نشریه دانشگاه علوم پزشکی بیرجند
سال چهاردهم شماره 4 (پیاپی 33، زمستان 1386)

The course of human development during intrauterine life, particularly during embryonic development is extremely complex. A huge number of biochemical, physical and organizational processes must be precisely coordinated to assure normal development. Many of these events are very critical due to their irreversible nature and their short duration besides, they may be sensitive to a lot of teratogens. These stages, which are called" critical developmental stages" have attracted special attention of the researchers to the effect of different teratogenic agents during the critical stages of conception. This paper reviews some molecular events of various stages in human development during embryonic as well as fetal development besides, critical periods, involved molecules in some body organs-including glycoconjugates, morphogens, etc. have also been explained. It is emphasized that identifying these critical processes would help our colleagues to offer the requisite points to pregnant women so that they would avoid undue taking of specific drugs and chemicals. This will hopefully prevent many of inborn teratogeneses.

Nowadays using herbal medicine is common among people. A large number of patients who take pharmaceuticals also use herbal medicine without knowing anything about the interaction between them. The present study was carried out to determine the effect of consuming garlic before anesthesia on the process of anesthesia with Halothane and Thiopental in male mice. In this study 24 mice with the average weight of 30±5 gr were divided into 4 groups (6 in each). Two groups of the animals received 40mg/kg of garlic concentrate intraperitoneally in the morning and in the afternoon for three successive weeks and after a two day's rest one of the groups were injected with halothane and the other one received pentobarbital. Simultaneously, the remaining two groups were injected with physiologic saline intraperitoneally and under the same condition. After anesthesia, four variables namely induction (A), duration (B), recovery (C) and heart rate (D) were assessed. The obtained data was analysed by means of SPSS software (12.0) and statistical t-test and P≤0.05 was taken as the significant level. In the former 2 groups which had been injected with "Halothane" and "Halothane+garlic" there was a significant difference in the variables A (P<0.001), C (P<0.001) and D (P<0.05). In the latter 2 groups injected with "Pentobarbital" and "Pentobarbital + garlic" there was a significant difference in all the four variables (P<0.05). Regarding the findings of this study and applying them to humans, positive and negative effects of simultaneous use of garlic together with anesthetic drugs must be taken into account. Thus, the dose of the drugs must be determined more accurately.

Occupational exposure may predispose health care workers to acquiring hepatitis B, C and HIV via the skin and mucous membranes when they expose to blood and body fluids. The best preventive measure in this respect is taking universal precautions. In the wards where occupational exposure is more likely-such as dialysis, operation room, emergency, and labour-these precautions are more important. The present study was carried out to determine the effect of universal precautions instruction on the occupational exposure of midwives as a high risk group. This case-control and quasi experimental research was carried out on all of the twenty midwives in the only maternity hospital of Rafsanjan (case group) and eighteen midwives in one of the maternity hospitals of Kerman (control group) through poll sampling. Means of gathering data was a bisectional questionnaire consisting of queries regarding some personal characteristics and number of exposure during the latest three months. The questionnaire was filled out by the cases at the beginning of the study and was filled out again after a three month period of face-to-face instruction. The obtained data was analyzed by means of SPSS software, paired and independent t-test and chi-square and P≤0.05 was taken as the significant level. Mean of occupational exposure before instruction in the case and control group was 25.7±10 and 21.6±7.1 respectively and after three months it was 14.6±4.6 and 20.2±6.1respectively. Comparing the mean of occupational exposure before and after instruction showed a significant decrease in the case group (P=0.001) but it was not significant in the control group (P=0.3). Regarding the results of the study it seems that universal education on precautions at work significantly reduces occupational exposure of health-care workers.

The main goal of health coordinating volunteer's program is the promotion of their knowledge and skills through an active and favorable instructional system. Holding different training courses on healthy life styles covering nutrition, mobility, stress management, and life skills seem necessary for health coordinating volunteers so that they could learn health life skills, and appropriately transfer to the community. The present study was designed and carried out to determine the effect of health education on the promotion of health coordinating volunteer's knowledge level concerning healthy life styles. In a quasi-experimental study, 112 health coordinating volunteers who collaborated with the Health center of Birjand University of Medical Sciences were assessed. They then attended training courses concerning nutrition, food-stuffs safety, mobility, stress management, and living skills. Pre-designed questionnaires were used to compare and evaluate pre- test and post-knowledge of health coordinating volunteers. Finally, the obtained data was analyzed by means of SPSS software using, paired t-test and Tukey test at P=0.05 as the significant level. Mean knowledge score of health coordinating volunteers revealed that their pre-intervention knowledge of 21.01 increased to 27.88 after intervention. The difference was statistically significant (P<0.01). Comparison between mean knowledge score of health coordinating volunteers before and after intervention showed that continuous instruction of health coordinating volunteers would be effective and thus holding regular training courses for them are essential. Besides, instruction provided by more educated health coordinating volunteers in the community has higher effectiveness on those with a lower level of education. Thus, selecting health volunteers out of educated individuals could be more useful in promoting the community health level.

In Iran about 24% of mortalities due to traffic accidents are brought about by motorcyclists. head injury is accounted as the main cause of this (65.7%-75%) fatality. Although helmet wearing can significantly decrease the risk of head injury, few motorcyclists make use of it. Planned Behavior Model is one of the important models which explains the major mechanism for accepting health behaivors.In the present study the Extended Model of Planned Behavior was applied in predicting helmet wearing among motorcyclist clerks in Yazd.. In this descriptive_analytical and cross-sectional study130 motorcyclist clerks from six offices in Yazd selected through clustered random sampling were surveyed. Questionnaires which were filled out during individual interviews were used for data collection. A panel of experts approved the validity of the questionnaire and its reliability was verified by means of Cronbach Alpha test (a =0.71-0.95). The obtained data was analyzed by SPSS (11.5) using Spearman Coefficient and Regression Analysis. Fifty-six subjects (43.1%) reported a history of motorcycle accident only six cases of them had worn helmets at the time of the accident. According to the results, there was a significant correlation between all the the variables of Extended Model of planned behavior and wearing/ intention to wear helmet (P<0.01). Regression analysis indicated that attitude, Perceived behavior control and being aware of wearing helmet by other motorcyclists accounted for 59% of vairance of intention to wear helmet among the subjects. Among the variables,the effect of perceived behavior control was the strongest predictor.Besides, perceived behavior control together with intention to use helmet on the part of other motorcyclists accoutned for 49% of variance on Helmet wearing among subjects(P<0.05). The results indicated a low level of helmet wearing among the subjects. Regarding the high prevalence of mortality due to head injury among motorcyclists, making more use of helmets should be recommended and promoted. Extended Model of planned behavior could be used as a theoretical framework in the instructional programms in order to predict the intention and wearing of helmets by motorcyclists.

Epstein-Barr virus (EBV) infection produces a wide variety of clinical symptoms ranging from an asymptomatic infection to the classic infection "mononucleosis". Clues of the virus have also, been found in some malignancies. Since the lower the age at infection onset, the weaker the clinical symptoms will be the disease can be asymptomatic and atypical in children. Regarding epidemiologic factors affecting EBV infection, the present study was carried out to determine the frequency of EBV anti-antibody titer in 1- 14 year old children. In this cross-sectional and descriptive study, which was done between 2005 and 2006, all 0-14 year old children who had been referred to Aliasghar Children Clinic in Zahedan were surveyed. Questionnaires covering individual information queries were filled out for all children and their blood samples were taken. By using ELISA the amount of EBV anti-antibody (vcA-IgG) in the samples was measured. Finally, the obtained data was analysed by means of SPSS software using chi-square statistical test and P≤0.05 was taken as the significant level. Out of 245 cases under study, 138 cases (56.3%) were males and 107 cases (43.7%) were females. Mean age of the subjects was 4.72±3.07 years and mean family members was 5.2±1.8. Most (81.2%) of the cases revealed positive titer, 11% had negative titer, and 7.8% were intermediate after excluding less than one-year old children from the study -because of their inborn antibody- the result in percentage terms was 81.3%, 11.1%, and 7.6% respectively which did not reveal a significant difference with the previous stage. Antibody titer in both sexes was not significantly different. Regarding the findings of this study, total prevalence of EBV infection among children is around 81.3%, which increases with age and living in large families. With respect to available statistics previous similar studies it revealed that the incidence of the infection in Zahedan was more than other sites, probably due to familial overpopulation and low level of hygiene.

Convulsion in infants with the prevalence of 4 to 6 cases in 1000 is the most common neurological disorder in pediatrics. The reason for this study was the rather high prevalence of convulsion, its psychosocial and cognitive importance, and determining the underlying factors of the disorder in infants.

In this descriptive- analytical study, 178 hospitalized infants suffering from convulsion were selected through purpose- based sampling. Data gathering was done by means of a three-section questionnaire which included personal characteristics, convulsion seizure, and diagnostic procedures performed. Then, the obtained data was analysed employing SPSS software, using chi-square, and correlation coefficient statistical tests at the significant level P≤0.05.

Out of 178 infants studied, 57.2% were males and 42.8% females. 86.7% had been born naturally and 13.3% through cesarean section. Mean hospitalized time was 5.63 days, €mean child age was 3.05 years, birth weight was 2838.92gr, and mean convulsion time was 7.85 minutes. Frequency of convulsion in 44.4% of the children was 3 times a day and 20.2% of them had a positive familial history 48.6% of the patients had febrile convulsion, 28.1% epilepsy, 5.6% infection, 9.6% static encephalopathy, and 7.9% revealed other factors of convulsion. There was not a significant relationship between either sex, delivery type, or birth weight to convulsion but the relationship to age at the onset of convulsion, its period and frequency was significant (P=0.00). Underlying factors of convulsion were fever, upper respiratory infection (40%), gastroenteritis (3.4%), urinary infection (4%), pneumonia (12%), otitis (5%), septicemia (3.6%), and unidentified fever (5%).

Although convulsion is a benign disorder in most cases, the frequency of those convulsions which require investigation and special treatment planning is of such level that complete description, careful examining and paraclinical assessment planning should be performed for each infant because diagnostic assessment influences treatment, family counseling, necessity of hospitalization, and particular follow-up of these patients. Presenting accurate reports of convulsion attacks will help the nurse to identify underlying and intensifying factors, reduce or prevent their frequency and decrease potential complications.

Major depression is one of the main causes of debility all over the world. Prevalence of depression is reported to be 15% in men and 25% in women during their life-time. Various researches indicate that utilizing religious approaches play an efficient and effective role in treating mental disorders. The present study was conducted aiming at determining the relationship between depression, as a mental disorder, and the level of reliance on the Lord as one of the bases of religious thinking among students. In this descriptive- analytical study, 400 students of Birjand universities were assessed by means of two questionnaires: 1. a standard depression test questionnaire (having 21 questions) 2.A standard reliance questionnaire (having 24 questions).The obtained data was analyzed by means of SPSS software, using statistical chi-square test, variance analysis, and independent t-test and P≤0.05 was considered as the significant level. The study showed that 43% of the subjects had no depression, 22.1% had minor depression, 10% required counseling by a psychiatrist, 16.6% were moderately depressed, and 8.2% were intensely depressed. The study also showed that 65.8% of the subjects had moderate level of reliance and only 14.3% had the advantage of high level of reliance. There was an inverse correlation between the students’ rate of depression and their level of reliance so that with the rise of reliance the degree of depression decreased and vice versa (P<0.001) The study did not reveal any significant relationship between depression and level of divine reliance to variables such as sex, order of birth, age, education, parents being alive. It was found that depression is discernible among students, but its rate varies with their reliance on the Lord therefore, it is predictable that religious beliefs, in addition to reducing the prevalence of depression, play a positive role in the course and prognosis of depression. Because students are regarded as the educated and efficient sector of society, the more their reliance on God and the more their sense of spiritual tranquility, the better their mental health. Moreover, religion is a supportive source for individuals, depending on religious beliefs and activities is effective on managing emotional tensions and physical complications.

Cryptorchidism or undescended testis is one of the most common congenital abnormalities in boys, and the majority of cases have no discernible etiology. There are unexplained geographical differences and temporal trends in its epidemiologic studies. There are limited studies regarding the epidemiology of this disease in Iran. The present study was carried out to evaluate cryptorchids operated in Birjand. In order to study the disease in Birjand, medical records of patients that had been treated for cryptorchidism between 1994 and 2001 in Emam Reza hospital affiliated to Birjand University of Medical Sciences were reviewed. Data was gathered through a questionnaire filled out by the researchers themselves. The obtained data was analysed by means of SPSS software and statistical tests. One hundred and forty-six patients were operated during this period. Minimum, maxim, and mean age were 7 months, 34 months, and 10±1.2 years, respectively. Localization was right, left, and bilateral in 52.7%, 33.6% and 12.3% respectively. For 14% of the cases, there was no record in the respective files. Out of 81 cases whose familial history had been recorded 10% (8 cases) had positive family history of cryptorchidism and 73 cases (90%) had no familial history. In 94.5% of the cases the testis was found during the exploration of the same side and 2.7% of the cases no testes were found. In 2.7%, which had bilateral undescended condition, one testis was not found but the other was. Totally, in 5.4% no testes were found during exploration. Location of the testis was in inguinal canal and abdominal cavity in 61.7% and 36.3% of the patients, respectively. Most (91.8%) of them had undergone orchiopexy and 8.2% had had orchiectomy operation. There was no malignancy in those who had undergone testis biopsy (7 cases). Regarding the findings of the study, it seems that for proper diagnosis and treatment of this very common congenital disorder there should be an instructional program for midwives, nurses and physicians pertaining to mandatory record of scrotal examination in the medical record of the all newborn and parents should be advised to treat their affected boys at age of 1 to 2 years.

Esophageal duplication cyst is a rare congenital foregut anomaly. Making a definite diagnosis is difficult preoperatively, although various imaging techniques can help to localize these lesions and exclude other causes. Here we present a patient who had an esophageal duplication cyst with infection, in which its signs on chest x-ray, computed tomography (CT), and barium swallow examination are reported.

Wolman's disease is a rare fatal autosomal recessive hereditary disorder caused by a chromosomal abnormality called "lysosomal acid lipase enzyme" that leads to accumulation of triglycerides and cholesterol esters in different body tissues of neonates. There is another form of the disorder called Cholesterol Ester Storage Disease, which is a benign adult form of it. Diagnosis is based on clinical, laboratory, and radiographic imaging. Prenatal diagnosis of the disease is based on `enzyme decrease through culturing amniocytes or chorionic villi. So far, 50 cases of the disease have been reported in the world. In this article a case of this fatal disease in a neonate in Birjand, South Khorasan of Iran is reported.