مقالات رزومه دکتر سید غلامرضا مرتضوی مقدم

With the emergence of Corona disease in late 2019, the healthcare network was directly and indirectly affected, and the process and management of patients other than COVID-19 changed. To evaluate some of these changes, the present study was conducted on post-COVID-19 hospital admissions of patients who have been infected with Coronavirus in the past. The census method was used for patients’ recruitment. The collected data was analyzed using descriptive/analytical statistical methods. A total of 202 patients with a mean age of (57.60±18.73) years, including 109 (54%) women and 93 (46%) men, were recruited. The number and percentage of cases admitted in internal, infectious, neurology, and heart wards, were 63 (31%), 52 (25.7%), 35 (17.3%), and 31 (15.3%), respectively. No correlation was found between the history of hospitalization and the type of treatment specific to COVID-19 (Remdesivir) and the disease that led to re-hospitalization after recovery from COVID-19 (P=0.08). Regardless of whether receiving Remdesivir or not, post-COVID-19 hospitalization due to various reasons in internal and infectious wards was the most frequent, respectively, followed by cardiovascular events.

Asthma is a chronic airway disorder with a rising prevalence. Dietary factors, antioxidant indicators and vitamin D deficiency are associated with the disease. Due to the presence of receptors for this vitamin in the lung, this study aimed to investigate the effects of vitamin D administration on lung function, serum immunoglobulin E (IgE) level and total serum antioxidant activity in patients with moderate to severe asthma.

In this clinical trial, 60 patients with asthma were randomly divided into two groups: a control group (placebo recipient) and an intervention group (recipient of 2,000 vitamin D capsules for 12 weeks). At the beginning and at the end of the study, 5 cc blood samples were taken from each patient, and spirometry test was performed. Total antioxidant capacity (TAC), IgE and vitamin D parameters were measured.

The mean score of forced expiratory volume (FEV1) and FEV1/FVC in both groups as well as the mean FVC in the control group did not change significantly after the intervention. The mean FVC score, vitamin D level and TAC in the intervention group increased significantly after the intervention, while the IgE levels reduced significantly.

Taking vitamin D tablets could increase the antioxidant parameters in asthmatic patients.

Regarding immune-regulatory roles of vitamin D as well as its effect on Chronic Obstructive Pulmonary Disease (COPD), the present study aimed to evaluate serum vitamin D levels in patients with COPD exacerbation. The study population included 70 patients with COPD exacerbation who were hospitalized in the general ward of an affiliated hospital with Birjand University of Medical Sciences, Birjand, Iran. Blood samples were taken from the patients and transmitted to the laboratory for vitamin D serum levels assessment after serum separation. The patients were staged according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Spirometry was performed during the disease exacerbation and one month after discharge. The Mean±SD age of the studied patients was 65.44±13.3 years. Out of the70 studied patients in this study, 33 (47.1%), 28 (40%), and 9 (11.7%) cases had vitamin D deficiency,  insufficient levels of vitamin D, and normal serum levels of vitamin D, respectively. Mean±SD vitamin D serum level in the studied patients was obtained at 14.1±1.98 ng/dl. No significant difference was observed between vitamin D serum levels in different stages in terms of severity of COPD (P=0.26). Based on the obtained results, most patients with COPD exacerbation suffer from vitamin D deficiency. Therefore, the measurement of vitamin D serum level and prescription of vitamin D supplements seem to be a necessary measure for these patients.

Student-centered educational models, such as Flipped classrooms, seem to provide more educational opportunities for learners, especially when combined with web technology. This study aimed to evaluate the effectiveness and satisfaction of medical students with the web-based Flipped classroom method in comparison with the lecture-based teaching method.

This is a quasi-experimental case-control study that evaluates 51 people in each of the two intervention and control groups. In the intervention group, pulmonary physiopathology e-contents were delivered to the students one week before the presence-based class in the form of digital files such as video, text, image, audio and interactive applications through Navid learning management system. Students were required to read the content before the class. Then the face-to-face classroom time was completed with group discussion, question and answer and problem-based learning. In the control group, teaching was carried out by the traditional lecture method in the classroom. Data were analyzed using SPSS, 18.

In terms of age, sex and, mean pre-test scores, there were no significant differences between the groups. The mean scores in the final exam turned out to be 14.66 (10.16-66) in the intervention group but 12 (9.14-3.66) in the controls (P < 0.001) to make a significant difference. In addition to gaining higher final exam scores as for the flipped classroom group, they were also more satisfied with the procedure (P < 0.001).

The flipped classroom approach not only improves learning but also leads to greater students’ satisfaction.

 Considering the cost and some limitations in measuring the percentage of expiratory volume in the first seconds (FEV1%), This study was performed to determine the relationship between oxygen saturation percentage (SPO2%) with expiratory volume in the first-second (% FEV1) in patients with obstructive pulmonary disease(COPD).

In a descriptive-analytical study, 25 women and 25 men with COPD were selected by Non-probability and simple sampling from patients referred to the outpatient clinic of Vali-e-Asr Hospital regardless of the severity of the disease. To measure% FEV1 by spirometry method And a finger pulse oximeter was used to measure SPO2.Statistical tests including Pearson test and independent t-test and linear regression model were used.

The mean patient age 18/63 ±  47/10  years,  average% FEV1 of 15/16 ± 60/36 and the mean SPO2% 20/84 ± 53/5 was respectively. The correlation coefficient between% FEV1 and SPO2% was 0.36 (P=0.01). Mean of SPO2% in smokers and non-smoker was %82.67±5.22 and %86.50±5.29 respectively (p=0.02). Regression analysis in constant conditions showed %FEV1 By increasing one unit SPO2%, The amount of FEV1% probability by a factor of 16/0 will be increased 0.36(P=0.02).

  The amount of SPO2% significant correlation at the medium level with the amount of %FEV1 and can predict to some extent FEV1%;  Therefore, it has been diagnosed in people with obstructive pulmonary disease and It can be used for evaluation and follow-up of patients instead of spirometry.

Chronic obstructive pulmonary disease (COPD) is a syndrome with progressive and irreversible airflow limitation. The aim of this study was to evaluate the effect of Atorvastatins on blood parameters includingblood gasses in patients with COPD. This randomized double-blind, controlled clinical trial study was conducted on the case and control groups of patients with COPD in Vali-e-asr hospital in Birjand in 2015. In the laboratory, 15 cc of venous blood was taken from each subject. Initial tests included white blood count (WBCs), hemoglobin(Hb), PH, and Pco 2. O2 saturation was observed at rest by means of Pulse Oximeter for the duration of one minute and the highest value was recorded. Out of the 34 patients, 18 cases (52.9%) were treated by atorvastatin and 16(47.1%). . received conventional treatment Mean age of the atorvastatin and control group was 65.8 ± 11.5 and 63.7 ± 7/6 years, respectivly. The case group showed a significant decrease in mean count of WBC and hemoglobin, but increase in O2 saturation after intervention. In conclusion, it can be concluded that taking atorvastatin has a significant impact on the reduction of hemoglobin and increase of oxygen saturation in COPD patients, which requires further studies.

Continuous evaluation of educational activities plays a critical role in the promotion of educational programs. The present study aimed at assessing . the viewpoint of medical students on the effectiveness of educational programs and regulations in clinical training.
A cross-sectional and descriptive-analytical study was conducted in the . internal medicine ward in vali-e-asr hospital of Birjand University of Medical Sciences. All medical students were selected via census from those who had passed their internal medicine training over the past 2 years (2014-2016). Viewpoint of the students on the effectiveness of the internal medicine ward regulations and educational programs were evaluated by means of a researcher-designed questionnaire. The questionnaire included 10 questions regarding educational regulations and 26 items about educational programs.Finally, the obtained data was fed into SPSS (V: 16) software using independent T-test for analysis at the significant level of alpha=0.05.
A total of 100 students, including 36(36%) interns and 64(64%) stagers filled out the questionnaires. Mean viewpoint score of the students on educational regulations was 2.66±0.86. Mean viewpoint score of students on educational rules affecting attendance of students and instructors in training fields was 3.25±1.22 and 3.23.09 , respectively. Regarding the educational programs, the highest and lowest scores belonged to the outpatient clinic ground conferences; (3.31±0.74) and (2.84±0.79), respectively.
A polyclinic can be an appropriate spot to transfer clinical-educational programs,but ground conferences are not considered suitable for stagers and interns.. Running educational regulations can gurantee more attendance of students and instructors in clinical training.

Familial Mediterranean Fever (FMF) is a hereditary disease. Recurrent peritonitis is one of the chief manifestations of FMF. Peritonitis attacks are often indistinguishable from those of abdominal surgery and may lead to one or more surgical procedures before diagnosis of FMF. Meningitis in patients with FMF is rare. The present report refers a 28-year-old man with recurrent attacks of peritonitis who had 2 abdominal surgeries and one attack of meningitis. Clinical diagnosis of FMF based on clinical history was made. After colchicine therapy، during 3 years follow up، just two mild attacks of abdominal pain but no further recurrence of meningitis was observed. Therefore، definite diagnosis of FMF based on Tel-Hashomer criteria was considered. The present case has three suggestions: one is that each abdominal attack of FMF patients may lead to an unnecessary laparotomy prior to diagnosis of FMF. The second is that FMF patients can present with mild abdominal pain while they are receiving colchicine، and the third is that meningitis should be considered as an unusual manifestation of FMF with excellent response to colchicine therapy.

A hemothorax is a condition that results from blood accumulation in the pleural cavity. By far, the most common cause of hemothorax is trauma. However, a number of nontraumatic causes or spontaneous hemothorax may occur. Here are two cases of hemothorax during the immediate postpartum vaginal delivery period. Both cases were in term and admitted to hospital because of vaginal delivery. One case was complicated with sudden hypotension and cyanosis during transferring to delivery room. Delivery induction was preceded for both cases and vaginal delivery followed with continuity of vaginal bleeding, because of uterine inertia in one and cervical rupture in the other. Both cases were managed with massive transfusion of packed cell and FFP. Respiratory distress was progressed in both cases and CXRs were demonstrated pleural effusion. Diagnostic thorasynthesis was compatible with hemothorax in both cases. Chest tube was inserted for evacuation of blood and bloody effusion was taken out, and both patients fell in good condition after 6 hours. Despite the continuity of coagulopathy, the blood drainage was stopped and chest tube pulled out after 48 hours. The possible thesis is the rupture of engorged pleural vessels during forced vaginal delivery in well muscular young women’s. In addition, induced coagulopathy or other abnormalities of pleura result in exacerbating the blood accumulation. It is logical to have in mind the less aggressive vaginal delivery and prevent coagulopathy to prevent the condition.

Without doubt, the largest human society's misfortune after the Second World War is AIDS epidemics. At present, the best way to combat the disease is prevention which in turn requires trainings for increase individual's knowledge. Therefore, this study was performed to determine the knowledge and attitude of Birjand disciplinary police personnel about AIDS.

This descriptive-analytic study was accomplished on 300 personnel of Birjand disciplinary police force which were selected by random cluster sampling in 2002. The data were collected via a questionnaire consisting of three parts (demographic features, knowledge and attitude statements) which were then analyzed by SPSS software using chi-square, t-test and ANOVA one way tests (P<0.05).

Findings showed that most of the participants in the investigation were jobholders (71%) with high school diploma (39%).The mean score of knowledge and attitude were 10.71±2.21 and 4.73±3.16 respectively on basis of their information about transmission, prevention of AIDS. Also we found a statistically significant relationship between the knowledge and attitude with education. (P<0.01)

Study results showed that, the knowledge of personnel about AIDS was relatively good but only a few of them had positive attitude. Therefore we suggest continuous and new training programs about transmission and prevention ways of HIV/AIDS infection

Tobacco, alcohol and drug abuse is one of the greatest complications in the society which causes waste of power, energy as well as financial and human assets. In this case, there are a number of factors that are important and influential such as genetics, critical period of adolescence, family affairs, friends and social affairs, immigration, industrial development, etc. Since the involvement of the youth, the educated, and the future makers drastically increases anxieties in the society, the present study was conducted aiming to assess the prevalence of drug abuse, tobacco smoking, alcohol drinking and other narcotics abuse among the students.

In this descriptive study, 870 students from Birjand Universities (Medical Sciences, Birjand and Azad Universities) in different courses were randomly selected. Sampling was done by cluster method according to the number of students in each university. Data collecting tool was a questionnaire that was developed in two parts and its validity was confirmed by content validity method. The first part contained demographic information and the second part included questions about drug abuse, background of addiction in the family, kind of addiction, first material used, age of beginning, motive, abuse, etc. The collected data was reported using descriptive statistics and distribution frequency tables of SPSS software.

Results showed that 61.5% of the subjects had no background of drug abuse and cigarette smoking. The most frequent abuses were: smoking cigarette (31.5%), alcohol (5.7%), hashish (1%) and opium (0.3%). Age of beginning in 43.5% of cases was under 20, and in 60.9% of cases offers from friends were reported. In 44.5% beginning of abuse was reported in friendly parties. 58.2% of the abusers were male.

Regarding the valuable role of universities as the centers of training and educating the future- markers of the country, the existence of drugs abuse among students is dramatically alarming. Therefore, the need for high enterprise of the authorities in root findings and reducing the prevalence of this destructive catastrophe is obviously observed.

Smokers are exposed to significant quantities of oxidative factors. The effects of smoking on plasma concentrations of antioxidants and susceptibility to oxidative stress in young subjects are largely unknown. This study was done for comparison of uric acid concentration and plasma antioxidant capacity in young smokers and non-smokers. In an analytical observational study, a sample of 23 male smoker with history of at least 10 cigarettes per day for 5 years and 21 healthy non smoker male, all aged 40 or under 40 years old, were included voluntarily in the study. All participants were free of major signs and symptoms suggestive of any disease. Fasting blood samples (10 ml) were collected in heparinized tubes just before morning smoking. Plasma samples were isolated and stored at -60°C for later evaluating. In this study, uric acid concentration was measured by an enzymatic method. The main methods for evaluation of oxidative stress were: determination of the Total Antioxidant Capacity (TAC) by Ferric reducing/antioxidant power (FRAP) assay, Ellman's reagent for measuring the amount of thiol groups, and concentration of 2,2-Diphenyl-1-picrylhydrazyl (DPPH) for determination of antiradical activities of plasma. Uric acid concentrations (mg/dL) in smokers and non-smokers was 6.2±1.5 and 4.5±1.7 respectively (P<0.001). Determination of the TAC (µmol/L) level by FRAP assay showed 980.7±214.4 in smokers and 997.4±156.9 in nonsmokers (P=0.75). Quantitative determination of per-oxiradicals by DPPH assay revealed 12.6%±1.4 in smoker and 15.3%±2.2 in nonsmoker (P=0.37). The plasma levels of thiol groups (mmol/L) were 281.1±60.9 in smokers and 256.5±57.8 in non-smokers (P=017). Given the role of cigarette smoking as a risk factor for cardiovascular diseases and the role played by oxidative stress in them, measurement of uric acid in young smoker subjects represents a marker against tobacco-induced oxidative stress and recommends their timely giving up of smoking.

While pulmonary thromboembolism is common, thromboembolic pulmonary hypertension is very rare. The present case is a 35 year old woman with chronic thromboembolic pulmonary hypertension, who presented with severe dyspnea and leg edema, following an earlier thrombotic event of 10 years earlier, after her her second childbearing. She also had a history of the first childbearing complicated with congenital heart disease and death of her infant by the age of 5 months. Despite conventional treatments for pulmonary thromboembolism including anticoagulants, her condition developed to severe pulmonary hypertension. The investigations including spiral CT confirmed bilateral pulmonary artery thrombosis, positive antiphospholipid antibody and negative serologic tests for rheumatic disease. Besides, the patient showed no symptoms of systemic vasculitis. Therefore, it was diagnosed that the patient had primary antiphospholipid syndrome without underlying rheumatic disease. Thus, the patient was referred to a thoracic surgeon for endarterectomy because of severe pulmonary hypertension (105 mlHg). However, due to extensive bilateral thrombotic involvement of pulmonary artery, surgical treatment was refused. Treatment with prednisolone 60mg/d and warfarin with high dose was carried out. The clinical condition was improved and dyspnea, edema and general condition recovered. The probable role of this syndrome in the development of chronic thromboembolic pulmonary hypertension, neonatal congenital heart disease, and also therapeutic strategies will be discussed in this report.

Background and Despite multiple interactions between diabetes melitus and reproductive function, little studies compare the natural history of menstrual cycles and reproductive functions in women with and without type II diabetes. Methods and materials: To compare these characteristics, a retrospective, descriptive, epidemiological study was conducted on women with cessation of menstruation for at least one year at the end of reproductive years who were aged 40 years and over and was living in Birjand in 2002. The standard cluster sampling technique was used and a total 810 menopausal women were recruited from nine health care centers. Data were collected using an interviewing questionnaire. Overt Diabetes was determined by history taking. Statistical measures were t and chi-square test. Of the total 810 samples, the complete questionnaire was obtained from 807 subjects. Of the total at postmenopausal age subjects, 98 (12%) were classified as diabetic and 709 (88%) nondiabetic. The mean age in total population was 58.91±8.4, with mean age of 47.19±5.31 years at menopause. Mean age at menopause was 48.5±5.53 in diabetic and 47±5.27 in non-diabetic (p....

The risk of asthma prevalence has increased dramatically in children in developed countries over the last three decade. The studies in developing countries have also detected an increased prevalence. There is limited data from ISAAC study in Iran. Considering ISAAC Study in Birjand in 1996, this study will reveals prevalence and time-trend of asthma in Birjand. Methods and Materials: For this purpose, a descriptive study was conducted. By simple sampling, 3540 subject aged 13-14 years, including all from 22 intermediate level schools were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) from across Birjand city in 2002. Subjects were studied by video questionnaires. In this method, the audiovisual presentation of the questionnaires included five scenes of asthma symptoms in different situation. After each scene, the subjects ticked the answer whether or not they experienced the same problems with breathing as the child in video. Analysis of data was done using descriptive analytic and chi-square test. There were 3,540 students including 49% females and 51% males from 22 intermediate schools. One girl school refused to participate in study. The amount of missing data was less than 1% each scenes. The prevalence rates in video questionnaire for any wheeze ever in life, and current wheeze in last 12 months, were 18%, 10.1% respectively. The prevalence of night cough in last 12 month, speech limiting wheeze at rest in last 12 month, and one or more time a month of any wheeze was 4.5%, 2.2% and 7.4% respectively. The prevalence of any wheeze ever in life, and current wheeze in last 12 month was higher in females compared with males (P<0.001). The results of this study on asthma symptoms, suggest an increase in the prevalence of asthma symptoms in Birjand when compared with prior study in this region. The results are suitable for comparison with other ISAAC studies. It also represents a baseline for further analytic epidemiological research.