). Also, 24 hour holter monitoring showed significant decrease in systolic (151.9±16.3 vs. 137.1±14.2 mm/hg) and diastolic (86.7±11 vs. 79.7±9.5 mm/hg) blood pressure (p<0.05).
CONCLUSION: The results showed that laughter and sense of humor is effective in short and long term (more than 2 months) effect on decreasing the blood pressure and can be used as a concomitant treatment of essential hypertension.

POSTPARTUM STRESS URINARY INCONTINENCE AND SOME RELATED FACTORS

Z Basirat,

BACKGROUND AND OBJECTIVE: Stress urinary incontinence (SUI) has many medical-psychosocial effects on womens life and in approximately 40% of patients it is a major problem in daily life. It has been reported that the prevalence after delivery was about 6-29% in different studies. The aim of this study was to find the prevalence of SUI after delivery and some related factors.
METHODS: This cross-sectional study was performed on 450 women delivered in Babol who referred two months after delivery to therapeutic and health centers of Babol, Iran. A questionnaire about some personal, social and reproductive variables and some questions about SUI were filled out. Then, they were visited and examined by the gynecologist to determine the volume and severity of SUI. Then data were analyzed by t-test and Fishers exact test.
FINDINGS: The results showed that 81(18%) women had SUI after delivery. Women with SUI were significantly older than women without it (p=0.0001). Numbers of delivery in women with incontinence were more than women without it. SUI was lower in women who had episiotomy (p=0.005). There was no significant difference between methods of delivery to achieve SUI. There were no significant differences between two groups in birth weight, head circumference, women body mass index (BMI).
CONCLUSION: The results showed that age and numbers of delivery were determinant factors for developing SUI, but womens BMI, birth weight and head circumstance of neonate and method of delivery had no effect on SUI.

CORRELATION OF HEARING IMPAIRMENT WITH DESFERAL AND SERUM FERRITIN LEVEL IN β THALASSEMIA MAJOR PATIENTS

K Kiakojouri,

BACKGROUND AND OBJECTIVE: In β thalassemia major that begins in the first year of life, iron deposition after blood transfusion is undesired event that must be removed with iron chelators such as desferal. On the other hand, it is not collected information about the hearing impairment in the patients who received desferal therapy The aim of this study was to assess the presence and absence of hearing impairment in β thalassemia major patients and its correlation with desferal and ferritin level.
METHODS: This analytical study was performed on 100 thalassemic patients in Amirkola thalassemic center. Fifty patients had received regular desferal therapy (case group) and fifty patients had received irregular desferal therapy (control group). Age, sex, ferritin level, route of desferal therapy and educational level had been recorded for both groups. They have been evaluated for auditory quality with tympanometer and audiometer.
FINDINGS: In the case group four patients (8%) and in control group eight patients (16%) had conductive hearing loss. It was not meaningful difference. Also in the two groups there were no meaningful correlation between ferritin level and hearing loss. Tympanometry had shown some disturbance in both groups seven patients (14%) and fifteen patients (30%) in case and control groups, respectively (p=0.029).
CONCLUSION: The results of this study showed that adequate regular desferal therapy in β thalassemia major patients is not associated with hearing impairment.

EVALUATION OF NEAR BINOCULAR VISION IN SYMPTOMATIC AND ASSYMPTOMATIC MICROSCOPISTS

H Momeni Moghaddam,

BACKGROUND AND OBJECTIVE: According to high prevalence of near binocular vision anomalies in people who have long term near work and necessity to treatment of these anomalies for increasing of efficiency, the purpose of this study was to evaluate near binocular vision in symptomatic and asymptomatic microscopists.
METHODS: In this cross-sectional study, 50 subjects of microscopists of Zahedan Medical University participated. These subjects divided into symptomatic and asymptomatic groups according to presence or absence of binocular vision problems. After determination of refractive errors with retinoscopy, if subject had inclusion criteria, referred to optometry department. Near point of convergence, positive and negative fusional vergence, near heterophoria and accommodation convergence/accommodation (AC/A) ratio were determined by use of millimeter ruler, prism bar, alternate prism cover test and gradient method, respectively. Stereopsis was measured by using TNO. The data was analyzed using independent sample t test.
FINDINGS: In this study near point of convergence, near heterophoria, positive and negative fusional vergence and stereopsis had significant difference between symptomatic and asymptomatic groups (p<0.05) but there was not statistically significant difference between symptoms and AC/A ratio.
CONCLUSION: In this study maximum difference between symptomatic and asymptomatic groups was related to positive fusional convergence and minimum difference was related to AC/A ratio. Hence, near point of convergence, positive and negative fusional vergence, near heterophoria and stereopsis are good indicators for binocular vision evaluation but AC/A ratio is not.

COMPARISON OF RESULTS AND COMPLICATIONS OF EXTERNAL DACRYOCYSTORHINOSTOMY WITH AND WITHOUT SILICONE TUBE

S.M.H. Emad

BACKGROUND AND OBJECTIVE: Nasolacrimal duct obstruction is treated with different methods of surgery. The purpose of this study was to compare the external dacryocystorhinostomy (EX-DCR) procedure with and without silicone intubation and complications caused by these two procedures.
METHODS: This study was performed on patients who underwent external DCR with or without silicone tube in Shahid Beheshti hospital of Babol, Iran during 1997-2006. Age, sex, duration of follow-up, probable cause of obstruction, and complications during and after operation were assessed. The success in operation with the decrease in epiphora and purulent discharge was evaluated.
FINDINGS: Of 300 patients, 220 patients (73.3%) were female and 80(26.7%) were male. The age of patients was 44.5±22 years. The most common complaints of patients were epiphora in 165(55%) and the most common factor was acute and chronic dacryocystitis in 135(45%). Regarding DCR method, success rate was 95.3% with silicone intubation and 88.7% without silicone intubation (p=0.054). The most frequent complication of DCR was recurrence of epiphora (8%) and unusual scar (2.7%). No major complication occurred during operation.
CONCLUSION: EX-DCR is a relatively easy technique with a success rate of more than 90% with few complications. This procedure is recommended to use in most ophthalmic centers.

PREVALENCE OF ENTAMOEBA HISTOLYTICA IN CHILDREN WITH DYSENTERY (AMIRKOLA CHILDREN HOSPITAL, BABOL, IRAN 2005-2006)

R Savadkoohi,

BACKGROUND AND OBJECTIVE: Dysentery has many adverse effects for the pediatric age group, their families and society. So microorganism detection in dysentery can affect on treatment process. The goal of this study was to determine the frequency of entamoeba histolytica trophozoite in children who were admitted because of bloody diarrhea to Amirkola children hospital.
METHODS: This cross sectional study was carried out on 537 toxic children less than 12 years suffering from dysentery and admitted to Amirkola children hospital from year 2005 to 2006. The fresh fecal samples (about 1-5 gr) was sent to lab as soon as possible and evaluated for amoebic trophozoite by logule staining. The frequency of amoebic was compared between sex, different seasons and place of habitance.
FINDINGS: In these 537 toxic children sexual differentiation was as 219(40.8%) girls and 318(59.2%) boys. Mean age of total children was 2±2.5 years. Dysentery was more common in autumn and summer. From total children, 32 children (6%) had ameobic dysentery, that 19 case (6%) were boys and 13 case (5.9%) were girls. Also 15 children (2.8%) were from city and 17(3.2%) were from rural areas. There was not meaningful relation between these variables and prevalence of amoebic dysentery, but seasonal prevalence was more common in autumn (p=0.001).
CONCLUSION: According to this study and low prevalence of amoebic dysentery, more consideration of non amoebic causes for dysentery is recommended.

QUANTITATIVE AND QUALITATIVE CHARACTERISTICS OF RURAL SOLID WASTES (BABOL, IRAN 2007)

AA Amouei,

BACKGROUND AND OBJECTIVE: Nowadays, one of the basic problems in rural areas of Iran is scattering and dumping of solid wastes. It is necessary to identify the quantitative and qualitative characteristics of solid waste before making any decision about solid waste management in rural areas. As any designation about anything is based on correct information, this study was performed to study the rate of per capita generation, density and physical composition of rural residues in Babol, Iran.
METHODS: This cross-sectional descriptive study was performed in selected rural areas of Babol in 2007. In order to measure the per capita generation rate of solid waste (gram per day per person) in selected villages, the rate of these materials was determined in 3 consecutive days of a week in the middle of month in the middle of any season. For determining density of solid waste and waste analysis, samples were mixed completely and provided in triplicate. Any sample was been transferred to a 0.25 cubic meter plastic container and its different components were measured.
FINDINGS: Maximum per capita solid waste generation rate was in the fall (786±77 gram per day) and minimum rate was in spring (387±21 gram per day). Mean per capita generation rate was 551±116 gram per day. Mean density of rural residues was 419±32 kg/m3. Mean percent of degradable materials, plastics and rubber, wood and paper, metal, glass, textile and others was 58.8, 11.9, 10.6, 6.3, 4.4, 2.4, and 5.7, respectively.
CONCLUSION: Considering composition of degradable materials, composting is a suitable method for removal of rural solid wastes in Mazandaran province. According to noticeable amount of recyclable materials (plastics, paper, metal and glass), segregation and recovery programs of solid wastes should be considered in rural areas of Mazandaran.

A CASE REPORT OF MIDDLE LOBE SYNDROME DUE TO HYDATID CYST

SR Modarres,

BACKGROUND AND OBJECTIVE: The term middle lobe syndrome identified with recurrent right middle lobe atelectasis or lingual that resulted from bronchectasis, TB, malignancy, etc. This syndrome was characterized by chronic cough, hemoptysis and repeated respiratory infection. In this report, hydatid cyst is very rare cause of this disease.
CASE: A 71-year-old man was presented with cough contain bloody sputum but he did not have fever and dyspnea, also sputum BK (Kochs bacillus) smear was negative. The patient repeatedly treated with different antibiotics but not cured. CT scan showed the consolidation in right middle lobe. Fiberoptic bronchoscopy revealed inflammation and erythema in right middle lobe and right lower lobe division. Since the patient did not respond to medical therapy, with diagnosis middle lobe syndrome was operated. Pathology report revealed hydatid cyst.
CONCLUSION: Hydatid cyst as one of the etiologic factors of middle lobe syndrome especially in endemic area should be considered and surgery is the only treatment for this disease.