مجله دانشگاه علوم پزشکی گیلان
پیاپی 91 (پاییز 1393)

Vertigo is one of the most medical complains and is due to the involvment of peripheral or central vestibular system. Considering the role of genetic factors, life style, and special diets in the incidence of some kinds of vertigo and the nessecity of informing the patients and family physicians about the common probable reasons and different clnical features of the symptom, it seemed nescesary to study its common reasons and the difference of its peripheral and central types in the studied area. To Determine the relative frequency and clinical, demographic and paraclinic characteristics of central and peripheral vertigo This cross-sectional study was performed on 152 patients with vertigo, referred to Amir-Al-Momenin and Poursina hospitals in Rasht, from October 2011 to October 2012. Patient's information and praclinic data were collected and then, analyzed using SPSS.17 software, chi square and Fisher tests. From 107 female and 45 malepatiens(mean age:51.84±16.8 years), 55 cases (36.2%) had otologic symptoms and 30 cases (19.7%) had neurological complains (e.g. diplopia, speech disorders, and focal signs).Of the first group, 40 cases (26.3%) had peripheral and 1 case (0.6%) had central vertigo (P=0.007), and in the second group 7 subjects (4.6%) had peripheral and 15 cases (9.8%) had central vertigo (P=0.0001). As shown, 113 cases under wentbrain MRI that revealed neuro-pathological deficits related to the vertigo only in 19.5% of the cases. Also, in 99 cases audiometery was performed that were abnormal only in 38.4% of the cases. Peripheral verigo was the most common type of vertigo (59.2%), especially Benig Paroxysmal Peripheral Vertigo (BPPV) (47.8%). The frequencies of central and peripheral vertigo in terms of age were not significantly different among the groups (p=0.062); however, central vertigo was more common in men than in women (p=0.04). The most common type of vertigo in our patients was peripheral type, and the physical examination can play an important role in the diagnosis of vertigo Conflict of interest: non declared

Medical complaints are always the most challenging items in the scope of practice and have great difficulties for both the physician and the patient. Due to the need for comprehensive data for health planning of Guilan province And the importance of this research as factors in occupational safety and health practitioners, patients, research in this area is necessary. Determining factors in a complaint to the Medical Council of Doctors in Gilan Province in the years 2005 to 2010 In this cross-sectional study of 425 cases related to medical malpractice lawsuits stemming from the Medical Council of Guilan during the years 1385 to 1390 was carried out. Thus the plaintiffs checklist includes information such as age, sex, date of complaint, the complaint doctors information such as gender, field of practice, location of practice, Work Experience and the first instance and appeal preparation was completed. The data were entered into a statistical software SPSS18 and were analyzed using descriptive statistics. Dentists had the most claims, followed by orthopedic surgeons, General Practitioners, General Surgeons and Gynecologists. Physicians were found innocent and guilty in 354 cases(83.3%) and 67 cases (15.7%) of cases, respectively. Also, patients quit their claims in 4 cases. The most common causes of complaints mentioned by patients, were medical error, complications of treatments and then, financial issues. Most causes of proposing a claim were malpractice, treatment complications and financial issues. The data showed that most of the claims recorded were unfounded and consequently, respective physicians were not guilty. Therefore, knowledge of the patient's physician, the patient is familiar with the methods of treatment and possible side effects and reduce the financial relationship between the physician and patient compliance in many cases can be prevented by a patient complaint.

Although children’s dental health has generally improved over recent decades, yet, dental problems has a high prevalence during childhood. Three main constructs perceived benefits, perceived barriers and perceived self-efficacy are the major motivational constructs because of helping people to shape a positive behavioral history for the future by focusing on the benefits of a behavior, teaching how to overcome barriers to carrying out the behavior, and engendering high levels of self-efficacy. Determining the predictive power of three main constructs perceived benefits, perceived barriers and perceived self-efficacy in brushing behavior among primary schools female students in Rasht city This cross sectional study was conducted on female students of grade four in Rasht in 2012. According to the statistical estimation and systematic sampling method, the number of samples and schools were 265 and 22, respectively. From each school about 12 students were selected with simple randomized sampling. The measuring tool was a questionnaire. Data were analyzed using descriptive methods, and analytical methods like Chi2, Mann-Whitney U test and Logistic regression. As shown, 17.4% of the students brush at least twice a day. The logistic regression analysis indicated that perceived barriers (OR=1.73, 95%CI=1.07-2.79, P=0.024) and mother’s educational level (OR=5.31, 95%CI=1.41-20.0, P=0.014) were the significant predicting factors for tooth brushing twice a day or more. According to the Mann-Whitney U test, perceived barriers, perceived self-efficacy and along with Chi2 test, mother’s educational level were significant factors (P<0.0001). There was also a significant difference between fatigue, laziness and impatience with brushing at least twice a day (P<0.0001). The educational intervention programs to promoting brushing behavior in this age group should focus on overcoming the barriers particularly on the three above-named barriers. Promoting the educational level of mothers and planning the educational programs for them in this field are recommended as well. As perceived self-efficacy has statistical significant difference with regular brushing behavior, it has no power to predict behavior. This finding could be supported by Piaget’s Theory of Cognitive Development, according to which children during the concrete operational stage still have difficulties with abstract terms

Till now multiple devices have been introduced in order to predict the ''patients'', disability, function, muscle force and mortality in the acute phase of stroke. Determination the relationship between electroencephalography (EEG) findings and change of disability, functional status, functional independency, muscle force and mortality of the patients with ischemic stroke. This cross sectional study was performed on 47 patients in the range of 50-90 years old involved by ischemic stroke in the territory of middle cerebral artery, referred to Poursina Hospital in Guilan-Rasht in the north of Iran. At first, for all the patients a brain CT and after 48 hours a brain MRI or CT scan were done routinely to confirm the diagnosis. EEG accomplished during 48-72 hours after stroke, and the ''patients'' were grouped in 3, accoring to EEG abnormality: normal EEG, moderate and severe abnormal EEG. The patients disability, functional independency, functional status, and muscle force, respectively were assessed by Modified Rankin Disability, FIM, Bethel index and Medical Research Council scale(MRC) and their mortality in the first 48 hours, one week and three weeks afterstroke.The data were processed by software SPSS 20 using Chi square, independent T, Post Hoc Tukey,Kruskal-Wallis, Anova,Repeated Measure Anova and Sphericity. A total of 47 patients (48.6% men, 53.2% women) with mean age of 73.09±9.01 years old participated in this study. Left middle cerebral artery involvement was evident in 46.8% of the patients and the others had right side involvement. First and second groups included 15 patients and third group17 patients and there wasn’t any statistically significant difference between groups in age and sex. (P>0.05) No significant difference was found, either between groups in means and change of means of Rankin score, FIM, Barthel Index and MRC during the study period. (P>0.05) EEG findings can’t determine prognostic value for functional outcome and mortality of patients.

Attention Deficit/ Hyperactivity Disorder (ADHD) is persistent pattern of inattention and/or hyperactivity- impulsivity behavior. ADHD is frequently accompanied by Developmental Coordination Disorder (DCD). To assess the Cardiovascular Fitness in children with attention deficit / hyperactivity disorder with and without developmental coordination disorder and normal children. In this descriptive comparative study, a total of 45 male children aged 9-7 years in which 30 individuals non-randomly selected from child psychiatry outpatient squarely addressed both public and private centers. Fifteen normal children were selected from elementary schools students in Rasht. Diagnostic criteria by clinical interview based on DSM-IV criteria, were performed by child and adolescent psychiatrist. Cardiovascular Fitness was tested with 6-minute walk. Data were analyzed using SPSS-16.0 software. Variables to determine statistically significant differences in the three groups ANNOVA test were used. Levels lower than the rate of p= 0/05 were considered significant. Children with ADHD with and without DCD showed poor Cardiovascular Fitness, compared with normal children (P<0.05). Cardiovascular Fitness in ADHD+ DCD group was lower than that in ADHD counterparts. ADHD children with and without DCD have poor Cardiovascular Fitness than normal children. Cardiovascular Fitness deficit may differentiate motor problems in DCD and ADHD

Although psychological factors such as stress can have adverse effects on quality of life in patients with Gastroesophageal Reflux Disease (GERD), there have not been sufficient research on the effects of psychological interventions such as stress management training on this condition. The purpose of this study is to determine the effectiveness of stress management training in enhancing quality of life in patients with GERD who were referred to a Gastroenterology and Liver Disease specialist in Anzali, Iran, during the past 18 months. The present research is conducted in the form of a semi-experimental study including a control group. We sampled 38 available female patients with GERD who were diagnosed by the specialists and received medical treatment; then, we randomly divided them into two groups – experimental and control. The patients responded to the Quality of life Questionnaire in Gastroesophageal Reflux] REFLUX-QUAL] at two stages: as a pretest –before implementing a group stress management training that included two stages of informing and training – and as a posttest – after the psychological intervention. We analyzed the resulting data using a one-way analysis of covariance. Stress management training improves the Global Quality of Life (p= 0.01), and four of its dimensions including Daily Life (p= 0.02), Quality of Life (p= 0.02), State of Mind (p= 0.05) and Worries and Concerns (p= 0.04) in patients with GERD, but did not significantly influence the other dimensions; Relationships, Sleep, and Food. Group stress management training can increase the quality of life in patients with GERD. Conflict of interest: non declared

Cardiovascular patients,especially coronary artery diseasecases in acute phase, experience much anxiety and will be at the risk of developing serious cardiac complications, five times more than other patients. Resiliency is the ablity to escape from hard satatus or modification of it. It plays an important role in psychology of evolution, family and mental hygiene which can be helpful in exuding from difficult state of medical diseases. This research was done to compare psychological resiliency in patients with coronary artery disease and their noraml counterparts. This is a cross-sectional with control group study in which the population consists of all the persons referred to angigraphy. In total, 372 persons were entered in the study through availabe sampling in Heshmat hospital. Tool of research was resilence standardized questionnaire (by Mohammadi, 2010, Iran). Analysis was doneby enteing data in SPSS-18 and using descriptive statistical tests, univariate analysis of covariance and Chi Square analysis. P value less than 0.05 was considered significant. Of the 372 persons, 220 (59.1%) were male and 152 (40.9%) were female and mean of age was 51.94±11.27 years. 82.8% had less than high school education. 94.7% were married and 26.7% were obese and 40% were overweight. There was a significant difference in terms of age (P=0.001) and sex (P=0.002) between the two groups. There was no significant difference between means of psychological relisience in patient group (65.50±15.81) and normal group (66.00±13.20) (P=0.986). Despite lack of relationship between psychological resiliency in healthy and patient groups, it can not completelybe concluded that psychological resiliency has no preventive effecton improving coronary artery diseaseand more studies with considering other risk factors affecting disease verification of hypothesis are recommended. Conflict of interest: non declared

After caesarean, mothers need to take care of their babies as soon as possible, and pain relief in them leads to more comfort and faster recovery and it reduces hospitalization time and complications such as pulmonary thromboembolism as well as treatment costs. Determining the effect of TAP block by injection of Bupivacaine 0.25% after caesarean section on post operative pain. This study was performed on seventy six women that underwent elective caesarean section. Then, the women were randomly divided into two groups. Six women were excluded from the study which was a double-blind clinical trial. In the case group: 20cc of Bupivacaine 0.25% was injected between transverse abdominal muscle fascia and internal oblique muscle fascia, and in control group the same amount of normal saline was used. Pain intensity was measured by VAS score at 2,4,6,12,24,48 hours after surgery. In both groups, if the patient needed pain relief, diclofenac suppository was used and its dose was recorded. Some complications such as nausea, vomiting and dizziness were recorded too, data were analyzed by SPSS (21) software, P value less than 0.05 was considered statistically significant. VAS score at 2, 4, 6 hours after surgery in case group was significantly lower than that in the control group. (P=0.0001, P=0.0001, P=0.039), respectively. The mean number of administered diclofenac in bupivacaine group was lower than that in placebo group (P=0.0001). The mean and standard deviation of pain free period in bupivacaine group was 13.77±2.41 and in placebo group was 5.94± 1.27. Survival rate of analgesia was 14.3% in bupivacaine group and 2.9% in placebo group. This difference was statistically significant (P= 0.001). Transverse abdominal plane block with Bupivacaine 0.25% can reduce post caesarean pain without any side effects, such as dizziness, nausea and vomiting, and any effect on the time of ambulation. It can also reduce use of analgesics Conflict of interest: non declared

Helicobacter Pylori infection is one of the most common infectious diseases.It can result in chronic gastritis, peptic and duodenal ulcers, MALT lymphoma and gastric cancer. The H-pylori infection can lead to a wide range of diseases and the cost spent on the eradication is much less than the cost spent on the treatment of complications of the infection Study the efficacy of quadruple therapy (Amoxicillin, Bismuth, Omeprazole and Clarithromycin) on the eradication of Helicobacter Pylori infection. Between March 2011 and December 2011, we conducted a Quazi- experimental study on Helicobacter pylori infectious patients in Anzali. They were included after doing an endoscopy. Eight weeks after taking four-drugs regimen, Urea Breath Test was done to check the rate of eradication. The majority of the patients were females (58.7 %). The most common symptoms before the treatment were flatulence (76 %) and epigastric pain (74.9 %). The eradication rate was 89.9 %. There were significant differences in all of the symptoms while the difference between gender and eradication rate was non-significant. Regardless of few side effects, all symptoms of the patients were treated significantly. As the eradication rate was 89.9 %, this quadruple drug regimen was effective on the eradication of the H-pylori. Conflict of interest: non declared

Bardet Biedl syndrome is a rare hereditary disorder associated with central obesity, mental retardation, polydactyly, retinal dystrophy, retinitis pigmentosa, hypogenitlism, hypogonadism, renal failure. Renal failure is a major cause of mortality in these patients. This report highlights the clinical importance of considering a Bardet Biedl syndrome diagnosis in adults with retinal dystrophy, polydactyly and renal failure. Case Report: we present the case of a 32 yr old woman presented to our emergency room with uremic symptoms and metabolic acidosis. Bardet Biedl syndrome, a rare often forgotten or not been diagnosed disorder, should be promptly identified by pediatricians and timely be referred to the ophtalmologist, endocrinologist, and nephrologist. Conflict of interest: non declared