نشریه دانشگاه علوم پزشکی خراسان شمالی
سال هشتم شماره 2 (تابستان 1395)

The hemodialysis effectiveness is depended on adherence to the therapeutic regimen recommendations. Every aberration from the therapeutic regimens, results to the severe clinical outcomes. Therefore, finding an effective teaching method is essential. The aim of this study was to assess the impact of training through text messaging via cell phones on the compliance of therapeutic regimens by the hemodialysis patients.
In this before and after quasi-experimental study, thirty hemodialysis patients had been selected through Simple Random Sampling method who were referred to Emam Ali Hospital of Bojnurd in 2016. One therapeutic regimen recommendation text message was sent for 4 weeks (28 Persian text messages per day). Data about the amount of serum phosphorus and potassium, interdialytic weight gain, and patient’s absence in the sessions were collected before and after sending messages. Statistical tests such as paired t-test were performed using the SPSS v 20.
There were significant differences in compliance of diet (p=0.002), medication regimen (p=0.003), and regular attendance at dialysis sessions (p=0.000) before and after training by text messaging via cell phones. There wasn’t any significant difference between fluid limitation compliance before and after training by text messaging via cell phones (p=0.759).
Regarding the effectiveness of text messaging and availability of this method for the majority of patients, planning for using this training method can be beneficial for the education of patients.

Staphylococcus aureus is one the main human pathogens which is involved in a wide range of infections. Although, Vancomycin is one of the best drugs to treat infections which are caused by S.aureus, indiscriminate use of vancomycin causes resistant strains. The aim of this study was to investigate the possible presence of vancomycin resistant strains and determination of their antibiogram patterns.
Material and In the present study, Staphylococcus aureus was isolated from the 100 clinical specimens. All the isolates were identified using gram staining, catalase test, tube coagulase test, growth on Mannitol salt agar medium, and the DNase test. Susceptibility of the isolates against 9 different antimicrobial agents was investigated using the standard disk diffusion. MIC values of vancomycin was also tested by agar dilution methods, according to the CLSI. Moreover, Polymeras Chain Reaction (PCR) was performed to detect the vanA gene.
All of the Staphylococcus aureus isolates were sensitive to vancomycin (MIC value ranged from 0.125 to 2 μg/mL). Ampicillin and vancomycin revealed the highest and lowest resistance rates with 80% and 1%, respectively.
Fortunately,vancomycin resistant staphylococcus aureus was not found among the tested isolates in this study. Therefore, vancomycin can still be used in treatment of Staphylococcus aureus infections.

Neuro-developmental cares refer to a wide range of interventions which are designed to reduce environmental stress and improve the living conditions of premature infants who are hospitalized in neonatal intensive care units. The aim of this study was to evaluate developmental care based on the three-part model of structure, process, and outcome.
Material & This cross-sectional study was conducted by 390 nurses and 200 pre-term infants from 27 of level III- NICU in Tehran. Data were collected with valid and reliable tools included structure's check list, developmental care's questionnaire, and outcome's check list. Data were analyzed using descriptive statistics and Pearson correlation coefficient with SPSS version 21.
The average age of the infants was 32.90 weeks. The average of quality scores of structure and developmental care were 43.06% and 72.29%, respectively. Mean time of started oral feeding and length of hospital stay were 5.28 and 11.49 days, respectively with a weight difference of 408.80 gr. There was correlation between "sensory cares" and "daily cares" with length of hospital stay and started oral feeding. There was also correlation between "family cares" with weight difference and started oral feeding. There was also correlation between "sleep and pain care" and weight difference.
Structure and process of developmental care require more attention. The correlation between the areas of structure and process with outcome measures indicated that the Donabedian's model is effective to assess the quality of developmental cares.

Lack of concentration in classroom is considered to be one of the most prevalent educational problems throughout education. The aim of this study is to discover and determine factors contributing to the students’ concentration in North Khorasan University of Medical Sciences.
Material & This descriptive study was performed on 460 students of North Khorasan University of Medical Sciences. A questionnaire consisting of two parts including; demographic data and 21 questions was used to assess the effective factors in students’ concentration. Data were analyzed by SPSS-14 software based on frequency of distribution, mean and standard deviation.
Most of the cases (66.3%) were female and the overall mean age was 21.3± 3.4 years. Among the teacher-related factors and student-related factors, "Proper time management by the teacher at presentation" (mean 3.34±0.90) and “Interest in the subject" (mean 3.42±0.41) were proved to be the main interfering factors, respectively. Among the environmental factors, proper lighting and ventilation (mean 3.2±0.86) were also the most significant factors.
According to the students’ views about concentration, changing some behavioral patterns among the students could lead to improvement in their concentration level. This may include planning for enough rest, paying attention to present the applied topics, and consequently encouraging students, and providing a convenient learning setting such as physical conditions of the classroom.

According to the report by Iran Drug Control Headquarters, 657 thousand drug-dependent patients are under maintained treatment in Iran. The aim of present study was investigation of treatment-retention in patients who were undergone the maintained therapy using Methadone, Buprenorphine, and opium tincture in Shirvan city. It should be noted that the treatment with opium tincture is done only in Iran. Therefore, the success of this method is a controversial issue.
Material & This is an analytical-descriptive study. The population of this study were included all active patients and also patients who have abandoned treatment in 6 public and private addiction treatment centers of Shirvan city in 1394. Data were analyzed by SPSS software, and chi-square test was used to compare the qualitative variables.
Retention rate of Methadone, Buprenorphine, and opium treatments were 84.5%, 71.7%, and 90.1%, respectively. A significant difference was observed among these treatments, so the opium maintained treatment has the highest retention rate.
The results revealed that the retention rate in treatment with opium tincture is higher than that in the other two methods. If we focus on the goals of harm reduction programs, results show that the opium tinctures treatment can reduce significantly the amount of social damage.

The drug addiction has different aspects and leads to the significant clinical damage. It can be related to the biological processes and personality traits such as temperament and character.
Material & This correlation study assessed relationship between temperament and character features and severity of addiction. Two hundred thirty five prisoners and 50 non prisoners who were drug-dependent individuals were randomly selected from Quchan. Participants replied to the Addiction Severity scale (ASI) and temperament and character features (TCI-125).
The results showed that there was a significant difference between temperament and character features in addicted prisoners and non-prisoners in all subtests of temperament and character features (P Attention to the personality character and severity of addiction can be effective on treatment, harm reduction and drug craving interventions.

Students are one of the main human capitals of societies. Therefore, paying attention to their health is considered as a new investment in future. One of the effective ways to improve the health of students is training of school health educators in higher education system. The current study aimed to design, develop, and provide curriculum topics in the continuous undergraduate of school health.
Material & This study was a qualitative applied research. The study population were included all the ideas of professionals in the field of school health and curriculum. These opinions have been shown in the form of documents. Study population also includes all curriculum planners and school health specialists who were working in the ministry of education, in Tehran. The targeted sample was included the curriculum and school health records (both internal and external), as well as a choice of 12 curriculum specialists and school health experts. The research tools were curriculum documents and school health and semi-structured interviews which were performed by the curriculum specialists and school health professionals.
The results showed that the curriculum model of Baccalaureate school health, with key elements including the curriculum (objectives, content, teaching methods and evaluation) is in line with the country's higher education system, and it can prepare the condition to train school health educators.
Commissioning of Baccalaureate school health in higher education system is not only a new way to train the health educator for schools, but also prepares the possible growth of student's personal and social health.

The maternal initial assessment of infant's temperament is one of the most important associated factors with mother-child interactions and maternal's adjustment with parental role. Maternal's psychological condition is one of the possible factors affecting her perception of infant's temperament. The purpose of this study was to determine the correlation between depression, worry, and perceived social support with basic understanding from infant's temperament.
This descriptive-analytical study was performed on 128 primiparous women who were referred to Mashhad health centers within five months in 2014-2015. Data were collected based on Edinburgh Depression, Cambridge Parental Worry, Bate's Infant Characteristic, and perceived social support questionnaires which were completed at the first two months after birth. Data were analyzed using the T-test, One Way ANOVA, correlation, and regression tests.
The mean score of perceived infant temperament was 51.56±10.54. The relationship between maternal's worry ((p=0.017) and depression (p=0.036) with perceived infant temperament were significant. There wasn’t any significant correlation between perceived social support and infant temperament (p>0.05). After entering these variables in the regression model, just parental’s worry was able to predict 0.093% of the infant's temperament variance.
According to this finding, there were significant correlation between worry, and depression, and maternal's perception of infant's temperament. This correlation probably indicates that the mental disorders in mother can affect the future outcomes of mother and infant. Further research is recommended to identify the other factors affecting maternal's perception of infant temperament

Stroke is considered the most common neurological disease and also includes the most common cause of mortality among neurosurgical patients. This study assessed the correlation between pumpkin seed oil diet on reducing the permeability of the blood-brain barrier and brain edema in a rat stroke model.
In this experimental study, thirty five male rats (Wistar) were divided into 5 groups with 7 members. These groups include the control, Sham, and three experimental groups that received oral doses of 0.25 and 0.50 and 0.75 ml/kg pumpkin oil through the gavages for 30 days. Brain ischemia (Middle Cerebral Artery Occlusion: MCAO) was induced two hours after the last gavage, and the permeability of the blood-brain barrier and brain edema was measured after 24 hours.
The permeability of the blood-brain barrier was significantly decreased in pretreated rats (0.50 and 0.75 ml/kg pumpkin oil) in comparison with the control group (p The results showed that pumpkin seed oil consumption in rats suffered from ischemia-reperfusion can be effective in reducing the symptoms of ischemic stroke.

Post-operative shivering is a common problem following the increased oxygen consumption leading to some other problems such as intracranial and intraocular pressure, and post operation pain. The goal of this study was comparing the effect of Pethedine (Meperidine) and Dexamethasone on prevention of shivering during the simple urological surgeries.
Material and This double blind clinical trial study -was performed on 120 patients who were candidates for simple urologic surgery. The patients were randomly divided into two different groups including those who were received Dexamethasone (D) and Pethedine (P). After pre medication using the Midazolam, Lidocaine, and Fentanyl, similar anesthetic induction was done by injection of Dexamethasone (8mg) and Pethedine (25mg) to the groups D and P, respectively. All the patients were controlled for visible shivering in recovery.
There were not any significant differences between two mentioned groups in the case of weight, age, and duration of surgery. Only nine cases (15%) in group D had post-operative shivering. Whereas, twenty six cases in group P (44.3%) had shivering and the difference between 2 groups was significant (P value =0.002).
Pethedine and Dexamethasone are effective drugs for the prevention of post-operative shivering in simple urologic surgery. The effect of Dexamethasone in preventing the post – operative shivering was better than Pethidine.

Acute appendicitis is one of the most common causes of abdominal emergency surgery. Experienced investigators will have an accuracy of more than 90% to diagnose the acute appendicitis. Sonography may diagnose many diseases which have similar clinical symptoms to the acute appendicitis.
In a prospective descriptive study, we reviewed the sonographic findings of 230 patients who were suspected to have acute appendicitis. The patients with typical clinical and laboratory sign were excluded from the study. The diagnostic accuracy of sonography was evaluated in detection of diseases with similar clinical symptoms among the patients.
In the present study, seventy-two (31%) cases had abdominal or pelvic pain of unknown origin and they were ultimately dismissed without any specific diagnosis. Acute appendicitis was approved in 78 out of 158 patients after the surgery and appendectomy and sonographic results in 70 cases (89.7%) was positive integer. In sixty out of 80 (82.5%) patients without risk of acute appendicitis, ultrasound accurately diagnosed that the acute gynecological diseases were the most common pathological cause of diseases. The urinary tract diseases and gastrointestinal diseases were other cases.
Sonography is a valuable modality to establish the differential diagnosis of acute appendicitis, which is recommended for evaluation of patients with equivocal clinical diagnosis. Therefore, in patients with a clinical diagnosis of acute appendicitis and negative ultrasonographic results, assessment of other abdominal organs and pelvic cavity by ultrasound can be a valuable diagnostic complementary procedure.

Water of swimming pools can be polluted by some materials of the swimmers bodies such as hair and respiratory microbial flora. Insufficient water treatment process will be a possible vector of infectious diseases to the swimmers. This study was performed to assess the biological quality of Ayoub hot spring.
Material & The present study was a descriptive cross sectional. The samples were obtained twice per month from Ayoub public hot spring pool in 3 months during June to August. Temperature, pH, ORP, DO, EC, turbidity, free chlorine were measured on-site sampling. Standard methods were used to examine the samples for the total and fecal coliforms such as P. aeroginosa, S.aureus, and HPC. Finally, the data were analyzed using the Excel and SPSS- 16 softwares.
The average of temperature was higher than that the standard and the average of pH was about standard. Most pollution by the coliforms was during the July and August. The P. aeroginosa was also the most important pollutant on June.
Pollution of hot spring in some of the seasons is higher than that the standard. Therefore, it is suggested that the monitoring and disinfection of the public hot spring pools should be considered more seriously. It is also necessary to limit the number of swimmers in public hot spring pools to reduce ratio of contamination.

The patients with gastrointestinal symptoms comprised a large number of cases who referred to the general and interior clinics. It seems that the reaction of people to stressful events is more important than the stress in the generation of digestive diseases. The aim of this study was to determine the relationship between coping strategies and peptic ulcer.
Material & The present study was conducted with a cross-sectional and analytical design. Two hundred people (100 patients with peptic ulcer symptoms such as duodenal, gastric, and esophageal ulcer and endoscopic indication who were referred to the Imam Reza hospital in Bojnurd and confirmed for the peptic ulcer and 100 healthy subjects who had no history of peptic ulcer) were compared together. These people were selected using available sampling method. The measurement tools were included: Coping Strategies Scale (CSS) and socio-demographic checklist. Data were analyzed using the Mann-Whitney test and SPSS 20.
There was a significant difference between people with peptic ulcer symptoms and healthy cases regarding to the coping strategies such as seeking social support (p Emotional and negative coping strategies in stressful situations can act as a risk factor for the peptic ulcer. The people with peptic ulcer symptoms used more emotion-focused and negative coping strategies such as re-evaluation-adjustment, and avoidant coping in comparison with the healthy subjects.

Posterior cruciate ligament is very important in stabilizing knee joint and its rupture and avulsion may result in instability and joint degeneration. The aim of this study was to evaluate the operation outcome of PCL ligament binding site avulsion.
Material & In present study about 30 patients with avulsion fracture on Tibial PCL binding site were undergone the open surgery and fixation with screw. The patients were followed up for at least 6 months after the operation and were evaluated by the Lysholm Knee Score checklist.
The mean age of patients was 28 years. The common injury mechanism for these patients was motor accident with machine (MCA). On the Lyshom Knee Score, twenty one persons (70%) scored as good (60-90) and 9 (30%) cases were scored as fair (30-59), with a mean score of 86.
Clinical outcome achieved from physical examination of the knee and the checklist score, suggests that the posterior cruciate ligament avulsion fracture injury is not solely a bone fracture and should be viewed as bone-ligament injury. It seems that operation approach is an appropriate method to improve knee function and reduce the complications.

Neonatal Sepsis is the most important disease in the first 28 days of life which is diagnosed definitely using the blood culture. The C-reactive protein test (CRP) is a simple method for the early diagnosis of sepsis, which is not so used. This study was conducted to determine the diagnostic value of this method in sepsis.
This cross-sectional study was performed on 100 newborns that were suspected of sepsis in Shahrood hospitals. Their quality CRP was measured using sepsis routine tests in the first 6, 24, and 48 hours of admission. The CRP≥1was considered as positive CRP.
Most of the certain sepsis cases were among the new borns who were heavier than 2500 g (p This study showed that the serumal CRP levels can be used as a quick and sensitive test, to approve or disapprove the certain sepsis especially in the first 24 to 48 hours of neonatal sepsis occurrence.