مجله دانشگاه علوم پزشکی شهرکرد
سال دهم شماره 2 (پیاپی 38، تابستان 1387)

High density lipoprotein cholesterol (HDL-C) is a known inverse predictor of coronary heart disease (CHD). Cholesteryl ester transfer protein (CETP) and hepatic lipase (HL) are key proteins in HDL-C metabolism so that decreased CETP or HL activity is associated with high HDL-C. -629C/A polymorphism in promoter of CETP gene and-514C/T in promoter of HL gene were previously reported to reduce related protein level in plasma. In this study association of these polymorphisms with CHD related to HDL-C level were investigated. In this analytical-descriptive study 321 subjects underwent coronary angiography and divided in two groups base on angiogram (non CAD = 135 and CAD = 186). Serum lipids profile was measured by standard procedure and genotype was detected using PCR-RFLP method. Overall the CETP genotype frequencies were in CAD patients: 58.8% (n=110), 28.9% (n=54) and 12.3% (n=23) and in non CAD patients: 45.2% (n=61), 41.5% (n=56) and 13.3% (n=18) for AA, CA and CC respectively. HL genotype frequencies were in CAD patients: 61.6% (n=114), 33.5% (n=62) and 4.9% (n=9) and in non CAD patients: 65.9% (n=89), 27.4% (n=37) and 6.7% (n=9) for CC, CT and TT respectively. In control group HDL-C concentration was higher for AA than CC genotype in -629C/A, and also for TT than CC genotype in -514C/T. Allele A in all subjects and T allele in woman were higher in CAD than non CAD group. A high increase in HDL-C level (10. mg/dl) was observed in individuals with CETP-AA/LIPC-TT and CETP-CA/LIPC-TT relative to CETP-CC/LIPC-CC across all subjects (P< 0.001) but there was no difference in CAD prevalence. Allele A from -629C/A, and T from -514C/T even with the increasing of HDL-C concentration had higher frequency in CAD than non CAD group. Therefore, it seems that HDL-C didn’t protect coronary artery when CETP or HL activity was reduced by these polymorphisms.

Increased inspired oxygen fraction (FiO2) has significant negative hemodynamic effects in conscious volunteers. The aspiratory gas during open heart surgery with on-pump technique usually consists of 100% oxygen without any N2O because of the risks of bubble embolism during these procedures. We sought to establish the effected of inspired pure oxygen in comparison to 50% oxygen in patients. During anesthesia in cardiac coronary bypass surgery. In a clinical trial study, sixty adult patients (40-70 y/o) with ASA II or III undergoing elective on-pump coronary artery bypass were elected. They received either a mixture of 50% O2 with 50% air (case group=30) or 100% of oxygen (control group=30) throughout the anesthesia. Cardiac index (CI) was measured by non invasive cardiac output (NICO) technique using end tidal PCO2. Measurements of systolic, diastolic and mean blood pressure as well as heart rate (HR) and central venous pressure (CVP), PaO2, arterial PH and CI were obtained at pre-bypass, post bypass, end of surgery and 2 hours after ICU admission. Intra operative requirements for isotropic drugs were also evaluated. Data were analyzed by SPSS software using X2, t, ANOVA and ManWithny tests, P<0.05 was considered as significant. No differences were found between the two groups with regard to age, sex pump time, operation time and body mass index and preoperative ejection fraction (EF). The mean values of systolic, diastolic and mean blood pressure as well as HR and CI were similar in the case and control groups (P>0.05) at all times of measurement. The control group required more isotropic drug support than the case group (16 vs. 8 patients respectively; P<0.05). Likewise, the mean CVP was higher in the control group compared with the case group (P<0.05). Hyperoxia increases CVP and isotropic requirements during cardiac surgery in anaesthetized patients. Therefore, exposing patients during and after coronary artery surgery to hyperoxia induces significant hemodynamic change as which require more extensive studies with invasive CI measurements and larger groups.

Multiple sclerosis is a chronic, progressive and degenerative myelin sheath of the central nervous system. Which significantly affects quality of life? The aim of this study was to assess the effect of Orem based self-care program on physical quality of life in multiple sclerosis.

In this clinical trial a total of 70 patients with multiple sclerosis with age range 20-40 years, (members of multiple sclerosis association) were randomly divided into two groups of experimental and control (35 patients in each group). The experimental group was treated with self-care program based on Orem self-care frame work compared to the control group. Data were analyzed using x2, t, and paired t tests.

There was no significant difference in the cases of quality of life and demographic characteristics of patients in the control and test groups, before intervention. The mean score of life quality, after intervention, in the test group (66.5±41.8) was more than that (43.24±12.79) in the control group (P<0.001). In the test group and after the intervention, life quality was significantly increased (P<0.001), but no significant difference was seen in the control groups.

Drawing and utilizing self care program base on the Orem frame work on physical quality of life in the multiple sclerosis patients would be beneficial. This is a non-invasive intervention and is safe, inexpensive and is complementary to medical intervention that can be used in the multiple sclerosis centers.

Human resources are important resources in an organization. The clarity of personnel’s role may cause their satisfaction and result in higher productivity. This study was conducted to determine the relationship between role clarity and occupational commitment of personnel of the colleges in Isfahan University of Medical Sciences. In this descriptive-analytical research, a total of 144 persons were selected from the 401 university employees using classified random sampling. Data gathering instruments included two questionnaires of role clarity and job commitment. Data were analyzed using one variable t test, Pearson correlation coefficient, and Hotelling t2. Based on our results, the mean of role clarity (2.76±0.52) and occupational commitment (3.39±0.41) was more than average (P<0.01). A significant and positive relationship was observed between the two variables (r=0.31). Also significant relationship was observed between the role clarity and job commitment subscales (professional commitment, organizational commitment, attachment to work values, participation) (P<0.05). Role clarity results in personnel’s satisfaction. It changes their vision and attitudes in relation to their duties and responsibilities. This causes higher job commitment and more attempts to realize organizational goals.

Milk is very important for the human nutrition. Control and monitoring of its preparation, transport, storage and presentation, based on healthy principals is essential. Therefore, this study was aimed to compare bacterial contamination of raw and pasteurized milk used in Shahrekord, Iran in 2006. This descriptive-analytical study is a descriptive analytical which has been done in 2006 in milk production factories in Shahrekord Township. In this order, 300 samples of raw milk using sterile containers of 200 cc volume, from five points and also randomly 120 samples of pasteurized milk from milk production factories have been gathered, on winter and summer seasons. Coli forms measured using MPN method in lactose broths medium and total count method used for the total bacteria in violate red bile Agar medium. E. coli determined in eosin methylene blue medium and IMVIC tests were used for coli form differentiation. Data were analyzed using descriptive statistics and Chi-square, Mann-Whitney, and Kruskal-Wallis tests. The results showed that 208 of 300 (70%) and 242 of 300 (80.5%) of the raw milk samples were contaminated with E. coli and coli forms, respectively. The most (88%) and the least (%58.3) rate of contamination were in the samples from southwest and northeast area, respectively (P<0.05). The rate of contamination of raw milk prepared during summer with E. coli and coli forms were more than those prepared in winter (P<0.05). Regarding the contamination of raw milk with E. coli and the other coli forms, particularly in summer, following of healthy principles and supervision in preparation, transport, storage, and selling of milk especially during the hot seasons are necessary.

Melasma is an acquired hyper pigmentation on the face which generally happens in women between the ages of 30 to 35. If there is no timely treatment, it can cause a lot of cosmetic problems. The aim of this study was to compare the effect of kojic acid cream and hydroquinone 2% in treatment of melasma. This clinical trial was done on 100 women who had epidermis melasma and were referred to the dermatology department of the 22 Bahman Hospital in mashhad, Iran. Each patient had at least two melasma scars with similar severity and size on both sides of the face. For each of the patient, kojic acid cream on one side of the face and hydroquinone 2% cream on the other side of the face was prescribed. The researchers assessed the rate of improvement during a three month period. Data were analyzed using Wilcoxon test. One month after the start of treatment there was a positive response of both applications, 7% from Koji acid treatment and 10% from hydroquinone treatment. Two months after the treatment there was a positive response of 24% from kojic acid and 22% from hydroquinone. In both treatments, there was no statistical significance but there was a statistical significance after 3 months of treatment which was 58% in kojic acid and 30% in hydroquinone, group. Based on the length of the treatment during the trial, kojic acid was found to be more suitable in the treatment of melasma. Therefore, it should be considered in the protocol of treatment for this pigmentation disorder.

Thalassemia is one of the most important genetic diseases in Iran. Warning of their parents about their children’s disease prevents the related problems and reduces its complications. This study was aimed at comparing the influence of lecture and booklet methods on enhancement of awareness and attentions of parents of children with Thalassemia major. In this interventional study, a total of 90 parents of children with Thalassemia who referred to Hajar hospital for medical treatments, were selected using simple sampling and were randomly divided in three groups of 30 parents. The parents in lecture group attended for seasons of lecture for 30 min. each with 3 weeks interval. A booklet with the same contents as the lecture group was given to the booklet group without any intervention. A questionnaire was designed to gather some information about the disease from parents of all three groups. To determine the statistical relationships, student t-test, Spearman’s correlation and of ANOVA tests were used. No significant differences were found among the three groups tested in terms of the mean age, gender, level of education, job, number of affected children, and age of the children. The results showed that the mean of knowledge before and after the education in the lecture group was 10.53±4.37 and 16.5±4.73 (P<0.05) and in the booklet group was 10.7±3.06 and 14.6±2.7 (P<0.05), respectively. There was no significant difference between lecture and booklet groups based education. After the education, the knowledge in the two groups was significantly more than that in control group (P<0.05). The results showed that lecture and booklet methods have positive effects on increasing of the parent’s knowledge about the disease. Thus, providing of the booklet for the parents, particularly in the region with high prevalence of the disease, is recommended

For good stereopsis, the two retinal images should have similar clarity, shape, and size. Anisometropia is one of the factors which has affect on stereopsis. The purpose of this study was investigation of induced anisometropia effect on binocular function and stereopsis. In this semi experimental study, a total of 135 students from Zahedan University of Medical Sciences who had inclusion criteria were selected randomly. At the beginning of the work, the refractive errors of the subjects were determined and corrected with retinoscop and their stereopsis measured using T.N.O test. Subsequently, this hyperopic and myopic anisometropia induced by use of negative and positive spherical lenses (power 1, 2, 3 diopter) in trial frame in front of one eye and in each state stereopsis measured again. In agreement and against the rule astigmatic anisometropia induced by positive cylindrical lenses in 180 and 90 degree axes and stereopsis measured again. Data were analyzed by SPPS.14 software using within subjects factorial and repeated measurement ANOVA test. This study showed that both type and amount of anisometropia had significant effect on stereopsis (P<0.001). The mean of stereopsis before intervention was (36.42±12.65). The most and least reduction of stereopsis were related to 3D hyperopic anisometropia (339.42±125.1) and 1D with the rule astigmatic anisometropia (36.57±12.6), respectively. The mean of stereopsis before and after different type and amount of induced anisometropia were significantly different (P<0.001). The result of this study showed that with increasing of anisometropia, stereoacuity decreases. Therefore, low degree of anisometropia, even 1D, can decrease both stereopsis and binocular function and thus, the amendment of stereopsis is necessary.

Pain is a health problem and major part of the life in childhood, pain associated with different illnesses is one of the most common symptoms that children experience in the hospitals. Relieving pain is always an essential part of nurses caring role, but yet they feel weakness in pain management. The purpose of this study was to determine pediatric pain management by nurses, in the education hospitals of Shahrekord, Iran. This research was a descriptive and analytic study which conducted on 100 nurses. The data gathering tool was a questionnaire with for subscales: demographic data, knowledge (20 items), attitude (20 items), and practice. Data were analyzed by the independent T-test, one way ANOVA test, and Pearson correlation. The finding showed that the mean knowledge, attitude and practice of pediatric pain management by nurses were 13.09±1.9, 76.1±7.2, 8.42±2.9 and majority of nurses demonstrated knowledge (73.1%), attitude (69.1%) and practice (71.3%) moderated. There was not a significant difference between practice with knowledge and attitude of nurses about management of pain in children. This study demonstrated that the knowledge, attitude and function of the nurses about the pediatric pain management were intermediate. It showed that they need to become more aware of pharmacologic pain management with opioids, risks of addiction, non pharmacologic pain management, and respiratory depression and assessment tools of pain.

The most valuable resource in every organization is its employees. Organization mobility depends on its staff empowerment. The aim of this study was to recognize and determine the priority of empowerment strategies in experts staff in health deputy in Shahrekord University of Medical Sciences in 2005. In a descriptive and analytical study, in 2005, all experts staff in provincial health center and health networks in 6 districts (approximately 210 persons) were introduced in this study. Need assessment questionnaires with 60 questions adjusted by Likrett indices were designed by surveyor. Data was collected and its suitability of factor analysis was confirmed by Bartlet test and Kaiser, Mayer, Olkin (KMO) test of sampling adequacy. Finally, 60 variables included 5 factors were selected and factor analysis was done by Varimax Yolling method. According to variables, factors and condition of each factor, 5 strategies were determined: 1-Liberty in job activities (42.25%), 2-Effective management of man power resources (5.99%), 3-Motivation (5.07%), 4-Self management (3.71%), 5-Development of organizational learning (2.84%). There was a statistical relationship between experts ideas about 5th strategy (development of organizational learning) and job location (P<0.01), between 2nd strategy (effective management of man power resources and age (P<0.01, r=0.19), between 5th strategy (development of organizational learning) and age (P<0.05, r=0.18). The main strategies for health expert’s empowerment are liberty in job activities and effective management of man power resources, motivation, self management and development of organizational learning. In point of view of older and more experts’ staff, development of organizational learning is more effective in organization development.

Using of some methods that regulate uterine contraction and accelerate labor is necessary. One of these methods is mothers position in active phase of labour. The purpose of this study was to evaluate the mother’s position in active phase of labour on length of active phase, Apgar score and type of delivery. In this clinical trial study, a total of 200 pregnant women who referred to Emam Khomeyni hospital of Falavarjan were selected using simple method. They subsequently, were randomly divided in 4 groups of lateral, sitting, ambulating, and free position. (Each group consisted of 50 women). Sampling was done during labor and a questionnaire was used for data collection. Data analysis was descriptive and analytic statistic and the software used in this research was SPSS. The length of active phase in primipara, mulripara, the 5 minute Apgar, the length of the active phase in partial cephalo pelvic disproportion (CPD) and the type of delivery all were 3.57±0.52, 2.23±0.31, 2.46±0.25, and 2.25±0.16 hours, respectively. The length of active phase in primipara was more than that in 3 others (P<0.01). Also, the mean of the second phase of pregnancy in these two groups was more than the earlier one (P<0.01). There was no difference among the four groups in the case of Apgar. However, Apgar of 8-10 in the fifth minutes in the sleep group was more than that of the other groups (P<0.001). Regarding the findings of this research, the mother’s position except lateral position can effectively decrease the length of the active phase of labor, improve the 5 minute Apgar score and decrease rate of c/s. Mothers position in labor also improve the length of the active phase of labor in woman with partial cephalo pelvic disproportion (CPD).

Simple myopia is one of the most common ocular abnormalities. Diet is amongst the factors that affect on myopia. Therefore, this study was aimed to evaluate the effect of Ramadan fasting on physiologic myopia. This descriptive-analytical study was conducted on a total of 61 individuals (122 eyes). The subjects were male myopic with simple myopia ranged 0.50 to -8D, aged 22-50 years. The refraction of their eyes was examined before and after Ramadan (3-4 days after Ramadan) using cycloplegic refraction. At the end of fasting month, the same examination was administrated and the findings obtained were compared using t test. The mean age of the patients was 31.20±11.24 (ranged 22-50 years). Visual intensity of the patients was 20.20. The mean of refraction deficiency of the individuals before and after the fasting was -3.21±2.80 and -3.16±3.00 D (P>0.05). Fasting has no effect on myopia in the male individuals aged above 23 years.

Tail gut cyst (TGC) is a non common cystic lesion with post anal origin which is occurred in retro rectal region. Case report: In this article we studied a 90-year-old man with a tail gut cyst who presented with post sacral ulcer. The patient did not cooperate well with taking history. For further evaluations the patient underwent surgical treatment for detriment and the region was drained off and repaired. At operation retro rectal cystic mass was excised for pathologic studies. Although the incidence of malignancy in TGC is extremely rare, it should be considered in differential diagnosis of retro rectal tumors especially in middle-aged women.