نشریه دانشگاه علوم پزشکی بیرجند
سال بیست و یکم شماره 2 (پیاپی 59، تابستان 1393)

With regard to high cancer incidence, as one of the major mortality causes worldwide, following human societies industrialization in recent years breast cancer, dealt with in the present article, has got a particular impact on women who possess a pivotal role in family and society. Thus, adoption of effective diagnostic procedures in the early stages of the disease is very important, which must be considered as a substantial component of the strategies aimed at women’s health promotion and decreasing of breast cancer mortality rate. Meanwhile, women’s education and their awareness promotion and advising them to carry out different methods of breast cancer screening in the early stages of the symptoms, as preventive measures, play important roles. The present review article attempts to study prevalence and epidemiology of breast cancer, its risk factors and its different stages of prevention.

Evidence-based care is defined as combining research findings with caring skills. The current study aimed at a systematic review of obstructions, facilitators, awareness, knowledge, function, perception, and results of interventions in evidence-based care in Iran. In the present survey different data base searching methods and manual search were applied using the key words of “evidence-based”, “evidence-based medical”, “evidence-based nursing”, “evidence-based practice”, “evidence-based care”, “evidence-based activity”, “evidence-based education”, “applying research results”, “research application”, and their combinations with the key words of “obstructions”, “facilitators”, “awareness”, “knowledge”,” function”, “perception”, and” Iran”; and their English synonyms in data bases of PubMed, Medlib, Magiran, SID, CINAHL, Google Scholar, and Iranmedex to collect articles. Out of 819 articles, finally 25articls were used for this study. The most important barriers of evidence-based practice were lack of facilities, lack of time, and lack of expertise in research methods. The rate of familiarity with evidence-based practice specific terms was low (44.22%). Reference books were considered as the most important information sources. Awareness, knowledge, function, and usage of evidence-based practice was low (<50%). Main concepts of evidence-based practice from providers’ point of views were scientific and professional care, patient-oriented and considering service quality. Interventional studies had a positive effect on the improvement of evidence-based practice. Weak knowledge, weak attitude, and time shortage. are among the most significant barriers of evidence-based care in Iran. These problems require more accurate planning and more favorable policies on the part of medical science authorities.

Regarding to various problems in the activation of dendritic cells and immune system’s responses, finding of a safe, effective and applicable agent is highly desirable. Chitosan is an effective gene delivery agent and also a part of nanoscaffolds. In the present study,chitosan nanopolymers effect on dendritic immune cells were assessed. In this experimental-laboratory study, chitosan (150 KD) in acetic acid 1% solution was depolymerized to 10 KD oligomers using NaNO2. The oligomers particles were obtained by means of 2 normal NAOH molecules. Denderitic cells were derived from the rats’ bone marrow using GM-SCF. On the treated denderitic cells CD40, CD86 and MHC-II maturation markers were evaluated by flowcytometery; and TNF-α release was evaluated using ELISA method and T cell proliferation. It was observed that dendrtic cells purity on the 8th day was more than 90%. Flowcytometery analysis showed an increase in all evaluated CD40, CD86 and MHC-II maturation markers (p<0.05). TNF-α release and T cell proliferation significantly increased by chitosan treated denderitic cells compared to unstimulated or lipofectamin treated cells (P<0.05). Results showed that chitosan nanopolymers significantly increased dendertic cell maturation phenotype, proinflamatory cytokine production, and induction of T cell proliferation. Therefore, chitosan nanocomplexes and scaffolds can induce and accelerate immune responses.

Stigmas of Crocus sativus L. is widely used against different human diseases.Regarding the properties of this plant, in the present study the effects of saffron extract on inducing cell differentiation of a rat's bone marrow-derived mesenchymal stem cells (MSCs) into osteoblasts was examined. Bone marrow cells collected from ……..Wistar rat's femor and flowcytometrywere used to identify them. In the experimental group (n=…..) MSCs treatment was done with various concentrations of saffron extract (i.e.0.5, 1, 1.5, and 2 mg/ml). Cytotoxic effect of saffron extract was evaluated using MTT assay and its aqueous extract effect on cell differentiation was investigated by means of Alizarin staining and alkaline phosphates activity. Flowcytometry results confirmed the presence of stem cells using CD44 antibody. MTT assay results showed that the extract concentration of 1.5 mg/ml resulted in the death of 50 percent of stem cells derived from therats’ bone marrow during 24 hours (P<0.001). Alizarin staining showed saffron aqueous extract increased osteogenic s cell differentiation in a dose dependent manner in 21 days. (The maximum cell differentiation achieved by700 μg/ml concentration). Besides, higher alkaline phosphates activity was evident in the experimental group compared to the control group (n=……) in the 14th day (P<0.001). According to the findings of the current study, MSCs derived from the rat's bone marrow transform into osteoblasts when treated with saffron aqueous extract.

Mesencephalic astrocyte-derived neurotrophic factor (MANF) is one of neurotrophines’ family which improves the dopaminergic cells survival and activity. The purpose of the current study was to investigate the protective effects of 12 weeks of voluntary exercise on MANF level in the brainstem of parkinsonian rats against the destruction of substansia nigra’s dopaminergic cells using 6-hydroxydopamine. In this experimental study, twenty-five male rats were divided into three groups: Base (healthy control, n=9), control-Parkinson (n=9), and voluntary exercise-parkinsonian (n=7). The voluntary exercise control group/ healthy group (n=9) were housed in individual cages geared with running wheels and had activity for 12 weeks. To induce parkinson in the second group (n=9), 250 microgram in 5 microliter 6-OHDA (dissolved in saline) was administered intracerebroventricularly (ICV) using a stereotaxic apparatus.The third healthy exercise group only had voluntary exercise for the same period. Finally, MANF levels in the brainstems were measured by means of ELISA. The obtained data was analyzed using one-way variance analysis (ANOVA) and Tukey post hoc. Mean running distance of the subjects was 5384±764/16 meter per day. In this study MANF levels between exercise group and Parkinson control had significant differences (P=.001). In other words, decrease in MANF levels was prevented in the exercise group (P=.001). MANF levels in the exercise group remained almost at the same level as the Base group (healthy control), P=0.615). voluntary exercises cause the amplification of MANF against oxidative damage induced by 6-OHDA toxicity and have a protective role against parkinson.

Nonalcoholic fatty liver disease is the most common cause of abnormal liver enzymes. We aimed to investigate the effects of of resistance and combined exercise on levels of liver enzymes in women with fatty liver disease. In this study, 37 women were assigned into three groups including control, resistance and combined exercise groups. Resistance exercise protocol included 8 movements, 3 sets, 8-10 repetitions which performed at %60-75 of one repetition maximum، 3 times per week for 8 weeks. Combined exercise included 4 resistance movement in the first half of training session and the aerobic exercise at intensity of %60-75 maximum heart rate in the other half. The AST, ALT and ALP were measured using biochemical methods. Paired t-test results for the extraction of one-way ANOVA, at a significant level of 0/05 were analysed. The level of ALP only in the resistance exercise group significantly decreased (p=0. 03), but AST and ALT levels did not significantly change in any groups (p>0. 05). The mean of ALT/AST ratio significantly increased in the resistance exercise group (p =0. 04), but no significant changes were observed in the combination and control groups. The mean of flexibility (p=0. 001), maximal oxygen consumption (p=0. 02), muscle strength (p=0. 003) and grip strength (p=0. 001), significantly increased after resistance exercise. None of the resistance and combined exercises had significant effect on the levels of AST and ALT, but the resistance exercise improved ALP and fitness indicators. Therefore, resistance exercise may be more favorite for fatty liver patients.

Exercise helps in the favorable function of insulin.The obese people have metabolic complications. Thus, the present study aimed at investigating the effect of aerobic exercises on pancreas Beta- cells function in obese men. In this semi-experimental study, fasting levels of glucose, insulin, triglyceride, and pancreas beta cells function in two equal randomized groups of obese men; i.e. the experimental group (28 men) and the control group (14 normal weight men men) were compared with those of a group ofThe experimental group participated in a three month aerobic training and the control group were banned from any exercise training during this period. Anthropometrical and biochemical indices in the experimental and control groups were measured again after the period of three months. Independent T test was used for comparison between the two groups Paired ‘t’ test was applied to compare the pre- and post-training values. It was found that obese subjects have a lower beta cells function and higher glucose and triglyceride levels compared to normal weight men (p ≤ 0.05). Beta-cells function significantly increased after aerobic exercise in the experimental group (p = 0.019). In addition, fasting glucose (p = 0.023) and triglyceride (p = 0.031) concentrations and anthropometrical indexes such as body weight (p = 0.028), body fat percentage (p = 0.016), and body mass index (p = 0.024) decreased due to exercise intervention in the experimental group. A significant negative relationship between beta cells function and FBS was diagnosed after the exercise program (P=0.014, r=0.68). Aerobic exercise training increases beta cells function and decreases FBS in obese men. These findings support the hypothesis that regular physical activity postpones the occurrence of type 2 diabetes in adult obese subjects.

Growth spurt during adolescence, particularly the occurrence of menstruation in girls, increases their nutritional needs. The present study aimed at determining the effect of nutrition education on nutritional knowledge and Behavior of secondary school female students in the city of Birjand. In this quasi-experimental study, 120 second grade secondary students in Birjand in 2012 were selected through two-stage cluster sampling method and were randomly divided into intervention and control groups. Data collection tool was a questionnaire which was completed by the students both before and one month after intervention. The obtained data was analyzed by means of descriptive and analytical statistics including chi-square, independent and paired t-tests, and ANOVA at the significant level of 0.05 using SPSS software (V:16). Mean scores of nutritional knowledge in the intervention group after education increased from 21.35±4.57 to 26.66±4.4 (P>0.001) and their mean performance increased from 1.84±7.39 to 1.86±8.31 (P<0.04). A significant difference in mean scores of knowledge between the control group and the intervention group was observed (P<0.05). However, performance mean difference between the two groups was not significant. Education through lecture and asking/answering questions can significantly increase adolescents’ awareness and to some extent, their nutritional performance, although more effective methods are advised to promote the situation.

Malnutrition is a prevalent health problem but an unknown one to which little attention has been paid. This can increase complications, morbidity and mortality of the disease. Therefore, early detection of malnutrition to provide nutritional support for patients is very crucial. The main objective of the present study was to determine the nutritional status of patients admitted to the hospitals affiliated to Birjand University of Medical Sciences (BUMS). This cross-sectional study on patients admitted to five hospitals affiliated to BUMS was done in 2011. Through stratified random sampling, 549 patients older than 20 years were selected from five hospitals and their nutrition status was determined by means of measuring their height, weight, and body mass index according to Malnutrition Universal Screening Tool (MUST) on their admission. The obtained data was analyzed by SPSS (V:16), using X2 at the significant level P <0.05. Mean age of the patients was 49 ±20 years. Among them, 52.8% were males. Prevalence of malnutrition was 58.8% from which 53 % were at high risk and 5.8 % at medium risk. Among the patients, 148 (57.1% female patients were at high risk of malnutrition; whereas, in the males the high risk was diagnosed in 143 (49.3%) which the difference was significant (men) (P=0.03). Prevalence of malnutrition in citizens was higher than villagers (P=0.001). It was also significantly higher in over 45 year olds compared to other age groups (P=0.04). Malnutrition is a common problem from which more than 53 % of the patients suffer. Therefore, an organized clinical nutritional service in the health centers are required.

Burn is among the most expensive injuries which occur at all ages. Regarding the notoriety of burns and differences in population, community, economics, and cultural sectors, obtaining particular information from each area is needed to plan for prevention and treatment. Thus, the present study aimed at determining epidemiological factors related to hospitalization in the burns ward of Birjand Imam Reza hospital. This cross - sectional retrospective study was done on 1160 burn patients who hospitalized in the burn center during 6 years, (between 21 March 2007 and 21 March 2013). The necessary data was collected by means of a researcher designed questionnaire. The obtained data was analyzed by SPSS software (V: 15.5) and applying descriptive statistics including chi-square and Mann Witnietests (P≤0/05). Mean age of the subjects was 24.6 20.6 years. Length of hospitalisation was 11.6± 12.4 days. The majority of the patients were men (58.8 %). Among the cases, 54.1% were single24.1% were unemployed, 71.4% had either no education or only primary education, and 60.4% were provided with health insurance. It was found that the most common causes of burning were kerosene and or gasoline flame (43.9 %); and most burns were due to accidental injuries at home (73.1 %). Among the patients, 37/8 % had burned body surface of 10% – 29%. Most (55.9 %) had a combination of 2nd degree and 3rd degree burns, of whom 14.1 % of died. Most patients were admitted in in winters (28.2 %) and autumns (26 %). There was a significant relationship between variables of burns causes in the patients (P=0.001) and the burned body surface percentages (P=0.001) and also with the season of the year. There was also a significant relationship between age groups and the percentage of burned body surface (P=0.001). Burns are more prevalent in men (compared to women) and in children.

Cutaneous leishmaniasis is an endemic diseases with important public health in Iran. The cinical signs of disease were seen as dry and wet forms. It is essential to distinguish leishmania species in every area for designing control of diseases. The morphology of leishman bodies in each speiecis are very similar and need to sensitive diagnostic method such as PCR to differntiate of them. The present study,a molecular study has been done to identify of leishmania species in Mashhad area from autumn in 2011 to summer in 2013. Firstly, tissue smears were collected from the lesion of one hundred patients and from the ulcer of 25 paitents were cultured in NNN nutrified with RPMI. The positive samples (tissue smears and culture) were used for DNA extraction and PCR. PCR methods were used in two steps. Firstly a sensitive PCR was used to detect the leishmania genus and secondly, the positive samples were examined with species specific semi-nested - PCR In first step of PCR, all of sampled were positive for Leishmania spp and in second step Leishmania tropica and L.major were detected in 94% and 6% in positive –PCR amplicon, respectively. Based on the results, Leishmania tropica is more prevalent than L.major in Mashhad.

Depression, due to its high prevalence and subsequent effects, is one of the important public health issues. Regarding the specific educational problems in the field of medicine and the importance of medical students’ mental health the present study aimed at comparing the prevalence of depression in the first two and the last two years of medical in Birjand University of Medical sciences. This descriptive analytical and cross-sectional study was done on 151 medical students in the first two and the last two years in Birjand University of Medical Sciences in 2010. Assessment of depression was done by means of Beck’s brief questionnaire in both groups who had been selected in a census. The obtained data was fed into SPSS software (V: 15) and was finally analyzed using by χ2 and independed Student-t tests at the significant level α<0.05. A total of 151 students whose mean age was 22±2 years participated in the current study. Prevalence of depression in all the cases in all types of the problem i.e. mild, moderate, and severe was 31/8%. Prevalence of depression in the first two years and the last two years was 29.8% and 34.3%, respectively; which was not statistically significant. Prevalence of depression in males was more than females, which was not significant either. Besides, no significant relationship was found between prevalence of depression with variables such as age, residence, parental education, housing, and employment status of parents. Apparently, prevalence of depression in medical students in Birjand university of Medical Sciences is high, although studying medicine is not significantly decisive in the occurrence of the problem.

Notwithstanding the benefits of radiography, the staff of radiography wards must take necessary care to minimize their own and patients’ exposure to harmful rays. Therefore, the present paper aimed at assessing the radiolographers’ awareness and performance concerning technical and protective principles. In this descriptive-analytical study, all the 26 radiolographers working in the radiology wards of Vali-asr and Imam Reza hospitals of Birjand participated. In order to collect data about their performance, a checklist whose reliability and validity had been approved was provided. For the radiography staff 17 technical and 12 protective items during three work shifts were checked and recorded. In order to measure their awareness of technical and protective principles, a 12-item questionnaire was completed by each of them. The obtained data was statistically analyzed by means of SPSS software using X2. Mean Performance score in the technical area in the three work shifts was 15±1.60, and that of the protective area was 10.9±1.1 both of which were at an average level. Around 46.5% of the subjects gave correct answers to protective and 37.2% of them to the technical questions. The comparison of technical and protective performance scores showed no significant difference in terms of work shifts, education, gender, and type of employment (P>0.05). The radiographers’ awareness of technical and protective principles was at a very low level. Therefore, both quality academic training and in-service education seem necessary.

Acanthamoeba is a free-living amoebae commonly found in the environmental sources such as soil, water, and dust. This parasite is the causative agent of amoebic keratitis (AK). The objective of the present study was to investigate the presence of Acanthamoeba genotypes in water sources in Bojnurd City. Totally, 50 samples of water were taken from different localities of Bojnurd including agricultural canals, rivers, and swimming pools. Filtration and cultivation were carried out on non-nutrient agar medium (NNA). PCR analysis was conducted on positive samples. Sequencing was done for 10 PCR products. Genotypes were identified by means of Blast search and homology analysis. The obtained data was analyzed using SPSS software (V:16). Acanthamoeba amoebae was found in 34 (68%) samples of the water. Genotyping of 10 samples proved to be T4(100%) genotype. While Acanthamoeba amoebae is found in our surrounding environment which unknowingly contaminates us every day. Thus, to prevent the contamination, hygiene consideration is recommended.

Ameloblastic carcinoma is an extremely rare malignant neoplasm which mostly occurs in the mandible and at a wide age group. It has no gender bias and has specific histopathologic features and its surgical treatment requires more aggression than ameloblastoma.. The number of reported cases of the disorder are rare, and it is very difficult to diagnose based on histopathologic findings because the diagnosis of this lesion requires differentiation from some other malignant neoplasms and ameloblastomas. The present report deals with a case of ameloblastic carcinoma in the mandible in which ameloblastoma should be taken into account, regarding clinical and microscopic features of the neoplasm.