مجله دانشگاه علوم پزشکی مازندران
پیاپی 67 (آذر و دی 1387)

Background and Hypothyroidism is one of the most common diseases in endocrinology Thyroid hormone deficiency effects on nerve and muscle fibers, pulmonary system and alveolar ventilation. The aim of this study was to evaluate the effect of Levothyroxine therapy on pulmonary function in hypothyroidism patients in Imam Hospital. This study was performed on 50 patients with hypothyroidism in Imam Hospital, Sari, Iran, 2006-2007. After a detailed clinical history and systemic examination, level of TSH, T4 and ABG test, chest radiography and spirometery was performed in all patients. The spirometery indexes including FVC, FEV1, FEV1/FVC, FEF 25-75, PEF were recorded. All patients treated with Levothyroxine 1.6μg/kg. After that all systemic and clinical examination, and chest radiography and spirometery performed again. Results analyzed by means of SPSS (11) software and paired t test. The p value less than 0.05 was considered to be significant statistically 50 female patients, with mean age of 34.98±13.4 years were studied. The mean of TSH, T4 before treatment were 51.44±25.3 mIu/l and 2.8± 0.9 μg/dl and after treatment were 3.64±2.4 mIu/l and 9.80±4.9 μg/dl respectively (P= 0.0001). The ABG parameters were in normal range and there was no statistically significant difference between before and after treatment. Statistical analysis demonstrated significant differences between mean of FVC, FEV1, FEV1/FVC, FEF 25-75, and PEF before and after treatment. Our study demonstrates that treatment of hypothyroidism with Levothyroxine can improves the pulmonary function according to spirometery findings.

Background and Seborrhoeic dermatitis (SD) is a common skin disorder. Malassezia yeasts have an important role in the etiology of SD. Since anti-fungal agents, especially in azoles are effective for treating SD, in this study, the effect of ketoconazole 2% solution on clinical signs and Malassezia in SD patients were assayed. 100 patients with SD were enrolled in this study. Patients were scored in regard to the severity of lesions at the initial evaluation and every 2 weeks for a 1 month period. Microscopic examination and culture of patients scale in days 0 and 28 were used for isolation and identification of Malassezia species. Patients were divided into two groups (ketoconazole 2% solution and shampoo) and followed after 14 and 28 days, and then clinical response was graded. 58% of patients showed lesions on their heads. In day 0, 51% of patients showed > 7 yeasts in each microscopic field. 77% of scale samples were positive to Malassezia spp. Growth and M. globosa (57.1%) had the most frequency. In day 28, 89.6% and 82.6% of treated patients with solution and shampoo showed 1-3 yeast in within entire smear, respectively. 94.8% and 82.6% of scale samples were negative to Malassezia spp growth, respectively. In day 0, patients with moderate SI had the most prevalence, whereas in day 28, patients with mild SI were predominant. Statistical test showed the correlation is significance only between SI and treatment with solution. The results of our study showed that according to decrease of yeast load and increase of improvement of SD signs after treatment with ketoconazole 2% solution, compared with ketoconazole 2% shampoo, 2% ketoconazole solution can be considered as an appropriate agent in treatment of Sd.

Background and Beta-thalassemia is the most common inherited disorder in the world, especially in Iran. According to Iranian thalassemia society registry, 18616 thalassemia patients now living in Iran, which Mazandaran and Fars provinces have the most patients. Previous reports have shown that the frequency of b-thalassemia carriers is more than 10% in Mazandaran province. Although b-thalassemia is very heterogenous in the molecular level, but in each population, 5 to 10 mutations are more common. In this research common mutation in eastern area of Mazadaran province was investigated. 5 to 10 ml peripheral blood samples were collected from volunteer patients who were referred to Boali Sina Hospital in Sari. DNA was extracted from blood, then 20 different mutations were screened and detected using two different methods, ARMS-PCR and Reverse-Dot Blot in Thalassemia Research Center in Sari and Amir Kola Thalassemia Center. From 240 chromosomes investigated in 120 b-thalassemia patients in total, 96.25% mutations were identified. 13 different mutations were identified from 231 chromosomes. Among different mutations investigated, IVSII-1G>A was detected as the most common with frequency of 68/3%, which was homozygous in 64 individuals (53/3%) and compound heterozygous with other mutations in 34 individuals (28/3%) respectively. Mutations C8(-AA), codon22(G>A)/ FSC 22/23/24(-7bp), codon 30(G>A), and IVSII-1G>A were identified in 83% of chromosomes which were studied (200 chromosomes from 240). Mutation IVSII-1G>A is the most common mutation in northern provinces (Gilan, mazandaran, Golestan) in recent study. Also, comparison of these results with the similar finding from other provinces showed that the distributions of mutations in the northern area are different with northwest, south or southeast of the country.

Background and The purpose of this study was to investigate the effects of single and repeated bouts of gymnastic training on salivary IgA and cortisol, in elite boy’s gymnasts. Twenty boys with mean age of 10 ± 0.8 years, height 145 ± 9 cm, weight 37 ±8 kg and body fat percent 14.2 ± 6(meam ± SE) in Ghaemshahr Club in 2007, performed the select and controlled gymnastic training in two bouts(single session, and double session), one week apart. The first bout, included one session a day, beginning at 6 to 8 P.M. and the second bout was performed in two sessions per day, beginning at 8.30 to 10.30 A.M and 6 to 8 P.M. Salivary samples (5 ml) to form un-stimulated were collected in pre-exercise, immediately after and 2 hours following gymnastic training. Levels of IgA and cortisol were measured by ELISA method. ANOVA test was performed for analysis of the obtained data. The IgA level indicated no significant change after two bouts of exercise within the same day (P>0.5), however, cortisol concentration increased (P<0.05). No significant correlation was observed between IgA and cortisol concentrations These findings suggest that two bouts of gymnastic training (120-minutes), at moderate intensity with a 7.30 hours rest in between, had no effect on IgA concentration, but caused an increased in cortisol concentration.

Background and Competency is a complicated and an ambiguous concept. It is also a challenging subject in the health care arena, which is significant in different aspects of nursing, such as education, clinic and management. There are ambiguities about it, thus, in this article, researchers conducted analysis of this concept. This research is a concept analysis by the hybrid method. This model has three steps. In literature review stage, 475 related articles exist in databases up to September 2007 were analyzed and evaluated. As to the importance of educational system in the training of nursing courses, 5 educators were interviewed in the field work stage. After listening to tapes, results were Tran scripted and content analysis was done. In the last stage, holistic analysis was carried out. Best definition and properties of competency was selected based on literature reviews. In the field work stage, categories and attributes, same as literature reviews stage, were emerged with interviewing of nursing educators, in addition to holistic view properties, in relation to attitude domain and creativity of management domain. In the last stage, a hybrid model was delivered. In the Iranian field of nursing, educational planning, implementing competency instrument, nurses and students evaluation can be performed according to this study criterion.

Background and

The development of pre-implantation mammalian embryos in vitro is compromised, compared with those grown in vivo. Selecting embryos with a high implantation potential is one of the most important challenges in the field of assisted reproductive technology. The aim of this study was to postulate morphometrical characteristics of good quality embryos, with comparisons between in vivo and in vitro produced mouse embryos.

Embryos was obtained from NMRI female mice after super ovulation. In vivo developed 2-, 4- and 8-cell embryos; morulla and full blastocyst were isolated from mice on 18, 36, 52, 60, 72 and 96 hours after hCG administration respectively. Ham, s F10 medium was used for in vitro culture of embryos. External and internal diameter of embryos, zona thickness and number of cells in full blastocysts were evaluated and compared between in vivo and in vitro groups.

External and internal diameter and zone thickness in oocyte and zygotes were 99.9µm, 75.4µm and 4.9µm respectively. These values did not change prior to the blastocyst stage in both in vivo and in vitro groups; but in full blastocyst stage, the diameter of embryos significantly increased and zone thickness decreased compared to prior stages in both groups (P<0.01). The diameter of full blastocysts of in vivo group (116.5 µm) were significantly larger than those of in vitro group (104.3 µm, P<0.05). Moreover, the full blastocysts of in vivo group had significantly more blastomeres (49), compared to in vitro group (43, P<0.05). Additionally, cultured embryos reached full blastocyst at 110 hours after hCG administration, while in vivo condition the time frame was 96 hours.

Based on the above results, embryo size and zona thickness can not predict embryo quality prior to blastocyst stage, however, in this stage; larger embryos and those that have more blastomere may show greater viability.

Background and Measurement of height and weight of children and adolescents are important sources of information and the best index for evaluation of their growth and nutritional and health status of society. This study performed to evaluate weight, height and pubertal stage of girls in sari. This cross – sectional study was performed on 1320 6-18 years old school girls in elementary guidance and high school of Sari. Their height, weight and pubertal stage were evaluated and recorded by educated personas. Also Body Mass Index was calculated and recorded. Then Z score (SDS) of weight, height and the Body Mass Index studied people was compared by using calculated standard curve and findings in NCHS curve and findings of 1997 in Sari. For analyzing data, descriptive statistics, Mean±SD, Frequency and percent were used. By using NCHS curve 1256 persons (95. 2 %) from total persons that were studied, had normal height (5 – 95 percentile) and the weight of 1254 persons (95 %) were in 5 - 95 percentile. 2/5 centemers increasing in height and 2.5 Kg increasing in weight were seen in comparison to 1997 study. BMI of persons in all age groups (expect 17 year old with ± 0.05 SD)were over than 50 percentile and mean age of beginning of menarche was 11.4 ± 1.1. Our study in Sari shows the improvement in growth index in comparison to 1997 study which become near to standard curve in developed country.

Background and Each year, about 50,000 new cases of cancer occur in Iran and the most common being the gastrointestinal (GI) tract (38%). Colorectal cancers account for the 3rd and 4th most prevalent cancers in Iranian men and women, respectively. Since genetic and environmental factors lead to differences in colorectal cancer occurrence in different geographic regions and races, we designed a study to assess characteristics of this cancer, in the Guilak race of Mazandaranian people. The records of all colorectal cancer patients who were referred to in a private GI clinic or admitted in hospitals and were studied during 1999 to 2007. Data was analyzed using SPSS software, Chi- Square and T-Tests. 296 cases of colorectal cancers (CRCs) were enrolled in the study. There were 2 cases of colon lymphoma and 1 case of cervical cancer with metastasis to colon. The remaining 293 patients had colorectal Aden carcinoma, of which 152 were males and 141 were females. The mean age of patients was 52.6 ± 15.2 years. 98 patients (33.5%) were under 45 years of age. A total of 70 cases (24%) had familial history of CRC. Moreover, 47% of patients under 45 years had positive familial history for CRC, of whom 43 patients (14.6%) were classified as having Hereditary Non- Polyposis Colorectal Cancer (HNPCC). 125 patients had rectal, while 168 cases had colon cancers. Right- sided colon cancers were 2 times more prevalent than the left- sided involvements. In addition, right- sided colon cancers were relatively more prevalent in those with positive familial history of CRC. Importantly, about half of all patients showed advanced stages of the disease (Lymph node involvement or distal metastases) at the time of diagnosis. Regarding the younger age of involvement, the significant positive familial history, the more prevalent proximal colon cancers and advanced stages of the disease at the time of diagnosis, we recommend to design screening programs for earlier detection of CRCs in this geographic region.

Background and One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse. In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis, slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis.Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital. In this descriptive research study, 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D. S.M. IV interview. The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used. The results obtained, showed that 79.1% were men, 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance – withdrawal and 95.2% for psychiatry problems. and also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow:60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia, 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the variables such as sex, residential areas, occupation, education, marital status, history of cigarette smoking and age of commence ment of smoking with substance dependency (p<0.05). Considering the high prevalence of Substance usage by the patients referred to psychiatric clinics, the Concurrency of substance usage and psychiatry problems are important in history taking and treatment of the patients. On the other hand to have a high success Coefficient, a simultaneous psychiatric diagnosis for the patients referred for withdrawal, should be kept in mind.

Background and Complication of surgery is one of the causes in further reference of inpatients to the hospital. Survey on complications is important resource in evaluation of rendered care to patient. This is a cross sectional retrospective study. Medical records of patient who discharged with complication of surgery during 2000- 2007 from Imam hospital were reviewed. A check list was designed for data collection according aims of research and review of literature. According to the ICD-10, complication classified in 3 types. Type on is certain complications related to surgical and other procedural e, g surgical wound infection, mechanical complication of implanted device. Type 2 conditions that occur either as a consequence of specific procedure or technique or as a result of the removal of an organ e. g post mastectomy lymphoedema and the final type is conditions that arises in the post procedural period e. g pneumonia and pulmonary embolism. The data were analyzed with SPSS soft ware and descriptive statistics. The results shown that during the years 2000-2007, the 72281 surgery was done. And the medical records of 409 patients were reviewed. The primary surgery of 292 the patients were done in Imam and the rest of them were admitted in this hospital only for complication of previous surgery which was done in other hospitals. According the ICD-10 classification and during five times hospitalization, 407(%88) of the patients have the type one complication, 53(%11/6) of them the second one. The third one was not occurred in any patients. The results of this study have shown that, the rate of hospitalized patient following complication of surgery was %0/65. Of course with the preventive precaution and finding the effective factors especially in evaluation process can decrease this rate.

Background and Death anxiety is defined as anxiety caused by conscious and unconscious fear of death that has relations with several variables. The aim for this study is to estimate the prevalence of death anxiety among a hospital staff in Sari This is a descriptive study and data was collected through a questionnaire. The number of cases was 576. The questionnaire (Templer’s Death Anxiety Scale) includes 15 True-False questions. After data collection processing was done through spss.16 and analyzing performed through T-test and Chi-square test. The age range was 20-53. 42.2% of cases had low death anxiety and 57.8% had high death anxiety. The mean of scores achieved by cases through questionnaire was 7.70 ± 3.133 by women and 6.19 ± 2.552 by men. The degree of death anxiety has had significant correlation with variable of sex while has had no relation with age, marriage condition, having or lack of child, level of graduation and career condition. The results of this study shows that the most cases have had high degrees of death anxiety that can be because of the special condition of working or the combination of cases's sex and age. With caution to results, it is recommended to Mental Health interventions to the same population to improve the mental health Quality additionally perform more comprehensive studies in more generally populations.

Ataxia-telangiectasia syndrome is an autosomal recessive associated with combined immunodeficiency, progressive cerebellum ataxia, telangiectasia, ocolomotor apraxia, dysartheria and respiratory infections. In this study we reported three cases from a family with classical symptoms. Second sibling was died at 13 old years because severe respiratory infection but third and forth siblings have life. The first sibling is female and normal.

According to the statistics provided by the World Health Organization (WHO), about 80% of the world population nowadays uses herbal drugs for treatment of diseases. Natural products obtained from medicinal plants, serve as a great source for drug production and are the main basis of new drug compounds. Unicellular organisms (Protozoa) are the cause of deaths and spread of diseases in various societies, especially in developing countries. There are anti-malaria herbal dugs produced from various medicinal plants, some of which are used for treatment of the disease and some under study. The first anti-malaria drug was quinine, produced from bark of the Cinchona tree. Recently, the drug artemisinin has been introduced by Chinese scientists for the treatment of malaria and is currently used extensively. Coetaneous leishmaniosis (salak) is one of the endemic diseases in most parts of Iran. Common drugs used against leishmaniosis (such as glucantim), have severe side-effects and in 10 to 25% of cases, there is a recurrence of the disease. Emetine is one of the drugs obtained from a root of the plant Ipecac, which is used for treatment of the disease sub-cutaneously. Giardiasis is an acute protozoan infection usually with no clinical symptoms, however, may appear as acute or chronic diarrhea. According to the announcement of WHO, more than 2/3 of the world’s population is infected with intestinal parasites and the prevalence of giardia is higher than other intestinal parasites. Herbal drugs, such as wild garlic, eucalyptus and thyme, are some of the major plants which can annihilate the giarda cysts. Annually, 75000 to 100000 people die of amebiasis (dysentery) worldwide. Due to the motility of the organism, it causes sever pathological changes and sometimes colon ulcers, and if entered into the blood stream, it may appear as liver or brain abscess. Medicinal plants such as ipecac, mango, and papaya tree are some of the anti-amebic (Entamoeba histolytic) plants. Trichomoniasis is a protozoal urogentital infection in men and women transmitted through sexual intercourse. The most effective drug against trichomona is metronidazole, albeit, there are several reports on its side effects and its spread of resistance. Medicinal plants, such as Myrtle and Lavender are among the main plants whose extracts and essence are effective against Trichomonas vaginalis.

Viral hepatitis is the most common cause of liver disease in the world. In the past 30 years, highly effective vaccines have become available for two of the five hepatitis viruses, and where implemented, vaccination has become a key component of hepatitis prevention. To provide a current review and critical analysis of the viral hepatitis, A (HAV) and B (HBV) prevention by immunization has been presented in this article.Review of medical articles obtained from Medline 2000 to 2007 and Iran Medix (1377 to 1386) database. There are signitificant differences regarding epidemiology of hepatitis A and B viruses’ infection between countries. A zero prevalence rate was highly correlated with sanitation and socio-economic conditions. Dramatic vaccine-induced declines in the incidence of both hepatitis A and B and have occurred in countries where HAV and HBV vaccines were integrated into universal childhood immunization. Improved sanitation and living conditions leads to a decline in the average HAV zero prevalence rates. Planning for large-scale immunization programs against HAV should involve careful analysis of the cost-benefit and sustainability in different appropriate hepatitis A prevention strategies. Due to the grave impact of universal infant HB vaccination on prevalence of HBV infections, continued universal infant HB vaccination is recommended. Moreover, this is to ensure continued success of hepatitis B immunization. The need for booster doses to preserve vaccine-induced immunity should be evaluated regularly as vaccinated cohort age.