مجله طب جنوب
سال سیزدهم شماره 4 (زمستان 1389)

Noise induced hearing loss is one of the top ten occupational diseases in worldwide and carbon monoxide (CO) can potentiate this disorder. Oxidative stress have been implicated in cochlear damage resulting from exposure to noise, but mechanisms underlying auditory impairment following exposure to noise plus CO are not well known. This study was performed to evaluate the effect of noise and CO exposure on blood antioxidant and blood glutathione (GSH) status in rabbits. In this experimental study, 24 male adult white rabbits are divided to four groups: control group, noise exposure group, noise plus carbon monoxide exposure group and CO exposure group. Ferric reducing ability of plasma (FRAP assay) and total blood GSH of groups were determined before and after exposure. Mean of total antioxidant ability of plasma after exposure to noise and CO were 707.5± 31.7 and 811.3± 51.8 µmol/lit. Blood GSH of these groups were 1.39± 0.09 and 1.79±0.08 mg/dl RBCs respectively. These values were less than the values in control group significantly (p value <0.05). Exposure to noise and noise plus CO can reduce blood antioxidant ability and blood GSH, but the role of noise in the reduction is more than CO

Thalassemic patients are prone to impair self-esteem duo to life-long side effects. Abnormal appearance at young age and higher risk of blood infections such as AIDS and hepatitis, affect their marriage opportunities. These side effects lead to hopelessness and isolation.. This experimental study was carried out to determine the effectiveness of cognitive behavioral group therapy (C.B.G.T) on stimulation of self-esteem in β-Thalasemic adolescents. A total of 59 Thalassemic patients were recruited and randomly assigned into experimental or control group. The experimental group participated in eight C.B.G.T sessions of 90 minutes each, following a manualized treatment protocol. The findings were assessed by using independent group t-test, two way ANOVA and regression analysis to examine the effect of the intervention on dependent variables (self-esteem and hopelessness). The score of hopelessness was decreased significantly (p<.001) and self-esteem was increased significantly (p<.001). There was positive direct correlation on self-esteem and hopelessness (P<.001). Social self-esteem changes wasn’t statistically significantly different (p>0.05). Based on the results of this study, cognitive behavioral group therapy leads to decrease in hopelessness and increase in self-esteem in general, familial, and educational level but it doesn’t lead to increasing social self esteem. It is necessary to increase social supports for these patients.

Osteoporosis is a major public health problem. This study designed to assess peak bone mineral density (BMD), its onset in rural women in Kawar-Fars as well as prevalence of osteopenia and osteoporosis according to WHO and local reference values. In this cross sectional study, 266 healthy women aged 20-85 years from Kawar-Fars participated and they underwent Dual-energy X-ray absorptiometry (DXA) scanning including two lumbar and femur regions. Peak bone mass of lumbar spine occurred during 29±2 years. Also peak bone mass of total femur occurred around the age of 34±2 years. Prevalence of osteoporosis in lumbar spine according to WHO reference data was 29.7% but using Iranian normative data was 10.5%. Also using WHO reference data, prevalence of osteoporosis in total femur in rural women was 15.4% whereas according to the Iranian normative data was 16.2%. This study provided a baseline normative data of BMD for rural Iranian women. Also it showed prevalence of osteoporosis in rural women is more than urban women

Food insecurity contributes to poor health and nutritional status such as higher prevalence of overweight and obesity and other mental and physical problems. This study was conducted to investigate the relationship between food insecurity and obesity in low-income women living in Bushehr. A cross sectional study was conducted among 300 Bushehrian women (19-49 years, non pregnant and non lactating). The women were interviewed for socio-economic, demographic, physical and household food security. The radimer-cornell food insecurity instrument and international physical activity questionnaire were used. For data analysis, logistic regression was conducted. Overall, a majority of the households (86%) experienced food insecurity. About more than half (55%) of the women were obese. The mean body mass index of food insecure groups (30.43 ± 4.67 Kg/cm2) were significantly higher than food secure group (21.41 ± 1.61 Kg/cm2) (p<0.05). After adjusting for other variables using logistic regression, housewives (OR=3.99) and lower physical activity (OR=2.65) significantly increased as well as food security (OR= 0.04) significantly decreased the risk of obesity. The consumption of chip and high dense food and lower physical activity can be important reasons for overweight and obesity in food insecure women.

Customer orientation and focusing on service quality are the key success factors of service organizations. How to measure service quality is the ever problem for service industries due to the importance of service quality and its significant effect on customer satisfaction. This study attempted to develop a construct for measuring service quality in healthcare context. By using an almost comprehensive literature review, different dimensions of measuring service quality are identified. After finalizing the dimensions, a random sampling method is used for collecting data from patients in hospitals. A structural equation modeling approach is used for analyzing the data. The findings indicate that the dimensions of the proposed model are of high validity and reliability for measuring service quality in healthcare sector. Reliability, responsiveness, assurance, atmosphere and tangibles, output quality and social responsibility can be considered as the dimensions of service quality in healthcare sector.

Diabetic retinopathy is the most common cause of blindness in 25-65 years old age population. Early diagnosis and treatment of diabetes can delay diabetic retinopathy. The aim of this study is to evaluate medical follow up of patients with diabetic retinopathy. In a descriptive cross-sectional design, patients with diabetic retinopathy, who had been referred for operation or laser therapy, were interviewed by an ophthalmologist and questionnaires were completed. Results Of 100 patients with mean age of 53 years, 65% were female and 35% were male. 50% of patients were illiterate. 24% of patients had regular ophthalmologist follow up and 75% of patients had no regular follow up. Causes of poor follow up were low awareness (42%), economical factors (12%), lack of family support (8%) and ophthalmologist unavailability (6%). Augmenting our information about the follow up of diabetic patients and probable problems in this trend can help the health organizations in order to design more effective control programs for them. It seems that a regional follow up protocol for diabetes is needed to check the trend of quality of care of diabetes in Iran.

Alzheimer’s disease (AD) that is identified by progressive cognitive deficit and behavioral disturbances (BD) are the most common form of dementia. As the population is aging, patients with AD are becoming a serious burden for societies. In this study, current medication for cognitive deficit and behavioral disturbances are reviewed. Also the new treatment strategies for cognitive dysfunction and behavioral disturbances are surveyed. The method employed in this researh was a systematic bibliographic review, in which only the double-blind placebo-controlled studies or the clinically detailed enough open-labeled studies using validated scales were retained. The efficacy of cholinesterase inhibitors (Tacrine, Rivastigmine, Donapezil and Galantamine) has been demonstrated in several double blind placebo controlled clinical trials. They have shown a mild efficacy in mild to moderate AD. Memantine, a NMDA antagonist is the only drug that has demonstrated mild efficacy in moderate to severe AD in controlled clinical trial. Clinical trials surveying the efficacy of active and passive immunization against B amyloid protoin has halted due to serious adverse events. Studies of inducing neurogenesis in brain of AD patients are preliminary. Antipsychotics have shown efficacy for controlling BD of AD patients but they are associated with adverse events. Except for carbamazepine, there is not enough evidence for other anticanvulsants to be effective for behavioral disturbances of AD patients. A controlled clinical trial and some open studies have shown the efficacy of citalopram for BD. Further studies are needed to confirm the efficacy of other medications like trazadon, buspiron and beta blockers for BD. Cholinesterase inhibitors have demonstrated disappointing results. Memantine is only mildly effective for cognitive deficit. To date, no amyloid-modifying therapy has yet been successful in phase 3 clinical trials. Further studies are needed for more effective and safe cognitive enhancing agents. Antipsychotics, the usually employed medication for behavioral disturbances are associated with adverse events so looking for safer and effective medication in this regard is necessary.

Multiple Lymphomatous Polyposis (MLP) is characterized by multiple polyps involving long segments of the GI tract. More than 75% of the cases are derived from pregerminal center B cells (mantle zone B cells) & less than 25% from germinal center B cells. Thus MLP is a heterogenous group that includes Mantle Cell Lymphoma (MCL) & Follicular Lymphoma (FL). Here we present a 75-year-old sailor who referred to us with abdominal pain, bloody diarrhea, iron deficiency anemia & lymphadenopathy in inguinal & femoral regions. The presence of intestinal polyposis in colonoscopic & endoscopic evaluations & the pathologic & immunohistochemical findings on tissue specimens that showed B cell lymphoma with moderate proliferative activity (50%) & nodular proliferation of small lymphocytes; accompanied with positivity for CD5, CD20, CD43 & negativity for CD3, CD10, CD23 revealed that these findings are consequent to MCL with accompanied MLP