مجله دانشگاه علوم پزشکی مازندران
پیاپی 89 (خرداد 1391)

Background and

Surgical Site Infection (SSI) is the third leading cause of hospital infections and lead to increased morbidity, mortality and costs after cardiac surgery. The importance of prophylactic antibiotics in cardiac surgery has been proved. The aim of this randomized clinical trial was to compare of two prophylactic antibiotic regimens (cefazolin and cefazolin + Gentamicin) on surgical site infection of CABG patients in Mazandaran Heart Center.

A total of 400 patients, meeting eligibility criteria, were randomly allocated into two equal groups. In the control group the prophylactic regimen consists of Cefazolin 2 g IV before sternal incision followed by 1 g IV every 6 hours for 72 hours. In the intervention group the prophylactic regimen consists of Cefazolin 2 g IV plus Gentamicin 1.5mg/kg IV before sternal incision followed by Cefazolin 1 g IV every 6 hours plus Gentamicin 1.5mg/kg IV every 8 hours for 72 hours. Patients were observed by cardiac surgeon for signs of surgical wound infection at 3, 7, 21 and 30 days after cardiac surgery. Also Creatinine and BUN was measured before, 2th and 4th days after surgery. Data were analyzed by Independent t test, Paired t test, Chi-Square, Fisher and Repeated Measures tests.

392 of 400 patients were examined, 198 patients in control group and 194 patients in intervention group. There was no significant difference between the two groups regarding demographic and clinical variables (P>0.05). After intervention there was no significant difference between the two groups regarding the incidence of infection (P>0.05) but serum level of Creatinine and BUN was significantly higher in intervention group (P<0.05).

With considering to the lack of significant difference in infection rates between two groups and significant increase in serum level of Creatinine and BUN in intervention group, Cefazolin alone is sufficient as a prophylactic antibiotic to prevent surgical site infection of CABG patients.

Background and Toxoplasma gondii is from toxoplasmatidea family that is seen first in ketynodactylus gondii rodent. The congenital toxoplasmosis is important and in detection of this organism the extraction of excretory-secretory [ES] antigens is needed to design ELISA AVIDITY kit in laboratory. The materials consist of peritoneal fluid of mice that is exposed of toxoplasma tachyzoite 7 days before and then aspiration of this fluid to centrifugation with 1000g for 15 minute and upper fluid of that is the main component of ES antigen from toxoplasma tachyzoite. The results show that in detection of toxoplasma IgG, if the antigens extract from tachyzoite [ES] and the kit was designed in laboratory, the results are higher in titer of antibody. The results from designed kit were better than commercial kit in detection of IgG Antibody against toxoplasma gondii.

Background and

Cancer is one of the most common growing diseases. According to statistics, the incidence of the disease in East Mediterranean region and Iran is increasingly growing. Considering the rise in the number of patients with cancer and threatening nature of this disease as well as problems of the patients and their family, the necessity to know and to understand the patients’needs and problems, especially after revealing cancer diagnosis is imperative and vital and recognizing patients’ needs will help to resolve them. The aim of this study is to understand patients’ needs during confronting with cancer diagnosis.

Using qualitative approach, the present study was done with content analysis method application. 19 participants including patient, physician, nurse and patient’s close relative were chosen amongst the clients of oncology unit, Cancer Clinic, and Cancer Patients Support Center. Purposeful sampling method was applied at the beginning and continued until data saturation. Face to face interview and taking field note were used to collect data. All the interviews were recorded and transcribed verbatim. Data were analyzed, by using descriptive content analysis method

565 primary codes in four categories were obtained which consists of “being supportive by family and relative”, ”appropriate and effective contact of medical staffs”, ”service from supportive organizations” and “needs to be informed and patient readiness”. The main common theme of categories was “support” which was the major need of patients with cancer

Research findings show that, after cancer diagnosis disclosure, patients with cancer will have a lot of needs, that recognizing these demands and understanding them by health managers and clinical staffs can improve their interaction with patients and health service provisions prepare more comprehensive support according to patients’ needs.

Background and

Leishmania is flagellated protozoa and causative agent of leishmaniosis that is most public health problem in some countries especially developing countries. Cantharidin is terpenoid component that exist in Meloidae and Oedomeridae beetles. Cantharidin is vesicant. It can induce apoptosis in cancerous cells. This study was performed with experimental design to determine the role of cantharidin in inducing apoptosis in the Leishmania promastigotes and macrophages infected with parasite.

In this study the effect of cantharidin with concentrations, 0.5-50 µg/mL on the L. major promastigotes and concentrations 5, 20 and 50 µg/mL on macrophages infected with L. major after 24, 48 and 72h was analysed by flow cytometry assay.

Results showed that cantharidin with concentrations 0.5 µg/mL and 50 µg/mL has 68.50% (as 63.23% apoptosis, 5.28% late apoptosis and 0% necrosis) and 14.29% cytotoxicity (as 13.12% apoptosis, 1.12% late apoptosis and 0.05% necrosis) in promastigotes after 72h respectively. Cytotoxicity of 50 µg/mL and 5 µg/mL cantharidin in infected macrophages after 48h was 61.81% (as 43.42% apoptosis, 1.27% late apoptosis and 17.11% necrosis) and 44.44% (as 31.05% apoptosis, 10.08% necrosis and 3.31% late apoptosis) respectively. Cytotoxicity of 50µg/mL and 5µg/mL cantharidin in non-infected macrophages after 48h was also 49.34% (as 21.35% apoptosis, 4.23% late apoptosis and 23.76% necrosis) and 43.79% (as 34.90% apoptosis, 7.27% necrosis and 1.61% late apoptosis) respectively.

Based on the results, it is obvious that cantharidin induces apoptosis in L. major promastigotes and macrophages infected with amastigotes in the time and dose-dependent manner.

Background and Quality of life by definition is "The individual`s perception of his or her position in life within the cultural context and value system he or she lives in. Our purpose was to study the quality of life enjoyment and satisfaction in medical students of Mazandaran University of Medical Sciences in comparison to Natural Resources students of Mazandaran University and assessment of effectiveness of various factors on this variable. This study was descriptive cross-sectional type in which all these students who were consent to fill the questionnaire have been included. The short form of "Quality of Life Enjoyment & Satisfaction Questionnaire" with a demographic questionnaire filled in with the students. Descriptive statistics, t-test and ANOVA was used by SPSS 17 software to compare two groups. The quality of life enjoyment and satisfaction in medical students was significantly worse than non-medical students (p=0.002). Students with better economic status (p=0.03), students who lived with their parents (p=0.009), medical (p=0.019) and natural resources (p=0.000) first year students and younger students (p=0.001) had better scores in this field. Decreasing quality of life enjoyment and satisfaction during acquisition in university is a warning to the people who are responsible for students education and welfare. Lack of satisfaction of quality of life in students may lead to a decrease in their working efficiency and makes medical students poor role models for their patients regarding physical and mental health.

Background and

Recent studies showed that erythropoietin (EPO) despite having role in hematopoiesis, has non-hematopoietic tissue protective effects on ischemia-reperfusion injury. In this study we evaluated the effects of erythropoietin on reducing ischemia-reperfusion injuries after coronary artery bypass graft surgery (CABG).

60 patients that was candidate for elective CABG randomly divided into two groups, EPO and control group. Patients in EPO group received IV infusion of EPO (700 IU/kg), at the start of reperfusion after aorta cross clamp. Cardiac markers: Troponin I and Creatine kinase MB (CKMB) assessed 8hours after CABG surgery. Also echocardiography was performed in all patients 6month after surgery.

Troponin I level had no difference in EPO and control group (P=0.30). CKMB level in EPO group was higher than control group (P=0.004). After 6month from surgery, Ejection fraction (EF) in EPO group was higher than control group but differences wasn’t significant (P=0.46). But Left ventricle end systolic diameter (P=0.017) and also Left ventricle end diastolic diameter (P= 0.04) in EPO group were significantly lesser than control group 6month after surgery

in this study the administration of erythropoietin was associated with reduction in ischemia-reperfusion injuries by improving ventricular function, and also with reduction in myocardial remodeling and decrease in Left ventricle end systolic diameter and Left ventricle end diastolic diameter

Background and Thrombocytopenia is the most common disorder in pregnancy after anemia, and occurs in 10 percent of pregnancies. Thrombocytopenia in pregnant women may be associated with maternal and neonatal morbidity. Because of the diagnosis of thrombocytopenia is effective in patient's treatment and according to its complications in pregnancy, this study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy. In this prospective study, all pregnant women with gestational age of 24< weeks and referred for termination of pregnancy to shahid yahyanejad and Ayatollah Rohani hospitals in Babol, selected and women who had the tests in microliters platelets less than 150,000 per microliters were enrolled. Cause of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients collected were recorded. Platelet count less than 100,000 in microliters as severe thrombocytopenia was considered. Then enter the data and statistical software SPSS 18 cases were analyzed. During the study period, 4589 pregnancies were examined, of which thrombocytopenia was reported in 239 pregnancies and the incidence of thrombocytopenia in pregnancy was 5.2%. Cause of thrombocytopenia were in 222 patients (%92.9) thrombocytopenia of pregnancy, in 11 patients (% 4.6) ITP, 5 patients (half percent) of preeclampsia and one patient (% 0.4) had HELLP syndrome. 6 pregnancies (2.5 %) was associated with IUFD. maternal complications occurred only in one patients with ITP, that It was bleeding during and after of delivery. No neonatal complications occurred in newborns of women with thrombocytopenia. The results of this study, gestational thrombocytopenia, the most common cause of thrombocytopenia in pregnancy and are considering this cause complications for the patient and the fetus did not have, but these diagnose should be differenthied from other diagnosis such as Hellp syndrome or preeclampsia that these need the urgency termination of pregnancy for prevension of complication.

Background and The goal of this research is to determine the relationship between the body index mass and the pattern of the distribution of fat with blood lipid serum in 10-14 years old girls. In this research, first the extent of body activity was determined by Beak physical activity questionnaire. Then a sample population of 106 persons was chosen randomly among 780 students in educating in secondary school in Bandar Abbas. 55 people were put in inacative group and other 51 in active group. Height, weight, waist perimeter and pelvic perimeter were measured in order to determine the body mass index and the patter of fat distribution in the body. Then blood’ sample was taken in order to examine blood fat level in the early morning. The Pearson correlation (measurement of relation within group) and t-student test (compare the groups) were used to data analyse. The results showed a meaningful relationship between the pattern on the distribution of body fat with the blood fat, and body mass index with the blood fat in the two groups (p < 0.05). Moreover, based on t-student statistical test among the testable population in two groups, there was a difference with respect to body mass index and the pattern of fat distribution, but there wasn’t a considerable difference between Low density lipoprotein (LDL) and high density lipoprotein (HDL), triglycerides, and cholesterol between the two groups. Based on the results, a remarkable relationship can be found between body mass index and the pattern of fat distribution and blood fats, which are important factors affecting heart illness, but based on the extent of body activity, no difference was seen between the people of two groups in same cases.

Background and Labor induction for Prepare the cervix to active phase of labor, is now one of the most common methods in the field of Obstetrics and Gynecology. This study was conducted to compare the effects of misoprostol and oxytocin in BoAli Hospital, Tehran in 2011. This study was a double-blind clinical trial by recruitments of 60 primiparous women that has been referred to BoAli hospital in Tehran in 2011. Individuals were divided into two groups by random allocation. For induction of labor, misoprostol and oxytocin were prescribe in individuals who candidate for pregnancy termination by four hours intervals. For Analysis of data, t test, analysis of variance with repeated measurements, linear regression and descriptive statistics were used. Mean age and standard deviation in intervention group was 24.07±3.96 and in control group equal to 24.13±3.97. Most frequent cause of admission regarding to research subjects were postdate pregnancy and no labor. Kind of treatment variable, cause of admission and hypertension history shown a significant association with increased or decreased time to achieve regular and suitable contractions for delivery (p<0.05). Results of t test in two groups of intervention and control shown that until three hours after receive Assigned treatment, there was no statistical significancy between two groups of study, But then we are clearly seeing the better impact of misoprostol drug in the intervention group (p=0.014). Using misoprostol in labor induction in order to reducing the Time to reach the short and effective contraction is more effective Instead of oxytocin and it can be a good alternative. It should be noted that the two drugs in terms of pregnancy outcomes, including meconium passage, fetal distress and premature rupture of membrane, havent any statistically significant difference.

Background and Utilization of evidence-based practice raises validity and quality of nursing care and nurses responsibility regarding their practice. Furthermore awareness of barriers to research findings utilization is essential instrument for evidence based practice. This study survey these barriers from viewpoint of clinical nurses. This cross-sectional study carry out on 313 nurses of three large hospitals of Babol university of Medical science in 2011.The instrument of this study was a questionnaire including two sections. One of that guttered the scientific activity and professional information of subjects, and the other one was Funks´ barriers scale. All statistical analyses (Frequency, Percentage and Factor analysis) were performed with the SPSS 17. Factor analysis identified 4 dimensions that called Report, Research, Nurse, Organization. The first three important barriers were “There is insufficient time on the job to implement new ideas”, Research reports/articles are not published fast enough”, and “Physicians will not cooperate with implementation”, each replaced in one dimension separately. Four barriers consist of the nurse is uncertain whether to believe the results of the research”, the conclusions drawn from the research are not justified”, “The literature reports conflicting results” and “Research reports/articles are written in English” did not replace in any dimensions. The important finding of this study was that the subjects relatively identified barriers in all of dimensions. According to the first three barriers, managers not only should provide facilities for research findings utilization and allow implementation, but also should provide some educational facilities to create knowledge, Skill and positive attitude regarding research in nurses.

Background and Despite of many improvements which have been happened in abdominal wall hernia repair but there are differential Ideas about the best method of hernia repair. Umbilicus is the most weaken of abdominal wall and Umbilical hernia is a common complication of adult population. It is multifactorial disease but the most important factors are chronic abdominal pressure and weakness of facia. There are two methods in repair. Mayo and tension free repair with mesh. The latter is associated with less recurrent and more effective and it is choice of abdominal wall hernia repair in large defects (≥3-4 cm) but small defects repair with Mayo technical.after primary repair (Mayo) rate of recurrent is range from %10-%30. because there is high recurrent rate in Mayo repair we did this study about using of mesh in the patients with umbilical hernia and small defect (<=1). Between oct 2006-apr 2008 we performed a randomized clinical trial in 80 patients referred to department of surgery of the Imam Khomeini hospital in Sari-Iran which were candidate for umbilical hernia repair. patients divided to case and control groups randomly and were followed up by physical examination abouth infection and recurrent and other potential risk factors then analized byspss soft ware and kai-squer study. Among 40 patiants with Mayo repair there were infection in 3 patiants and recurrence in 7 patiants but infection and recurrence is not seen in mesh repair group. There were meaningfull statistical difference between the groups in recurrence (% 17.5 in Mayo repair and zero mesh repair). Between 2 groups of patients with umbilical hernia and small defect mesh repair is bether than Mayo repair and recommend to use of mesh in repair of patients with umbilical hernia at any size if there is risk factors obesity, multiparity and other causes of high abdominal pressure.

Background and The oral health one of the most of public health that attention this program important role in prevention cronic disease based on scope WHO. Women with pregnancy is highrisk for dental care and need more attention his and fetus. This is a analytical study that carried out on 340 women with pregnancy were selected with multistage random sampling method from health centers in arak. Index DMFT and construct HBM (Susceptibility-severity-benefit and barieer) and self-efficacy, as well as their performance of the oral hygiene behaviors of brushing and flossing with cheklist and finally analysis. The results showed that mean age of women is 28.2 ± 3.7 years and mean of DMFT is 5.4 ± 2.83. Self-efficacy and perceived barriers to most, predictor of oral health behavior in pregnancy women based on health belief model. The mean performance of women about oral health care is 43.1 ± 9.7. In this study, between perceived susceptibility and performance (r= 0.44, p= 0.008), perceived severity and performance (r= 0.51, p= 0.002), self-efficacy and performance (r= 0.61, p= 0.001) positive correlation was observed. While among the perceived barriers to oral health care and behavior in an inverse relationship was observed (r= -0.65, p= 0.001). According to research barriers predicted oral hygiene behavior (brushing), suggest that clinical interventions should target barrier reduction processes. Also self-efficacy has predicted a range of health behaviors (flossing); in women pregnant therefore, dental professionals should encourage women self-confidence to floss at recommended levels.

Accessory mitral valve Tissue is a rare congenital malformation that has been reported in the literature in approximately 130 cases. It can be Found Isolated or in combination with other cardiac Anomalies and is usually detected in nearly childhood. It is in differential diagnosis with other cardiac masses as tumors or vegetations. We describe the case of a 27 years old, Asymptomatic Female who was referred to our hospital For the evaluation of cardiac mass. Transthoracic and then tranesophageal echocardiography showed that mass in LVOT is a membranous type of accessory mitral valve tissue without obstruction in LVOT. Echocardiography is highly mandatory in differential diagnosis and planning for surgery or medical follow up in these rare patients.

An uncommon form of children diabetes is Roger’s syndrome that characterized with Diabetes Mellitus, Megaloblastic Anemia, and sensory neural hearing loss. We described three children with this syndrome from consanguineous Iranian families (2 sibling and 1 cousin). They referred to pediatric ward of Imam Reza Hospital for hyperglycemia, anemia and sensory neural hearing loss. Molecular genetics study revealed novel mutation in SLC19A2 gene. Then we started thiamin and after therapy anemia reversed in all patients and normoglycemia achieved in two of patients but hearing loss persisted Diagnosis of TRMA should be considered in diabetic patients with hearing loss, anemia. Early diagnosis and therapy can ameliorates the diabetes and anemia and also hearing loss.

Psudoanurysm and cellulites of femoral artery has a high rate between intravenous drug abuser. In European countries this condition has reported many years ago but in IRAN because this condition was rare so was started in the late of 2000, in case report forms. And now we reported many cases, in a sever form and complicated with immunodeficiency condition such as AIDS. In this article we reported 14 cases.