مجله علمی دانشگاه علوم پزشکی کردستان
سال بیستم شماره 6 (پیاپی 80، بهمن و اسفند 1394)

Inequality in the distribution of health resources is one of the main issues that have been a matter of concern for researchers, planner, and managers in the health sector during the last decades. This study investigated the situation and trend of inequality in the distribution of health resources across the Kurdistan province using Gini coefficient and Lorenz curve from 2006 to 2013. This was a cross-sectional study, which investigated the inequality in the distribution of health resources in Kurdistan province using Gini coefficient and Lorenz curve. Data including total number of general physicians, specialists, dentists, laboratories, pharmacies, hospital beds, and health centers were obtained from the statistical calendar of the province. We used Stata V.12 and DASP software for data analyses. The mean values of Gini coefficient for general physician, specialist, and dentist, laboratory, pharmacy, hospital bed, and health centers were 0.21, 0.368, 0.38, 0.2, 0.218, 0.33 and 0.23, respectively. The highest and lowest inequality rates in 2006 belonged to the number of dentists and health centers, whereas, in 2013, the highest and lowest inequality rates were related to the number of specialists and laboratories, respectively. Our study revealed inequality in the distribution of health resources across the Kurdistan province, but the inequality in their distribution in 2013 compared to 2006, was declined significantly. The results of the study suggested that equality in the distribution of health resources is possible by implementing appropriate distribution policies on the health resources.

Probiotic products may have positive effects in the non-alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the effects of consumption of probiotic yogurt on some metabolic factors in the patients with nonalcoholic fatty liver disease (NAFLD). This double-blind, randomized, controlled clinical trial included 72 patients between 23 to 63 years of age with NAFLD (33 males and 39 females). The intervention group (n = 36) consumed 300 g/d of pro-biotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 and the control group (n = 36) consumed 300 g/d of conventional yogurt for 8 weeks. Using SPSS software version 16, data analysis was performed by chi-square test, independent sample t-test, analysis of covariance, and paired sample t-test. Fasting blood samples, anthropometric measurements, and dietary records (24 h/day for 3 days) were collected at baseline at the end of the trial. Probiotic yogurt consumption resulted in 4.67%, 5.42%, 4.1%, and 6.92% reductions of serum levels of alanine aminotransferase, aspartate aminotransferase (P<0.02), total cholesterol (P<0.001), and low-density lipoprotein cholesterol (P<0.001), in the intervention group, compared to the control group. Both groups showed no significant changes in the levels of serum glucose, triglyceride, or high-density lipoprotein cholesterol (P>0.05). Probiotic yogurt consumption improved hepatic enzymes, serum total cholesterol, and low-density lipoprotein cholesterol levels in the subjects. Therefore, it might be useful in the management of NAFLD risk factors.

Ectopic pregnancy is one of the leading causes of death among the women of reproductive age. Injection of single or multiple doses of methotrexate can be used as a therapeutic approach. The aim of this study was to compare the effect of single and multiple-doses of methotrexate therapy on the tubal patency in women with ectopic pregnancy. This was an interventional study and included 80 patients with ectopic pregnancy who had been treated with a single dose or multiple doses of methotrexate. After 3 months of hospitalization and treatment, hysterosalpingography was conducted to assess tubal patency. Data were analyzed using SPSS version 21. The frequencies of ipsilateral tubal obstruction were 12 (30%) and 3 (7.5%) in the patients who had received multiple-doses of methotrexate and single-dose methotrexate respectively. Also, 33 (82.5%) patients in the single-dose methotrexate group and 18 (45%) patients in the multiple-dose methotrexate group did not have bilateral obstruction. There was a significant difference in the frequencies of tubal obstruction between the two groups treated with single and multiple doses of methotrexate (P<0.05). The incidence of tubal obstruction in women with ectopic pregnancy was significantly lower in single-dose methotrexate group compared to multiple dose methotrexate groups.

Multiple sclerosis is a progressive degenerative disease of myelin in the central nervous system. One of the main complications of the disease is development of balance disorder. Since considerable attention is needed to the balance issue, this study aimed to compare the two methods of single and dual task balance training on balance in the women with multiple sclerosis. 20 women between 25 to 45 years of age participated in this study. They were members of the MS association of Khorasn Razavi province with disability scores of (1-4). The patients were randomly assigned to two equal groups (single and dual balance groups) and conducted balance exercises three sessions per week for 8 weeks. The dual training group performed a cognitive task in addition to the balance training exercises. Using the Biodex balance analyzer instrument, we evaluated the indices of patients’ balance.Using SPSS software, data analysis was performed by analysis of covariance. Covariate effects were significant for all three variables (p<0.01). The indices of overall and anterior - posterior balance were significantly different between the two groups (p<0.01, p<0.02). The mean values for the overall and anterior-posterior balance indices decreased in the dual training group, but no significant differences were found in the medial-lateral index (p<0.4). According to the results of this study, dual training exercises were suitable methods to improve balance disorders in the women with MS.

Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized by the presence of autoantibodies against nuclear antigens. The exact cause of SLE is unknown, but some of these genes are active in the key pathways, including immune complexes, host immune signal transduction, and interferon pathways which have significant roles in the pathogenesis of SLE. Since the classical HLA class I and II molecules are highly involved in the peptide presentation to the components of immune system, the genes that encode these molecules can be primary candidates associated with susceptibility to autoimmune disorders. HLA-G belongs to the family of non-classical HLA class I antigens. The purpose of this study was to evaluate the association of INDEL polymorphism of the 3’UTR region of HLA-G gene with SLE. In this study, 80 patients with SLE, and 102 healthy individuals were examined. Genomic DNA was extracted from peripheral blood. The genotypes were determined using ARMS-PCR. Data analysis was performed using MedCalc version 12.1. The frequencies of homozygot genotypes for the presence of (+14bp/+14bp)14bp, hetrozygot genotypes for (-14bp/+14bp), and homozygot genotypes with deletion of (-14bp/-14bp)14bp segments in the healthy individuals were 21.57%, 41.18% and 37.25%, and in the patients were 17.5%, 42.5% and 40% respectively. The most frequent genotype in the healthy individuals and hetrozygot patients was (-14bp/+14bp). We found no statistically significant differences in the genotype distributions between the cases and controls (Ρ>0.05). In this study INDEL polymorphism of the 3’UTR region of HLA-G gene showed no association with systemic lupus erythematosus. However, further studies are required to confirm the validity of these results.

Shoulder injuries are common in wrestling which can result in functional and psychological problems in the wrestlers. In case of high-intensity injuries, they can lead to discontinuation of the sport. On the other hand, fatigue may be one of the major risk factors for injury. Thus, the aim of this study was to compare fatigue of groups of shoulder girdle muscle during a simulated wrestling match. Fourteen amateur wrestlers (age 20.7±3.2 years, weight 70.3±12.9kg, and height 174.2±5.8cm) were selected using convenience sampling method. After a preliminary warm up, strength of the shoulder girdle muscles of both sides during 10 shoulder motions were measured by a portable isokinetic dynamometer. After 2 rounds of three-minutes, high-intensity freestyle wrestling with 30 seconds rest between the two spans, the measurements were repeated and force loss percentage for every movement was calculated. Dependent T-test was used to determine the difference between the mean values of the pre and post-tests. The results indicated that a significant reduction in the muscle strength of all selected motions was made after the simulated wrestling match, except for the non-dominant external rotation (p<0.05). The highest degree of fatigue occurred in the scapula stabilizing muscles (retractor, protractor and elevator muscles). The results can be used to design a fitness program in order to prevent shoulder joint injuries, increase muscle performance, and improve the wrestling quality.

Viral hepatitis B is one of the most prevalent infectious diseases which can lead to liver cirrhosis (LC) and hepatocellular carcinomas (HCC). Recent studies have shown an association between single nucleotide polymorphism (SNP) of interleukin 17 and inflammatory diseases. Inflammatory responses are important factors in the disease process, especially in the viral infections and chronicity or virus clearance from the body, and are closely dependent on the proper cytokine secretion from immune cells. The aim of this study was to investigate the association between IL-17 (rs763780) SNP and chronic Hepatitis B virus (HBV) Infection. Blood samples were collected from 150 patients with chronic HBV infection and 150 healthy individuals. Genomic DNA was extracted by salting out method. IL-17 (rs763780) polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) methods. Genotype and allele frequencies of rs763780 did not show any statistically significant difference between the patients and control groups. Genotype frequencies were 84.6% for TT, 14.7% for TC and 0.7% for CC in the patients with chronic disease and 88%, 11.3% and 0.7% for TT, TC and CC in the control group respectively (p=0.69). The results showed that there was no association between IL-17 SNP rs763780 and susceptibility to develop chronic HBV infection. It seems that genetic variations in other cytokine genes other than IL-17 gene, may affect progression of infection to chronic disease.

Childhood obesity is one of the most important health problems in developed and developing countries that may result from the parents’ overweight. This study aimed to compare the status of obesity and overweight in the children of overweight or obese mothers with the children whose mothers were not overweight or obese.

In this cross-sectional study, 249 elementary-school children from Bijar, Kordestan, Iran were selected using simple random sampling. Children's food intake and physical activities and mother's and children's anthropometric (weight and height) indices were measured by standard method. The relationship between overweight or obesity of the mothers with overweight or obesity of the children was assessed and analyzed by logistic regression.

Body mass index (P value < 0.01) and maternal age (P value<0.01) were significantly higher in the children of overweight or obese mothers compared to children whose mothers were not overweight or obese. No significant differences were found between the two groups of children in regard to energy intake, physical activity, and consumption of the main food groups. Overweight or obesity of the mothers significantly increased the risk of overweight or obesity in the children after adjustment for age, sex, physical activity, energy intake, and maternal age. (Odds ratio: 3.00, P value = 0.04).

According to the results of this study, overweight or obesity of the mother can be associated with the likelihood of overweight and obesity in the school age children in rural areas and this relationship is independent of energy intake, physical activity, and consumption of different food groups.

Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus cereus can cause food poisoning and digestive disorders in human beings. Propolis has been known as an antimicrobial agent against bacteria. The aim of this study was to determine the in-vitro antimicrobial activity of propolis extract on bacterial strains.

In this study, we evaluated antibacterial effects of propolis alcoholic extract on Staphylococcus aureus (ptcc1112), Bacillus cereus (ptcc1247) and Pseudomonas aeruginosa (ptcc1707) for three times, by means of paper disc method (determination of inhibition zone diameter) and broth dilution, determination of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Using SPSS software, statistical analysis was performed by DUNCAN test.

The results showed that the antibacterial activity and inhibition diameters for Staphylococcus aureus, Bacillus cereus and Pseudomonas aeruginosa (in a propolis extract concentration of 5.25 mg / ml) were respectively 18.66±0.58, 18, 14.33±0.58, respectively. S. Aureus had the highest sensitivity and Pseudomonas aeruginosa showed the highest resistance to alcoholic extract of propolis. The minimum inhibitory concentrations (MIC) for Staphylococcus aureus, Pseudomonas aeruginosa and Bacillus cereus were 0.656, 0.656 and 2.62 mg/ ml respectively and the lethal concentrations (MBC) for Clostridium sporogenes, Escherichia coli and Staphylococcus aureus, were 0.656, 0.656 and 2.62 mg/ ml respectively.

The alcoholic extract of propolis had inhibitory and antibacterial effects on Staphylococcus aureus, Pseudomonas aeruginosa and Bacillus cereus. Considering organoleptic effects of propolis extract, it can be used as a preservative in food.

In recent years, the production of extended-spectrum beta-lactamases (ESBLs) among clinical isolates of bacteria in particular E.coli has been on the rise. Production of beta-Lactamase in E.coli has caused many problems in the treatment of the patients. The CTX-M-2 gene is one of the several factors producing resistance due to ESBL. The aim of this study was to evaluate the antimicrobial susceptibility to beta-lactam antibiotics and investigation of the CTX-M-2 gene level in E. coli isolated from urine samples. In this study, 260 UTI samples were collected from medical centers in Sanandaj and 100 E.coli isolates were collected and confirmed by biochemical tests. Then susceptibility test to 11 selected antibiotics were performed by disk diffusion method and the ESBLs producing strains were identified by the combined disk method. Using PCR method, ESBLs positive strains were examined for the presence of CTX-M-2 gene. The results of the phenotype tests showed that out of 100 E.coli strains, 27 (27%) were ESBLs producing. Also, PCR showed that among these 27 strains, 2 (7.4%) strains contained CTX-M-2 gene. Considering the high rate of resistance to the third generation cephalosporins, careful antibiogram tests is an inevitable necessity before prescribing antibiotics for the treatment of infections caused by ESBLs producing organisms.

The aim of this study was to compare the effects of three tailored interventions for repeated mammography among non-adherent women using the Health Belief Model as a theoretical framework.

In this randomized trial, 360 women (≥50 years) from Sanandaj, were randomly divided into 4 groups. Intervention groups were pamphlet group, face to face counseling group, telephone counseling group and the 4th group was control group. All groups were compared with one another before the intervention, 2 weeks, 3 months, and 6 months after the intervention. Data were analyzed by using SPSS software. The statistically significant level was considered as p<0.05.

Demographic characteristics (age, education, and income) were not significantly different before the intervention (p> 0.05). In terms of perceived susceptibility, severity, benefits, and barriers to mammography, mean scores of intervention groups had statistically significant differences six months after the intervention (p<0.01). The highest rate of repeated mammography (50%) was observed in the face to face counseling group.

This study provided empirical support for the Health Belief Model as a framework to conduct repeated mammography. In addition, face to face counseling was the most effective way.