مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال هفدهم شماره 1 (پیاپی 67، بهار 1388)

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in both industrialized and developing countries and is projected to be the third most common cause of death in both men and women by the year 2020. This descriptive (case series) study evaluated risk factors of 300 COPD patients admitted in Shahid Sadoughi and Shohadaye Kargar hospitals of Yazd using the respiratory disease questionnaires. 81.34% were men, 18.66% were women and their age range was between 33-92 years but majority of patients were in the 65-74 years age group (41.34%). Mean age of women were more than men which was significant (70.858.68). The results were as follows: Cigarette smoking was the only risk factor in 18.7% (23% of men), 43.6% had occupational COPD(87.5% of Women & 33.6% of Men), while 35% had both the risk factors (5.4% of Women & 41.7% of Men) and 2.7% had an underling disease as the only risk factor.55% of patients had only one risk factor (76.8% of Women & 50% of Men), 39.3% had two and 5.6% of patients had more than two risk factors. 77.7% of patients had occupational exposure overall, the most frequent occupation was farming but in women it was bread making in the bakery. The most frequent underling disease was HTN (29%) but the most frequent related disease was allergy (9.3%). There was a relationship between number of risk factors, duration of symptoms and disease severity but sex, type of job and different risk factors had no significant effects on it. Mean of FEV1 did not differ significantly in men and women (35.7416.57). Majority of patients were more than 65 years of age. The most frequent risk factor was occupational exposure that shows its important role in development of disease in both men & women. It is therefore necessary to perform screening tests like spirometry in this high risk group. Type of job, risk factor and sex had no effects on disease severity but number of risk factors had a significant effect this indicates that combination of risk factors is more important than type of risk factor for example we should try to prevent smoking in people with occupational exposure. Duration of symptoms also had a significant effect on severity and therefore emotional support, intensive treatment and rehabilitation programs should be considered in patients with chronic symptoms.

Cerebrovascular disorders are the third leading cause of death in individuals over the age of 50 mental disorders of this origin are reported in up to 50 and even 78 percent of patients. The global goal of this study was to assess mental disorders of stroke patients. In a cross-sectional study, 100 consecutive stroke patients in the neurology clinic of Rasool hospital were evaluated by accidental sampling and use of Neuropsychotic Inventory (NPI). Data was analyzed using Chi square and t-test. 37 men and 63 women with mean age of 62.5 years were assessed over 1 to 12 months after their stroke. The results of Chi square suggested men patients had higher frequency in subscales of delusion, aphaty, disinhibition and sleep disorders and women patients in subscale of anxiety. The results of t-test reported that there was a correlation between right hemisphere lesions and euphory. Depression, anxiety and aggression were the most common mental disorders after stroke, respectively.

Corrosive gastroesophagitis is one of the major problems in surgery and though multidiciplinary approach is used in these patients, prognosis of such patient is poor. In this retrospective study we selected patients with corrosive gastroesophagitis who had referred to Loqman hospital in the last decade and the results of treatment were analyzed. We analyzed patients with corrosive gastroesophagitis who had referred to Loqman hospital in the last decade retrospectively. Factors included age, sex, grade, substance use, surgery option and results of endoscopy. In this study, 88 patients were evaluated. Most of the patients were men (64%) in the 31-40 years age group and the most common substance involved was acid (42%), cleaning (25%) and alkaline (15%) solutions. Mortality on the base of grading was: grade I= 0%, grade II = 8.5% and grade III= 64%. Endoscopy results in operated group were as follows: 48% ulcer and 26% stricture, while in the non operated group 7% had ulcers and 46% strictures. Mortality was 59% in the operated group and 80% in the non operated group. But all grade III patients had dysphagia. In grade II corrosive esophagitis, gastritis surgery is the best option for decreasing morbidity, but in grade III patients, surgery has a very poor prognosis.

Multiple sclerosis is a chronic, progressive and degenerative myelin sheath disease of the central nervous system. It frequently occurs in young people in the productive stage of life who are solicitous about their role and family responsibilities. One of the treatment and vigilance intervention index in improvement of chronic illness is quality of life. The objective of the implementation of this study was to assess the effect of Orem self- care program on physical quality of life in multiple sclerosis patients. This study was a quasi-experimental research on 70 multiple sclerosis patients’ who were randomly allocated to experimental or control group (35 patients in each group). The experimental group was treated with self-care program based on Orem self-care frame work and compared with the control group. Data was analyzed using presumption statistics. T test showed that there was no significant difference in the physical quality of life score before intervention in the two groups (P=0.33, T=-0.69), while after intervention, the same test indicated a significant difference between the two groups (P=0.001, T=14.42). Pair t test showed significant difference in experimental group before and after self care program (P=0.001, T=-14.20), whereas the same test showed no significant difference in the control group (P= 0.95, T= -0.06). According to the study result, self care program based on the Orem frame work can have an effect on the physical quality of life in multiple sclerosis patients. Therefore, if a program is designed on the basis of educational needs and the “Orem self- care model” approach, it can be effective for enhancing the multiple sclerosis patients physical quality of life, and it can be recommended as a nursing interventional program. This intervention is safe, inexpensive and complementary that can be used to support multiple sclerosis patients in treatment centers.

Organization culture explains the characteristic of any organization. Organization culture includes values, standards and portrays behavior of members of that organization. Considering the pivotal role which is played by human resources and also the cost borne by these human sources, any kind of neglection on part of management can be drastic. This cross-sectional study included 95 employees of Yazd health care institutions. Data collection was through a questionnaire based on 10 dimensions and 44 indicators about organizational culture in EFQM environment. The situation regarding organizational culture dimensions was not appropriate from viewpoint of EFQM in any of the health care institutions. Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. In this case, making some potential situations and using the study results of improvement of organizational culture can develop environmental situations for employee’s promotion and firm growth.

Natural killer T (NKT) cells are a subset of lymphocytes that express some NK cells properties. NKT cells have a regulatory role in immune responses. Little is known about the potential role of NKT cells in human infectious diseases. The goal of the present study was determination of frequency of Vα24Vβ11 and CD3CD56 NKT cells in tuberculosis patients. According to our criteria, three groups were selected for our study: 30 healthy PPD positive skin test reactors, 30 healthy PPD negative skin test reactors, 30 new case active TB patients and 25 Multi-drug resistance Tuberculosis (MDRTB) patients. Frequency of Vα24Vβ11 and CD3CD56 NKT cells in fresh peripheral blood was determined by Flow cytometry. Frequency of Vα24Vβ11 NKT cells in the new case TB and MDRTB patients as compared to PPD positive healthy donors was significantly decreased (P<0.05), whereas CD3CD56 NKT cell numbers were similar in all groups. According to our results decrease in frequency of Vα24Vβ11 NKT cells may be related to insufficient immune responses to mycobacterium tuberculosis infection, especially in MDRTB patients.

Survivin is a new member of the Inhibitor Apotosis Protein family (IAP) which plays an important role in the regulation of both cell cycle and apoptosis. Its distinct expression in tumor cells as compared to normal adult cells introduces Survivin as the fourth transcriptom demonstrated in tumors. Breast cancer is the most common malignancy among women and scientist`s efforts to classify it has lead to various molecular subtypes and controversial results. Because of the high prevalence of these tumors and lack of suitable molecular markers for diagnosis and prognosis, there are ongoing efforts to find molecular markers which can distinguish nontumoral from tumor tissues. In this study we evaluate the potential usefulness of Survivin and its splice variants ΔEx3, 2b and 3b as molecular markers in breast cancer. We studied 18 tumor and 17 non tumor adjacent tissues. Transcription levels were measured by Semiquantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and normalized by ß2m as an internal control. 1)Survivin and its splice variants Δex3, 2b and 3b showed differentially higher expression levels in tumors than adjacent normal tissues. 2) The expression levels of Survivin, Survivin-ΔEx3 and Survivin-3b were significantly correlated with the type of tumors. 3) Survivin-2b was expressed in a few samples. 4) Survivin-3b was detected only in tumor samples. Also, our results showed that ΔEx3 variant can be introduced as a dominant expressed variant in breast cancer. Our data indicated that the expression of Survivin, Survivin ∆Ex3 and especially, Survivin-3b were correlated with cancerous nature of tumors and Survivin-∆Ex3 was the most common expressed variant in breast carcinomas. These results besides confirming the potential usefulness of Survivin and its splice variants as molecular markers in breast cancer, demonstrated the role of the gene and its splice variants, especially 3b in these lesions that enables distinguishing normal from tumor tissues. Therefore, evaluation of the expression of Survivin and its splice variants might be used as markers to stratify breast cancer patients for more optimal treatment modalities or it could be a promising new target for therapy.

Since time memorial, herbal medicine has played an important role for relief of various symptoms including pain relief. Many researches have focused on the curative as well as antinociceptive effects of herbal extracts. Cinnamon Zeylanicum has long been prescribed in traditional medicine for the treatment of inflammatory-related diseases such as rheumatisms, bronchitis and muscle pains. However, there is little if any scientific research indicating this effect. This experimental study was carried out in Shaheed Sadoughi Medical School on 25 Wistar Rats (200-300grams) randomly divided into 5 groups. In this study, the analgesic effect of intraperitoneal administration of hydro-alcoholic Cinnamon extract in different doses (50,100,500mg/kg) was assessed by using Formalin Test (for chronic pain) during 1hr. post Formalin injection. Our results indicated that cinnamon extract in high dose (500mg/kg) decreased the chronic pain intensity in the 2nd phase of formalin test. This analgesic effect was significant (P<0.001) as compared with sham group, but the lower doses (50 &100mg/kg) of cinnamon extract did not show any analgesic effect on chronic pain in Formalin Test. Data from this study confirms the analgesic effect of high doses (500mg/kg) of cinnamon extract on chronic pain in Formalin Test which may be due to anti-inflammatory effect of this plant material.

Performance measurement, programming and goal setting for performance improvement are needed for organizations to improve their performance. Despite advancement in performance measurement systems, many organizations still emphasize on old models. This paper analyzes the efficiency of Yazd governmental hospitals by using DEA model from 2004 to 2006. The inputs in DEA model are 3 variables including number of physician, number of health personnel and number of beds. The outputs in DEA model are also 3 variables number of in-patients, number of out-patients and number of bed days. This paper results suggest that hospitals in Ardakan, Maybod, Khatam and Tabas Counties and only Afshar hospital in Yazd city are efficient. Inefficient hospitals include Savaneh Sookhtegi hospital of Yazd city and the hospital in Abarkooh County. Also, this paper determined the input and output targets of efficient and inefficient hospitals. For example, hospital in Taft County is efficient when number of inpatient increases to 54494, number of outpatients increases to 5225 and number of bed days increases to 21009 by output orientation model. Manager of hospitals can measure efficiency of hospital sections by using DEA models and plan for efficiency improvement, respectively.

Intensive care unit is one of stressful wards for patients and stress creates some alterations in physiologic indicators of patients. So it is necessary to use a low expense and comforting method to stabilize physiologic indicators. The purpose of the present research is to determine the effect of foot massage on physiologic indicators including pulse, respiration, mean arterial pressure, temperature and arterial blood oxygen saturation. This research was a quasi experimental study and a clinical trial with repeated measures in which 46 patients with brain stroke hospitalized in intensive care unit of Tajrish Shohada Hospital in Tehran were studied. Information was collected 10 minutes before and 10 and 30 minute intervals after foot stroke massage on the second, third and fourth days of ICU admission. Data was analyzed with repeated measures ANOVA statistical method. Findings showed that after 5-minute foot massage, pulse rate, respiratory rate and mean arterial blood pressure significantly decreased (P<0.001) and spo2 increased (P<0.001). Decreasing temperature was significant but alterations were little and clinically it can be said that body temperature had no alteration and approximately remained constant. Findings showed that parasympathetic activity after foot massage results in alteration of various body physiologic responses, relaxes patients and decreases their anxiety. Therefore anxiety of patients can decreased with using a simple, low expense and non invasive method and can stabilize physiologic indicators and decrease effects of vital signs instability.

Malignant mesothelioma of the tunica vaginalis constitutes a very rare but often fatal malignancy of the male genitalia. This diagnosis should be suspected in patients exposed to asbestos and those presenting with clinical symptoms of either hydrocele or inguinal hernia. We report here a case of malignant mesothelioma of the tunica vaginalis. A 69-year-old man with a left hydrocele and inguinal mass was referred for left inguinal orchidectomy and hernioraphy. Histologic examination showed a malignant mesothelioma. Malignant mesothelioma of the tunica vaginalis testis is a very rare occupational neoplasm with highly aggressive biological behaviour. Treatment is difficult, and widespread local invasion and/or metastatic disease at presentation are associated with a poor prognosis.