نشریه دانشگاه علوم پزشکی بیرجند
سال پانزدهم شماره 3 (پیاپی 36، پاییز 1387)

Hot flash affects approximately 75% of women at menopausal age and 40% of perimenopaursal ones. Those who experience hot flashes have higher rates of sleep and temper disturbances than women not affected by hot flashes. The present study was done to investigate whether treatment with an anticonvulsant drug such as gabapentin would be effective in reducing hot flash frequency and severity in menopausal women. In a clinical-trial study 100 postmenopausal women with an average of seven or more hot flashes per day, which were accompanied by sweating, were randomly divided into case group(receiving 300 mg of gabapentin daily) and control group(receiving placebos) for a period of 8 weeks. The obtained data was analysed by means of statistical soft wares PASS 2004, SPSS, using statistical tests 2, t, and Mann- Whitney; at P≤0.05 as the significant level. After 8 weeks of treatment with gabapentin a reduction of 56% in hot flash frequency and 50% reduction in its composite score (frequency and severity combined into one score) from baseline were observed. In the control group (taking placebos) the decrease was 12% and 15% compared to before treatment respectively. After eight weeks of treatment the number of hot flashes was 7.88±0.4 and 9.4±0.52 in the case and control groups respectively; the difference was statistically significant(P<0.001).Besides, after eight weeks of treatment composite score of hot flash(i.e its frequency and severity) was 10.6±0.66 and 16.98±0.84 in the case and control groups respectively, which was statistically significant(P<0.001).In the case group frequency and severity of hot flashes were obviously lower than their levels in the control group. Gabapentin is effective in treating hot flash and can be considered as an alternative therapy to reduce the disorder.

Lead (Pb) poisoning is the most common occupational poisoning that may affect family members of lead workers specially their children. The most important and irreversible effect of lead poisoning in children is on the developing of central nervous system and its evolution. High cost and severe side effects of chelating agents may result in incomplete treatment of lead poisoning in some cases. The aim of the present study was to assess the effect of Coriandrum Sativum l. (Cilantro) extracts on renal lead excretion in 3-7 year old children. In this randomized, case–control clinical trial, 32 children aged 3-7 years whose parents were lead-exposed workers were randomly divided into 2 groups. The test group received Cilantro extract and the controls were given placebos for 14 days. Blood and urine lead concentrations were determined at the beginning of the study and 14 days later. Questionnaires were designed and used for data collection. The obtained data were analyzed by T-student and Paired t-test using SPSS version 11.5 Numerical data were shown as mean ± SD and P≤0.05 was taken as the significant level. Mean age and weight of the children was 4.9±1.46 years and 17.32±4.74 kg respectively and 59.4% of them were males. Duration of father's exposure to Pb at work was 9.14±5.63 years. Blood and urine Pb concentrations and renal lead clearance of children were 163.81±57.19, 97±48.12 µg/L and. 012±.009 L/day, respectively at the beginning of the study. There were no significant differences in blood (P=0.87), urine (P=0.73) Pb concentrations and renal excretion of lead (P=0.96) between the two groups. After two weeks use of Cilantro, the mean blood lead concentration decreased (P=0.006), urine lead concentration increased (P=0.038) and renal excretion of lead increased significantly (P=0.019). But similar significant changes were observed in the control group (P=0.034, 0.021 and 0.009, respectively). There were no significant differences in blood lead concentration (P=0.93), urine lead concentration (P=0.93) and renal lead clearance (P=0.77) between the two groups at the end of the study. According to the results of this study, it seems that Coriandrum Sativum is not effective in lead elimination. Increasing renal lead elimination in both groups of children may be due to other factors like improvement of nutrition following the necessary educations at the beginning of this study.

Nowadays coronary surgery is done by means of cardiopulmonary pump (on-pump) or without using it (off-pump). Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be potentially hypercoagulable with an increased risk of graft thrombosis in their transplanted vessels. To counteract this complication and reduce ischemic events, antiplatelet drugs including ticlopedin is used in most therapeutic centres of the world. The purpose of this study was to determine the side effects of early ticlopedin administration after OPCAB. This clinical trial study was done on 300 patients admitted to cardiosurgical ward of Imam Reza hospital affiliated to Mashhad University of Medical Sciences between 2005 and 2007. Those clients whose postoperative drainage was less than 100cc/h were divided into two groups with 150 cases in each. The first group took ticlopedin for four weeks, but the second group (control) was not administered the drug. Aspirin was administered preoperatively and postoperatively to all patients. Telephone follow-up was made 6 to 12 months after being discharged. The obtained data was statistically analysed by means of 2 at the significant level P≤0.05. None of the patients in the first group required re-operation for mediastinal hemorrhage. Mean chest tube drainage was 1005±423 in ticlopedin group and 950±400 mL in patients who had not received ticlopedin. The total number of blood units transfused and the number of patients receiving blood transfusions was almost similar in the two groups. In-hospital mortality was 1.2% in ticlopedin group and 3.2% in the control group (P=0.314). No group difference in mortality or adverse cardiac events were observed during 6 months. Gastrointestinal bleeding occurred in 2.5% of ticlopedin patients but in 0.9% of the controls. The study showed that ticlopedin administration does not increase postoperative mediastinal hemorrhage.

Perturbations in copper (Cu) metabolism are characteristic of diabetes type I. Hyperglycemia and increased free radicals generation result in increased Cu plasma levels and leads to oxidative stress. The aim of this study was to determine the antioxidant effects of ascorbic acid on Cu plasma levels in streptozotocin (STZ) induced diabetic rats. This study was done on 30 male wistar rats. Diabetes type I was induced in the rats by single intraperitoneal injection of streptozotocin (60 mg/kg). Four days after diabetes induction the animals showed hyperglycemia (>350mg/dL). After six weeks, the animals were divided into five groups as follows: controls, diabetics, diabetics treated with ascorbic acid, diabetics treated with insulin, and diabetics treated with insulin + ascorbic acid. Treatment was administered for two weeks and then plasma cu level was determined by atomic absorption method. The results showed that in uncontrolled diabetes Cu plasma level increased significantly compared to of its level in the control group (P<0.05); whereas diabetic rats treated with insulin, insulin+ ascorbic acid or ascorbic acid showed no significant difference in Cu plasma level compared to those of control group (P>0.05). The results of this study indicate that treatment with insulin or ascorbic acid alone or in combination can preserve Cu plasma at normal level in diabetic rats.

Marriage and establishing a family is one of the most important events of everyone's life which has significant effects on personal and social health if it occurs appropriately and is intertwined with enough knowledge. To reach these positive effects, pre-marriage consultation is taken into consideration and it is accurately planned. Under such an instructional program, couples are familiarized with fertility health problems and this promotes their health level significantly. This study aimed at determining the effect of pre-marriage consultation classes. This pre-post quasi-experimental study was done on 250 couples attending pre-marriage instruction classes. Means for data collection was an autonomous questionnaire which had been designed according to the aims of the study and its reliability and validity had been confirmed. The questionnaire consisted of three sections; namely demographic questions, knowledge questions (27 cases), and attitude questions (18 cases). The questionnaire was filled out in two stages; i.e. before and after pre-marriage consultation program which was presented in lectures. Then, the effect of such an instruction was analyzed by means of statistical paired T-test, one-way variance analysis, and Chi-square. Mean age of the couples under study was 22.4±4 years. According to the results of the study, 83.2% of the couples had weak knowledge, 16% average knowledge, and 0.8% had good knowledge before intervention. After instructional intervention the knowledge of 60.4% was weak, 31.6% had average knowledge and 8% benefited good knowledge; thus, the difference was statistically significant (P<0.001). Moreover, mean knowledge was 8.7±4.8 before intervention but it reached 12.4±5 after intervention (P<0.001). Mean attitude increased from 42.6±4.9 (before intervention) to 47.5±4.3 after invention; (P<0.001). The study also showed that the difference in mean knowledge and attitude before and after intervention regarding fertility, family planning, genetic diseases, and disabilities was statistically significant (P<0.001). Although mean knowledge and attitude of the couples under study increased after instruction the increase was not so high in knowledge (only 4.3%) and after intervention only 8% of the couples gained acceptable knowledge. Thus, in order to develop a relatively stable behavior in young couples it is recommended that the quality of the instructional classes would be overemphasized.

Oral diseases are among the most prevalent diseases in the world, which usually begin during adolescence but oral health can reduce them to a great extent. This cross-sectional study which aimed at determining factors related to oral health in high school female students in Yazd on the basis of HBM (Health Belief model) was used as a framework in order to analyze the related factors of oral health behavior (OHB) during the school year 2005-2006. In this cross-sectional (descriptive and analytical) study 201 female high school students in Yazd were surveyed. Multistage randomized sampling was used. Means of data collection was a questionnaire designed according to oral health beliefs or OHB (perceived severity, susceptibility, benefits, barriers). The obtained data was analyzed by means of SPSS software, descriptive statistics, and Pearson coefficient tests, variance analysis, and Tukey test; and P0.05 was taken as the significant level. The subjects of the study aged 14-17 years with a mean of 15.2±0.8 years. Mean of perceived barriers of the students whose fathers were clerks was 9.77 and that of students whose fathers were labourers was 11.35.Statistical variance analysis test showed a significant relationship between these two (P=0.006, df=2, F=5.306). Most (65.5%) of the students brushed once a day, 37.5% of them used dental floss, and 11.1% saw a dentist every 6 months. Pearson coefficient test showed a significant relationship between perceived severity and oral health behavior/ OHB (P=0.036, r=0.148). Besides, perceived barriers were correlated with OHB (P=0.012, r=-0.176). No significant association was found between sensitivity and perceived benefits on one hand and behavior on the other. In this study, perceived severity and barriers showed a significant correlation with the expected behavior. There was no significant relationship between sensitivity and perceived benefits with behavior. Moreover, it was found that mean grade of the students at perceived “severity”, “sensitivity”, and “benefits” was favorable but their behavior was not favorable with regard to it. It seems as if other factors, beyond these beliefs, are effective in the occurrence and quality of oral health behavior. Therefore, more extensive research is recommended in respect of this.

According to various studies, obese women, have an increased risk of a number of pregnancy complications and adverse pregnancy outcomes. Worryingly, the prevalence of obesity is rising during pregnancy. The present study was done to determine the incidence of obesity and its relationship to pregnancy complications. In this prospective study, all pregnant women in their early stage were referred to women’s clinic of Fatemiyeh Hospital by all health care centers and private clinics as soon as diagnosed. Obesity was defined as having a body mass index (BMI) of ≥30 kg/m² or more. So, pregnant women were divided into obese and non-obese cases according to BMI. All the women had no previous systematic diseases and received routine prenatal care until their labor. Demographic and pregnancy data were obtained on arrival and were recorded in special files; and the cases’ economic status was determined by means of a special checklist. The obtained data was analysed by means of non-parametric variance analysis of, chi-square, Fisher exact t- test, Mann Whitney U, linear regression, and correlation co-efficient; and P≤0.05 was taken as the significant level. Totally 1194 pregnant women were studied. Prevalence of obesity was %13 (162 pregnant women). Obese women were older and had more childbirth. According to variance analysis and confounding factors including age and parity, obesity was found to be an independent factor in the occurrence of pre-eclampsia (P<0.001), gestational hypertension (P<0.01) and hydramnios (P<0.001) as well. Cesarean rate in obese women was greater and significant (P<0.001). Results confirmed that despite appropriate prenatal care, obesity was associated with an increase in pregnancy complications. So in order to improve the quality of care, pre-conceptual care is recommended. Weight losing, as an easy and inexpensive procedure in women who refer to the health centers to receive health care and family planning service, is essential and is recommended.

Gender differences are of intrest to numerous researchers trying to conceptualise psychological well-being. This study was conducted to determine the role of sex discrepancies in psychological well-being scales- adjusting to age as a covariate variable. In this descriptive-analytical study, 376 students (158 males and 218 females) filled out Riff’s Scales of Psychological Well-being. Analysis of covariance (ANCOVA) was used to examine gender differences in the scales of psychological well-being (i.e. autonomy, environmental mastery, personal growth, positive relations with others, and purpose in life and self-acceptance). Results of ANCOVA showed statistically significant gender differences in scales of positive relations with others and personal growth. In other words, the results indicated that female students scored higher on positive relations with others and personal growth than male students while, no significant gender differences were found on autonomy, environmental mastery, purpose in life and self-acceptance. The findings emphasize the need to recognize the role of gender differences studying scales of psychological well-being. Implications of these findings are discussed with mental health professionals.

Diabetic microalbuminuria is one of the complications of diabetes, which has a higher incidence in type II diabetics than in type I patients. The disorder is accounted the principal cause of the end stage of renal disease (ESRD) across the world. The present study was carried out aiming at determining the prevalence of diabetic microalbuminuria in type II diabetics and its relationship to blood lipids (cholesterol, triglyceride) level, hemoglobin A1C, age, sex, and smoking. In this descriptive –analytical study, all patient's files (between March 2005 and March 2007) available in Kasra Specialized diabetic clinic and Vali-e-Asr hospital, affiliated to Birjand University of Medical Sciences, were studied. Requisite information including age, sex, blood pressure, diabetic period, blood lipids level etc, was recorded in a review-form. Then, the obtained data was analysed at the significant level P≤0.05 by means of the statistical software SPSS using Student-t and Chi-square at the significant level P<0.05. Totally, the files of 964 patients were surveyed. 30.8% of the patients aged between 51 and 60 years.361 cases (37.4%) were women.267 cases (27.7%) had a history of smoking and 74.3% a history of hypertension. Besides, 87 patients (9%) suffered microalbuminuria. In most of the cases (60.6%) the period of having diabetes was less than or equal to five years. Mean time of having diabetes was 5.86±4.8 years. Cholesterol and triglyceride levels were higher than normal (55.5% and 63.9% respectively) and their mean values were estimated 213±66mg/dL and 214±142mg/dL respectively. Logistic regression test showed a significant difference between variables such as period of having diabetes (P=0.001), and hypertriglyceridemia (P=0.01) with microalbuminuria (P<0.05); but no significant relationship was found between age and sex to this disorder. Admittedly, based on the findings of this study, time span of having diabetes, hypertension, and smoking are among the important risk factors triggering the occurrence of microalbuminuria. However, more studies with a larger sample size are recommended.

Vitiligo is an acquired depigmentation disorder that is recognized by loss of melanocytes in epidermis, mucosal surfaces and other body tissues. Vitiligo might be an autoimmune disorder with anti-melanocytic antibodies. This study aimed at determining demographic characteristics of vitiligo cases referring to dermatology clinic of Vali-e-Asr educational hospital in Birjand. In this descriptive study 300 patients with clinical diagnosis of vitiligo who had referred to the dermatology clinic of Vali-e-Asr hospital between 2002 and 2007 were evaluated with regard to characteristics such as age, sex, familial history, sites of lesions, form of involvement and some of its associated diseases such as halonodus, alopecia areata and hair involvement (leukotrichia). Out of 300 patients analyzed, most were females. 23.6% had positive familial history. Most sites of lesions were limbs and face and the most common form was generalized involvement. In association with vitiligo, halonadus in 6.6% alopecia areata in 1.33% and hair involvement in 11% were observed. Considering that the majority of cases were females and the fact that the external areas of the body such as hands, feet, and face were the mostly involved sites; studying the genesis of the disorder, development and distribution of it seems important so that by decreasing the number of cases and prescribing an effective treatment the emotional, psychological and social complications of the disease would eventually decrease.

Birth rate of patients with schizophrenia during the winter and spring months is 5%-8% higher worldwide than their rate in the general population, although the reasons are unknown. The aim of this study was to determine birth season of schizophrenic patients hospitalized in Sina hospital of Hamedan city between 1999 and 2004. In this descriptive- analytical (cross-sectional) study, 645 schizophrenic cases who had been hospitalized in Sina psychiatric center of Hamedan city between 1999 and 2004 and their disorder had been determined based on Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-IV) were surveyed. Means of data collection was a questionnaire consisting of personal history queries and queries regarding the aims of the study. The obtained data was analysed by means of SPSS (10) software and using descriptive-inferential statistics at the significant level P≤0.05. The subjects included 381 men and 273 women. Most cases had been born in spring (46.2%) and winter (31.8%), and the least births (7.6%) belonged to summer. The results showed the effects of seasonal variations on the occurrence of schizophrenic patients’ births as their births had a higher frequency in spring and winter rather than in summer and autumn.

Hypertension is a chronic asymptomatic disease which is one of the most public health problems afflicting many of people over 35 years old in the world. The disease is the most important cause of all cardiovascular diseases, stroke, heart attack, renal disease, etc. It is also the primary contributor to disability and mortality, which is usually incurable but it must be managed. Management of the disease requires a certain degree of self-regulation, which is defined as the mental and physical processes that manage a person in order to achieve a goal. The purpose of this study was to investigate the factors related to hypertension self-regulation based on the model “goal directed behavior”. This cross-sectional study was carried out on 200 patients referring to health centers of Yazd Township, who were selected in two stages. First, the health centers were selected through cluster sampling in Yazd Township and then the patients were selected by means of simple sampling methods in the health centers. Data was gathered using a questionnaire whose reliability and validity were approved on the part of experts; and its alpha was 0.83 (a=0.83).The obtained data was analysed by means of the statistical software SPSS.WIN (11.5) using coefficient correlation, Mann-Whitney, Kruskal-Wallis, and regression tests. Out of the 200 subjects, 45.5% were men and 54.5% women. Mean years of being hypertensive was 8.7 ±7.6. About 61.5% of the patients indicated that their reason for referring to health centers was to reduce their blood pressure and 35.5% wanted to maintain their current blood pressure. There was a significant statistical relationship between all the variables of Model of Goal Directed Behavior except one (predicted negative emotions) (P<0.001). Moreover, there was a significant relationship between hypertension self-regulation of the cases and all the variables with the sex of the patients (P<0.0001). The results of this study showed that the Model of Goal Behavior can explain over 52% of hypertension self-regulation cases. Therefore, this Model can be a basic Model for educational intervention to decrease and control hypertension in patients.

Breast cancer is the most prevalent cancer among Iranian women. Early diagnosis of the disease is vitally important in successful treating of it and reducing its mortality and care-cost burden. In our country,the major causes of mortality and other unfavorable complications of the disease are due to late referring of women. So far, the nature of this behavior has not been studied. The present qualitative study was done on a number of Tehran women to clarify the concepts of breast cancer control and prevention; and factors affecting this procedure. A content analysis with a qualitative approach (Grounded Theory) was conducted in depth on 31 women through semi-structured (individual and group) interviews. Data collection continued to saturation point. Data analysis was done by means of constant comparative analysis method, using theoretical sampling and constant comparison analysis The study was done on 31 females aged 49±8.05, of whom 54.8% were in employment and 45.1% were housewives. Education level was average in 48.3% of the cases and 27% of them were married. Individual and social factors were the two effective categories that shaped the women’s behavior, which regarded women’s early detecting behavior and respective factors were classified into 3 categories: Inappropriate attitude toward behavior, Inadequate risk-perception, and inefficient perceived data. The mentioned concepts are the same obstacles and frustrations which may occur in detecting breast-cancer behavioral procedure, together with a shade of subjective behavior. Controlling is a multidimensional concept which has individual and social aspects but individual intentional rate is higher. After final analysis of the obtained data, inappropriate attitude towards control and prevention of breast cancer was taken as the central variable and conscious persuasion was recognized as the corrective factor. Health promotion of women, who make up half of the active population of the country, is one of the requirements of stable development and planning appropriate methods to warn women of health risks is among health education missions. The indispensable factor in this respect is attention to women's attitude construct and qualitative studies seem to define behavioral situations better than quantitative methods; and, thus, help planning educational interventions. Therefore, it is suggested that defining the concept of breast-cancer control and prevention according to routine quantitative methods and comparing it with the results of the present study should be taken into account.

Mucormycosis is the most fatal systemic fungal disease which is precipitated by diabetes or immunodeficiency state. The most common form of the disease is the rhinocerebral involvement. The disease has a high rate of mortality if not diagnosed in time and treated properly. This article presents Mucormycosis in a diabetic. The case was a 26 year old young male with diabetes mellitus being treated with insulin; who was presented with fever, facial and right eye swelling, general bad condition, having a 3 year history of heroin (crystal) addiction, and referred with initial diagnosis of cellulites. On examination, it was found that the case had right eye proptosis and ecchymossis, unilateral bloody discharge of nose and dispnea. Moreover, black necrotic lesion was found in nasal mucosa. Biopsy of necrotic tissue was done and staining with PAS was performed, which proved the existence of rhinocerebral mucormycosis. The patient was taken to ICU and was Administered broad spectrum antibiotic treatment and 1mg/kg amphotericin B. But the next day, in spite of the treatment, the patient got dementia and deceased three days later.