مجله دانشگاه علوم پزشکی ایلام
سال بیست و یکم شماره 2 (پیاپی 79، خرداد 1392)

Cutaneous leishmaniasis (CL) is a parasitic disease in many tropical and sub-tropical countries، caused by protozoa of the genus Leishmania and can be transm-itted by sand fly bites. This study was carr-ied out to identify the epidemiologic status of cutaneous leishmaniasis with emphasis on trend of its incidence rate in Kashan. This investigation was a descriptive and retrospective study based on existing data. Sample consists of all persons who were referred to the central laboratory in Kashan during the last five years (20 March 2005 to 19 March 2010) for parasitological diagnosis of cutaneous leishmaniasis، and their diseases were con-firmed. Demographic characteristics and clinical information of cutaneous leishma-niasis (positive cases) were recorded and analyzed. The results revealed that the nu-mber of infected cases in Kashan was 1599 people during the study. Of these patients 1315 (82. 2%) lived in urban and 284 pati-ents (17. 8%) in rural areas. Incidence rate in rural dwellers was significantly higher than urban residents (19. 10 vs. 9. 46 cases per 10،000 population). During the study، patients showed a significant increaseing and positive cases of cutaneous leishma-niasis had been increased from 192 cases to 405 cases in the last year of the study. The annual incidence rate of the disease has increased significantly. Among the patients with active cutaneous leishmaniasis، 717 (45%) were females and 882 (55%) male. 92% of cases were Iranian and the rem-aining of non-Iranian. The highest incid-ence rate was observed in the age group below 10 years، with 14. 87 per 10000 inha-bitants، and the least rate in the age group 40-49 years with 5. 93 per 10000 inha-bitants. The prevalence of active CL pati-ents in the age group less than 20 years (43. 84%) was significantly higher than the corresponding value in the same age group in the general population (34. 02%) in Ka-shan. Most commonly affected organs، hands (45. 8 % alone، 7. 1 percent، with feet and 2. 9% with face)، followed by feet. Single lesion in the majority of patients، was followed by two or more ulcers on two or more parts of the body. Discussion & The findings showed an increasing trend of the prevale-nce and incidence rate of cutaneous leish-maniasis over the period study in the regi-on. Also، cutaneous Leishmaniasis remains a public health threat in the future. There-fore، it is recommended that the regional authorities paying more attention to control the spreading of the disease.

Low back pain is one of the most common and important public health problems of the current societies and it is the major cause of functional limitation for people under the age of 45. Eighty five per-cent of the chronic low back pain is clas-sified as «non specific». The aim of the pre-sent study was to investigate the relation-ships between pain intensity or disability level and musculoskeletal conditions. Ninety patients diag-nosed as nonspecific chronic low back were recruited for this study. Flexibility of some important lumbopelvic muscles was meas-ured with a goniometer and endurance of trunk flexors and lateral flexor muscles was evaluated with static flex endurance and static side bridge endurance tests، respect-ively. Also، pain intensity and disability levels were measured by the visual analo-gue scale، roland moris and oswestory disa-bility indices، respectively. The results of this study showed that only the endurance of lateral trunk fle-xor muscles had correlation with the disab-ility level in these patients، albeit it was not strong (r=0. 238، P=0. 024). Moreover، flexibility of the hamstring، tensor fascia lata and hip lateral rotator muscles had only strong correlation with pain intensity level (r=0. 815، P<0. 01) meaning that muscle shortness have profound effects on pain intensity. Discussion & These findings could be important in the design of reha-bilitation programs for people with nons-pecific chronic low back pain. This means that physiotherapy treatments should be directed towards impairments that have stronger correlation with pain، functional limitations and disability as these are the major complains of these patients.

Neurofeedback is used not only for diagnosis and treatment of different disorders but also for improvement of healthy person''s daily activity and its quality. The purpose of this study is to evaluate the effect of neurofeedback training on competitive-trait anxiety in athletes. The present study is semi-experimental and applied type of research; in which pre-test and post-test of three groups،including interventional،control and sham،are compared. Therefore 36 volunteer athletics have been chosen and organized into groups. Intervention was made in a form of increased Alpha-wave in O1 and O2 regions over 12 sessions. SCAT questionnaire was used for evaluation of trait-competitive anxiety state. Univariate analysis shows significant relationship between the actual neurofeedback training and decreased trait-competitive anxiety state (p= 0. 015). Hoc test revealed the only significant discrepancy exists between interventional group and control group (p=0. 009) and no significant difference exists between interventional group and sham group (p=0. 058) and between sham and control group (p= 0. 477). Normal brain reaction to stress is decreased Alpha-wave and increased beta-wave. Therefore when a person is faced to a stress situation،brain function is increased and beta-waves appear. Alpha-waves induce alert relaxation،mind integration and anxiety reduction.

Heart disease، particularly coronary heart disease is a major cause of mortality among patients with diabetes mellitus. High level of hs-CRP is considered as a risk factor for heart diseases. Treatment with pioglitazone in patients with or without type II diabetes decreases serum concentrations of hs-CRP. The purpose of this study was to compare the effects of pioglitazone and metformin on hs-CRP level. A randomized clinical trial was performed on 40 patients with type 2 diabetes and defined inclusion criteria. Patients were divided into two groups receiving metformin and pioglitazone. Blood levels of cholesterol، triglycerides، fasting blood glucose، Alanine transaminase، Aspartat aminotransferase، HbA1C and hs-CRP were measured in all subjects before and after 3 month drug therapy. The average change in each group before and after drug therapy were analyzed by paired T-test، the mean change between groups were compared by T-test. In both groups، hs-CRP level was significantly decreased after drug therapy. The mean change of hs-CRP، HbA1C، cholesterol was significantly higher in metformin treated group. Since the average reduction in the level of hs-CRP، cholesterol and HbA1C in diabetic patients treated with metformin is significantly higher than patients treated with pioglitazone; treatment with metformin is recommended to reduce risk of heart disease

Currently، nursing authorities، researchers and scholars closely criticize nursing researches and documents based on its philosophy and methodology، hence the concept development is considered as one of the most important approaches for nursing knowledge development. The present study was a review that used Walker and Avant approach for the autonomy concept development. This approach is one of the methods of conceptualization and concept development that eventually resulted in the theory development. In this study، the autonomy concept was searched by using of the autonomy keyword، in valid data bases، PMDR and INLM. Then all of the related articles reviews and themes related to the autonomy keyword were determined. There are various definitions of autonomy in nursing literature and the concept has been in evolution until now and based on professional literature review، many concepts including themes of self governance، ability، capacity، competent، self-controlling، freedom، critical reflection and decision making have been extracted. Discussion & The concept of autonomy is an abstract and complex concept and its meaning has intervened with other concepts. Formal analyzing of the concept could result in appropriate usage، semantically.

Increasing the duration of admission and labor has harmful effects on mother and fetus. Lack of maternal education and preparedness increase medical intervention and create complications for both mother and baby. Therefore،Childbirth preparation classes during pregnancy can be an appropriate solution to address these problems. This was a HSR and descriptive – analytical sort of research، which was performed during 2009-2011 in Arak Taleghani Hoapital. 170 nulliparous pregnant women who were selected by simple sampling، were assigned in to two group (case and control). Case group participated in preparation classes for eight sessions، 2 hours once two weeks، and trained with a coach of midwifery. Control group received only usual pregnancy care. The duration of admission and satisfaction of mothers were assessed and gathered by questionnaire. Data were analyzed by SPSS software. Duration of admission in the case group (30. 70±11. 14hours) was significantly shorter than the control group (38. 17±15. 33hours. p=0. 001). Satisfaction rate of mothers in the case group (94. 20%) was significantly higher than the control group (67. 24%. p=0. 001). Our study showed Childbirth preparation classes decrease duration of admission and increase satisfaction of mothers. Therefore it is recommended that all pregnant women participate in these classes during

Enterococci are part of the normal flora intestinal tract of human and animal. In contrast to the beneficial role that Enterococci play in intestinal homeostasis،becoming important to human health as leading cause of nosocomial infections. The most important characteristics of Enterococci is the considerable amount of antibiotic resistance. Some strains of E. faecalis can form biofilm، which increase their ability to colonize patients and persist at infection sites. Bacteria in biofilms are generally showing more resistance to the antibiotics in planktonic condition. In this study، strains Enterococci isolated from some patients following the determination of antibiotic resistance and measured amount MIC and MBC، The most sensible strains were chose for the biofilm modeling invitro. The effect of antibiotic have been studied on biofilm. The most and the least antibiotic resistance of Enterococci strain was determined respectively to Penicillin (100%) and Nitrofurantoin (7%). Antibiotics Ampicilin،Gentamicin،Tetracycline even in densities 10times more than MIC of planktonic condition were disable in obliterating of the biofilm of strains. Different densities of Nitrofurantoin antibiotic collapsed bacterial biofilm absolutely. The least density 256 µg/ml was seen in one-day biofilm and the most density 1024 µg/ml،on the fifth day. Discussion and The results of bactericidal activities confirm the overt difference between planktonic cells and biofilm showing resistance of biofilm toward planktonic. According to the results obtained، it seems that Nitrofurantoin antibiotic is more effective for treatment of Enterococci in planktonic and biofilm condition.

Alteration of abusing pattern of addictive drugs from classic opioid to ps-ychostimulant drugs threatens young people life. Glass abusing has been increasing am-ong young adult، although this drug has not been incoming Iran for a long time. The main compound of glass is methamphet-amine. Heroin and glass in addition to nervous system have very toxic effects on cardiovascular system. The aim of this study was to compare the toxic effects of heroin and glass exposure on the blood and serum parameters. Male adult rats were given intraperitoneal injection of heroin or glass (10 mg/kg، once per day) for 15 days. At the end of 15 days، the blood samples were taken from rats and analyzed for red blood cells، white blood cells، platelets، cholesterol، triglyceride، LDL and HDL. Our data showed that glass sign-ificantly decreased the total red blood cells، white blood cells، hemoglobin and haem-atocrit (P<0. 05). Also، heroin decreeased the level of hemoglobin (P<0. 05). Serum trigly-ceride، cholesterol and HDL did not change significantly in heroin and glass group wh-en compared to control group. The level of LDL in heroin group significantly decree-sed compared to glass group. (P<0. 05) Discussion & Industrial psyc-hostimulant drugs in comparison with clas-sic opioids have more impairing effects on blood factors and during short time lead to cardiovascular problems، anemia، weak-ening immune system and، ultimately pre-dispose addicted people to infectious disea-ses.

Methylphenidate (MPH)، a mild psychostimulant drug administered orally inADHD، narcolepsy and postural orthostatic tachycardia syndrome has a short 2-4 hours half life and 3-5 hours duration of action. Thus، frequent MPH administration is required to maintain its therapeutic blood level. The main objective of the present study was to utilize simple pelletization technique to prepare MPH pellets suitable for the once daily dosing schedule. MPH matrix pellets consisting Avicel، lactose and different amounts of GMS، Eudragits (RSPO، RLPO، RS30D، and RL30D)، carbomer، HPMC and Na CMC were prepared by extrusion-spheronization technique. The particle size of the pellets was determined by the sieve analysis. Hardness، weight variation and disintegration time of pellets were also evaluated. The drug dissolution study was carried out in 500 ml water at 37°C using USP apparatus (paddle) at 50 rpm for 12 hours. The content uniformity of pellets was also determined according to the USP guidelines. Most 11 pellet formulations had acceptable physical properties with regard to size distribution، sphericity، flowability، crushing strength and friability. MPH pellets comprising Avicel 60%، Eudragit RSPO & RLPO 5%، GMS 15% and HPMC-K15M 15% were، however، released the drug in a more time-controlled manner than other formulations with the release of 50%، 60% and 70% of its drug content after 60، 210 and 420 min، respectively. Hardness and pellet size did not have significant effects on drug release from pellets. Discussion & Simple pelletization can be used to produce MPH pellets exhibiting a dual release pattern of a burst release followed by a slower release rate، providing the loading and maintaining doses of drug. This can benefit patients with avoiding repeated dose administration and improve their compliance.

UV/O3 is among the advanced oxidation processes and is used to break down volatile organic compounds. This study was designed to examine the efficiency of the UV/O3 process in the removal of benzene from the airflow and to study the effects of such factors as relative humidity، ozone dosage، and exposure time on the efficiency of this method Methods and Materials: The present study is of the experimental type and was performed on a laboratory scale. The laboratory equipment consisted of an air pump، an injection pump، mixing chamber، rotameter، an ozone generator، a 15-Watt UV-C lamp، and a humidity generating system (consisting of an impinger and a heater). 80 ppm of benzene was exposed to the combined UV/O3 process under varying conditions of different humidity levels، different ozone dosages، and different exposure times. The different concentrations of benzene before and after exposure to the afore-mentioned process were measured and compared. The data was analyzed using descriptive and inferential statistics and three-way ANOVA

The findings showed that all three factors of relative humidity، ozone dosage، and exposure time affected the efficiency of the UV/O3 process. Increasing the relative humidity enhanced the efficiency of the system in removing benzene up to %60. Additionally، increasing ozone dosage and exposure time led to augmentation of the benzene removal in the UV/O3 process

Given the ease of use and possibility of performing the reaction under the normal conditions of the environment، the UV/O3 method can be used as an effective method in removing benzene from the airflow. Altering variables such as relative humidity، ozone dosage، and exposure time can enhance the efficiency of the system

Leukemia is a progressive and malignant disease of hematopoietic organs of the body. Genetic abnormalities play an important role in the development of leukemia in the body. Many studies have been accomplished on the molecular factors that involved in the disease. DNA micro-array technology provides a general picture of gene expression in whole genome and applied for the exploring of candidate genes that lead to diseases. In fact، having analy-zed a large number of genes together along with the expected changes provides more closely examination the disease under stu-dy. In the present study، the DNA micro-array data of leukemia disease were analy-zed by bioinformatics software (DAVID). The aim of the study was to functionally analyze the genomic and proteomic lists of data that have been obtained with high-throughput tools during biological studies. Microarray leuke-mia gene sets were obtained from the data-base http: //www. biomedcentral. com/ cont-ent/supplementary/1471 and analyzed with the bioinformatics software (DAVID). The communication gene expression in different classes، chart and clustered genes were examined. The list of genes was identified by the DAVID analysis program. A chart consisting of 615 ident-ified genes associated with various diseases was detected. Most genes involved in the disease were those genes that were also involved in cancers. 23. 7% of the identified genes (146 genes) were cancer genes. Of 615 genes، 70 charts of the identified biolo-gical pathways (the database KEGG) were associated with the disease. Of 615 genes identified، 12 clusters were associated with the disease based on the functional annot-ation. Discussion & The results sho-wed that the program، DAVID، is capable of analyzing genome. Also، the program was capable to evaluate the main classes of genes and pathways involved in the disease to determine the best candidate gene mark-ers for the diagnosis and treatment of leuk-emia disease.

Hypertriglyceridemia is asso-ciated with many risk factors that elevate the incidence of cardiovascular and diab-etes diseases. Therefore، informing the pre-valence of hypertriglyceridemia may be helpful for health authorities to make pro-grams for controlling of the condition. Aim of this present study was to obtain an ov-erall estimation of hypertriglyceridemia and trend of the condition in Iran.

Using some valid keyword including triglycerides، prevale-nce، and meta-analysis in the databases of Googles choolar، SID، Pubmed، Magiran، Irandoc، Medlib and Iranmedex a total of 155 articles were collected. From the articles، 24 articles were reliable and inclu-ded in the study. Variance of each study was obtained using the binomial distrib-ution. Heterogeneity of the studies was assessed using I2 index، and the data were analyzed using random effects model and the STATA V. 11 software.

Collectively، 24 articles were enrolled in this study. The overall preva-lence of hypertriglyceridemia was obtained 36. 6%. Prevalence of hypertriglyceridemia was estimated as follow: In general popula-tion، 27. 2% (95 CI: 21. 1-33. 3)، in diabetic population 62. 1% (95% CI: 51. 1-73. 2)، in patients with heart disease 35. 2% (95% CI: -6. 9-77. 4) and in other patient groups (me-tabolic syndrome، obesity، impaired glucose tolerance، or benign vertigo) 36. 7% (95% CI: 25. 8-47. 7). Discussion &

The prevalence of hypertriglyceridemia was low in general population in Iran، however، incidence of the condition was higher in patients with diabetic and cardiovascular diseases. So the health authorities should provide relevant programs to control the disorder.

Psychological stress in work-place is among the stress-inducing factors that influence the workers’ health and dam-age their occupational performance and sa-fety. The present study was carried out to investigate the relationship between general health and workers’ sleep quality as well as the work safety in Gole Gohar Mineral Ind-ustries Co.، Sirjan، Iran. The present cross-sectional and descriptive-analytical study was carried out in 2011-2012. The statist-ical population included 337 workers in Hematite and Pelletizing section in Gole Gohar Mineral Industries Co.، Sirjan in Iran. The sampling was carried out in a simple random selecting method. A general health questionnaire having 28 questions (GHQ) and the Pittsburg Sleep Quality In-dex (PSQI) were applied in the study. Anal-yses of data were carried out using SPSS 19 software and descriptive and inferential statistics tests. The average age of workers was 30. 92±4. 78 years and their working experi-ence averaged 5. 47±3. 24 years. 82. 9 perc-ent of the workers responding to the questi-onnaire were satisfied with their jobs، and 17. 1 percent were not satisfied. Using 23- point break in large-scale and 6- point break in small-scale، psychological disorders were detected in 29. 4 percent of workers. Also، 46. 9 percent of the workers experienced satisfactory sleep and 53. 1 percent of them experienced unsatisfactory sleep. Discussion & With the high incidence of industrial accidents in Iranian industrial environments، the workers’ health must be regarded as a prime necessity. The results of the present study could provide valuable information about the treatment and prevention of psychological disorders for policy-makers and relevant authorities

Nowadays، cancer diseases are the most important causes of death wor-ldwide and the breast cancer is the most important of them within women. Asses-sing the survival of the patients is one of the most important indices of controlling the cancer. This study aimed to make a compa-rison between the prediction of artificial neural networks (ANN) and Cox regression models for the breast cancer survival. The data of the sur-vival study gathered from 344 breast cancer patients between 2005 and 2012 that regist-ered at the Fayyazbakhsh hospital، Tehran، Iran. The status of survival was considered as a dependent variable. Area under rece-iver operative characteristic curve (AUR-OC) and classification accuracy were used for the comparison of artificial neural netw-orks and Cox regression models. Data anal-ysis was performed by R and Minitab sof-tware. The age of participants expres-sed as Mean ± SD، was 49. 9±10. 93 years and the median of survival was 44. 6 mo-nths. Up to the end study، 45 (13. 1) were died. Results showed that AUROC for AN-N and Cox regression were 87. 6% and 75. 4%، respectively. In addition the clas-sification accuracy of ANN and Cox regres-sion were calculated as 89. 42 and 77. 68، respectively. Discussion & According to the results، the total classification accuracy of the ANN was better than those of the Cox regression; therefore، the ANN model is suggested to predict the survival status of breast cancer disease and also is suggested for diagnostic goals.

Given the importance of zinc metal (zn+2) as an essential element in boil-ogical systems and the toxic effects of metals، on the other hand، and the emerg-ence of strains of Staphylococcus aureus (S. aureus) smr+ resistant to tetravalent amm-onium compounds (QACs) due to widesp-read use of materials containing Biocide QACs led to compare the sensitivity of S. aureus strains resistant to zinc and those strains having the biocide benzalkonium chloride and smr genes. S. aureus strains isolation from dairy and clinical samples was performed by using of mannitol-salt-agar medium at 37 ° C for 48 hours and the strains was identified with morphological and biochemical methods. The Smr gene was investigated by PCR and the minimum inhibitory concentration (MIC) of zinc for the bacterial strains was determined using broth microdilution. 20 strains of S. aureus were sele-ctively isolated from 40 samples of dairy and clinical. Smr genes were observed in all S. aureus strains resistant to the biocide benzalkonium chloride. The MIC concentr-ation was reported to be ppm 20. Discussion & The results showed that the growth of all strains of S. aureus، that is، the susceptible and the resis-tant to benzalkonium biocide zinc chloride substance is inhibited in 20 ppm concentr-ation of zinc and the presence of smr gene has no effect on resistance to zinc.

One of the leading causes of death around the world is cancer. Despite the advances in science and technology، man has still failed to cure the disease. The discovery of amazing biological properties of carbon nano tubes caused that they would be good candidates for the research on cancer cells. Functionalization of carbon nanotubes is known to improve their prop-erties. Many compounds that have appli-cations in medicinal chemistry have diazo group. In this paper، we tried to func-tionalize MWNT-COOH with diazo comp-ounds. Modification was confirmed by FT-IR، Raman and SEM spectroscopy. The products were tested on colon cancer cells (SW742) by MTT assay. Viability of the colon cancer cells was investtigated in different concentrations of the functionalized products. The results demonstrated that the viability of cancer cells was profoundly de-creased in the presence of the function-nalized nanotubes. Discussion & Our results reve-aled that the functionalized nanotubes could be a suitable candidate for the synthesis of effective drugs on colon cancer.

Physical and verbal violence against nursing are very critical problems that could influnce the quality of nuring cares. The extent and causes of violence against nurses are not fully determined in Iran، yet. So، the present study investigated all kinds of violences in the training hospitals of Ilam city in 2012. In the discriptive research، 147 subjects of nursing staff who had experinced physical or verbal violences during 2012 were randomly selected from the training hospitals of Ilam city using an author-made questionary. About 88. 7% and 23. 1% of the studied subjects had experinced the verbal and physical violence، respectively. Also، 89. 8% and 23. 8% of the nurses had experi-enced the verbal and physical violence، respectively from the patient followers. Based on the results، the most common violences against male and female nurses were verbal and physical، respectively. Mo-reover، a meaningful relationship was found between the violences and the age of nur-ses. Discussion & Conclosion: The occurance of physical and verbal violence against the nursing staff is high. The situation warns to the scurity autorities of hospitals to pay more attention to the nursing staff. Also، the using of media and the training of medical personnel may be helpful to alleviate vila-nces against nursing staff.

Cardiovascular diseases are the most common causes of mortality and morbidity that threaten the life of human being. American Heart Association (AHA) has estimated that until 2020، approximat-ely 25 million deaths would be occurring because of the diseases and these would be recognized as the first cause of mortality. The aim of the present study was to survey the effect of education on the knowledge and attitude of the teachers regarding card-iovascular risk factors in middle and high school children.

This research was a descriptive study in which 42 teachers in middle and high schools in the urban reg-ions of Ilam were selected by a convenience sampling method. To evaluate the effecti-veness of the education on teachers the interventional education method and two-step test (pre and post education test) were used. At first، data collected by a questi-onnaire that consisted of three parts: Demo-graphic characteristics، questions about knowledge and attitude. After education، the knowledge and attitude of teachers reg-arding cardiovascular risk factors was assessed. Finally، the collected data were analyzed by the SPSS software and the statistics tests، chi-square، fisher exact and parried T- test.

The mean score for the knowl-edge of teachers was 37. 71±3. 1 and 41. 80±1. 5 before and after the education، respectively (P<0. 01). The teachers'' attitude mean scores were 18. 97±5. 1 and 18. 99±4. 6 in pre and post stages of the education which was not significant (P=0. 4). There were significant relationships between the effect of education on the knowledge/ attitude and the job of husband in pre and post stages of the education (P=0. 02 and P<0. 05، respectively). However، there were no significant associations between the sco-re of knowledge/ attitude and other param-eters including age، gender، educational level، location of residence، illness history، and family history of cardiovascular disea-ses (P>0. 05). Discussion &

Results of this research indicated that there was a signi-ficant differences between the knowledge of teachers in the pre and post education stages (P=0. 000). However، there was no significant difference between the attitude of teachers in the pre and post education stages (P= 0. 04).

Ethanol known as ethyl alc-ohol is a volatile، flammable، colorless liq-uid. It is primarily known as the type of alcohol found in alcoholic beverages. Its consumption is very high around the world. It has been reported that ethanol intake is associated with different diseases. There-fore، here in this study the effect of ethanol on human fibroblast cells was investigated. We have carried out cell survival and morphologic studies via Invert Microscope and MTT assay methods to evaluate survival rate and morphological alterations of human fibroblast cells treated with different concentrations of alcohol. Our findings suggested that etha-nol could possibly change human fibroblast cells morphology and survival rate after 48 h incubation. In addition to this، examining fibroblast cells after 48 h culturing without ethanol showed the maintenance of these changes in next generation of the cells. Discussion & It can be conclu-ded that ethanol can possibly cause genetic alterations of the human fibroblast cells، so karyotype evaluations is required to deter-mine these consequences.