مجله طب جنوب
سال یازدهم شماره 1 (شهریور 1387)

Sinoatrial node (SAN) is the primary pacemaker of the heart. If the SAN activity fails in any way, then the atrioventricular node (AVN) immediately starts to regulate the activities of the heart. The aim of this study was to assess the existence or non existence of ultrarapid delayed rectifier potassium current (Ikur) and its role on pacemaker activity of two intact SAN and AVN of rat. The pacemaker activities of distinct intact SAN and AVN by two separate metal microelectrodes that contact the endothelial surface of nodes were recorded and cycle length (CL) of action potential was measured. The recording was done before and during 50µM 4-Aminopyridine (4-AP) as an Ikur blocker. Compared to control condition, CL of action potentials of SAN and VAN preparations had increased by 17.60 +/-2.9% and 35.90 +/-2.9%, respectively (P<0.05). It is possible to conclude that the Ikur was present in AVN and SAN and the effect of 4-AP on CL of action potential nodes was significantly different.

Consumption of abundantly accessible metals like aluminum and lead or their salts can cause a wide range of diseases. As plasma biochemical parameters including VLDL, LDL-cholesterol, HDL-cholesterol, total cholesterol, triglycerides, sodium, potassium, urea and creatinine change in many diseases such as coronary artery and renal diseases, it is necessary to investigate the acute and chronic effects of aluminum and lead on these biomedical parameters. A number of 30 New Zealand white rabbits weighted 1350 ± 50g were chosen to investigate the acute and chronic effects of these metals. This study was conducted in vivo, using two different doses, the acute and chronic. To perform the acute stage, aluminum chloride and lead acetate (25 and 13 mg/kg body weight respectively) were injected in to the peritoneum of the rabbits (5 in each group) every other day for two weeks. For the chronic dose, rabbits were administered with aluminum chloride and lead acetate (12.5 and 6.5mg/kg body weight respectively) on alternate days for seven weeks. At the same time deionized water was given to the control groups. Following the acute doses of aluminum and lead salts, plasma concentrations of VLDL, LDL-cholesterol, total cholesterol, triglyceride and sodium were increased significantly, while there were no changes in the plasma levels of HDL-cholesterol, potassium, urea and creatinine. The chronic doses of aluminum and lead salts significantly increased the plasma concentrations of VLDL, LDL-cholesterol, total cholesterol, triglyceride and sodium, but decreased the potassium level. There was no change in the plasma concentrations of HDL, urea and creatinine. Consumption of aluminum and lead are harmful for the body and by increasing the plasma parameters such as VLDL, LDL-cholesterol, total cholesterol, triglyceride and sodium and decreasing potassium may lead to cardiovascular diseases.

Intraductal carcinoma of breast is a prevalent cancer type and one of the main reasons of mortality caused by malignancy in women. Changes of cell and extracellular matrix glycoconjugate are the most prevalent recognized features of cancer cells. These changes are responsible for different and aberrant biological behavior of cancer cells. The aim of the present study was to identify L-fucose containing glycoconjugate in cancer cells in different grades of intraductal carcinoma. Paraffin blocks belonged to 15 patients with intraductal carcinoma were collected from pathology file of Khatam-AL-Anbiya hospital of Zahedan. Sections with 5-7 micrometer in thickness were prepared and stained by Hematoxylin - Eosin and UEA/Alcian Blue pH=2.5. Lectin was diluted up to 10 μg/mL in phosphate buffer solution. The sections were graded blindly according to staining intensity to lectin (0-3). In this study, the presence of a small amount of L-fucose in extracellular matrix of grade I was shown. The staining intensity of interlobular connective tissue was more than intralobular connective tissue. Tumoral stroma did not react to lectin in grade II and III. Statistical analysis did not show any significant difference for extracellular matrix and tumoral cells in different grades of intraductal carcinoma. It seems that reaction of cancer cells to lectin was negative or very poor, and L-fucose containing glycoconjugate did not change in neoplastic changes of intraductal carcinoma.

Carpal tunnel syndrome (CTS) is a painful disease which presents with pain, paresthesias, numbness and tingling. Conservative therapy by using wrist-hand splint is one of the suitable and current remedies. Low-level laser has also been noted very much recently. This syndrome is seen recurrently in patients with spinal cord injury, due to excessive use of their wrists. A number of 21 CTS cases in veteran wheelchair users were included in this study in 2004. They were divided randomly in two control and case groups. Both groups had wrist-hand splints. Low-level laser was given to the case group on volar surface of the carpal tunnel, in ten sessions, every other day. Sham laser was given to the control group in the same number of sessions. Although both low-level laser and conservative therapy were effective in improving symptoms of CTS, low-level laser was more effective in improving paresthesia (P=0.005) and nocturnal pain (P=0.018). Low level laser was not significantly associated with pain reduction. Also it was more effective in improving Falen (P=0.016) and Tinel signs (P=0.031). Low-level laser can be used for treatment of CTS in spinal cord injured patients as an effective and harmless method.

One of the most common factors of mortality and morbidity in premature infants is respiratory distress syndrome. Corticosteroid administration to pregnant women at risk of preterm delivery has been proven to reduce incidence of neonatal death, respiratory distress syndrome and other morbidity in preterm neonate. Repeated administration of antenatal corticosteroids is a common practice in women who have not delivered 7-14 days after the first course of corticosteroid. However, the benefits of this practice as compared to single-course administration have not been proven and many controversial researches are there in this case. This cohort study has been performed with matched controls on 108 preterm neonates (54 neonates in single course and 54 repeated courses). The surveyed variable measures were several maternal and neonatal characteristics, the incidences of neonatal death, respiratory distress syndrome, intraventricular hemorrhage and necrotizing entrocolitis. Matching criteria in neonates were sex, route of delivery and gestational age at delivery. We recorded the obstetrical data from maternal files and then neonatal data in the form of prospective method. There are no statistically significant differences in mean birth weight, head circumference and APGAR score between single and multiple course of antenatal corticosteroid. The incidences and odds-ratio of neonatal death and morbidity were compared between the two groups as follows: neonatal death (7.4% and 13.0% OR=1.80), respiratory distress syndrome (29.8% and 35.0% OR=1.30), intraventricular hemorrhage (22.2% and 22.2% OR=1.0) and necrotizing entrocolitis (11.1% and 9.2% OR=0.7). It seems that multiple courses of antenatal corticosteroids do not reduce mortality and morbidity in neonates.

Fungal sinusitis is a well known disease in immunocompromised patients, but recently many reports have indicated an increased prevalence of fungal sinusitis in otherwise healthy individuals. The aim of this study was to assess the frequency of invasive fungal sinusitis (IFS) in neutropenic patients and to determine outcome factors that may affect their survival.

A total of 142 patients who were undergoing chemotherapy were followed by clinical and radiological features suggestive of fungal sinusitis. Patients with fever, headache, facial swelling and radiological finding underwent endoscopic sinus surgery. The biopsy materials were studied by mycological and histopathological methods.

Eleven from 142 patients were identified to have IFS. The ethiologic agents were Aspergillus flavus (5 cases), Alternaria sp. (3 cases), Aspergillus fumigatus (2 cases) and mucor (1 case). Eight of 11 cases died.

Invasive fungal sinusitis causes a high rate of mortality among immunocompromised patients. Therefore, early diagnosis with aggressive medical and surgical intervention is critical for survival.

Acute appendicitis is the most common and cause of abdominal pain resulting in surgery. The aim of this study is to evaluate etiology of reported high incidence of appendicitis, in Chaharmahal and Bakhtiari province clustering pattern. In a retrospective case control study, 54 subjects who had appendectomy were enrolled in the case group, and 54 were considered as the control group, all from 11 villages in Chaharmahal and Bakhtiari province. The 24-hour Recall for Food Intake was used for both groups. The rate of appendicitis in 11 surveyed villages was 1.57 % and it was 12 % in a village (population=275) which was considered as the core of the study. Diagnosis accuracy of appendicitis based on pathology was 57.14%. Comparing the exposure history revealed that suspected subjects in appendicitis group had history of consumption of wild vegetables [Kangar, Karafs, Tareh, Leveh and Mocheh); with 0R=7.75 and 95% CI: (2.8-21.87)] alone or mixed with local yogurt and consumption of a mixture [Telikeh; with OR=6.25 and 95% CI: (2.4-16.1)]. In medical examinations of suspected cases for clustering appendicitis and candidates for appendectomy, attention to the nutritional history especially wild vegetables is necessary.

Cryptosporidium is an important enteric parasite which causes diarrheal illness in humans and animals worldwide. With attention to the role of cryptosporidium in producing diarrhea and mortality in immunocopromised patients and children under 5 years of age, the present study was designed to identify the prevalence of cryptosporidium and potential risk factors in Isfahan province. This descriptive study was done in Isfahan province from October 2003 to April 2004. A total of 642 children under 5 years of age, immunocompromised patients and high risk persons selected randomly and their stool samples were studied microscopically using Sheater's Sucrose Flotation technique and stained by modified Ziehl-Neelsen staining method. The overall prevalence of cryptosporidium was 4.7% (30 samples). The prevalence rates of infection were 4.6%, 3.5% and 5.4% in children under 5 years of age, immunocompromised patients and high risk persons, respectively. The highest prevalence of infection (6.2%) belonged to 1-2 years old children in the group of under 5 years of age, 3-4 years in immunocompromised patients group and 5-10 years in high risk persons group (10%, 6.2% and 14.8% respectively). Cryptosporidium is significantly prevalent in children under 5 years of age, immune­compromised patients and high risk persons in Isfahan province. Therefore, health policy makers have to design a plan to identify and treat infected subjected with cryptosporidium; thus as a result the transmission of the disease can be prevented in the society.

Legionella species are ubiquitous in natural aquatic environments, capable of existing in waters with varied temperatures, PH levels, and nutrient and oxygen contents. Of 49 known legionella species, 20 species have been linked to pneumonia in humans. Contamination by legionella has occurred in the distribution systems of many hospitals. Aerosol-generating systems such as faucets, showerheads, cooling towers, and nebulizers are responsible for their transmission from water to air. A total of 113 water samples were gathered from different wards of 32 hospitals in different geographical regions of Tehran city. These samples were concentrated by filtration, treated with the acid and temperature buffers, and isolated on a BCYE agar culture medium. A total of 22 hospitals out of 33 (26.5%) were contaminated by legionella species, and 30 samples (26.5%) out of 113 were positive. Chlorine concentration and pH level of the water samples were 0.18-2.2 mg/l and 6.6-7.6, respectively. The high rate of waste water contamination in Tehran hospitals with Legionella indicates the resistance of this microorganism to chlorine and other disinfectants, or inadequate disinfection process, representing the insufficiency of the current decontamination of hospital water distribution system. Thus identifying legionella species and their controlling in water distribution system of hospitals is of great importance.

Knowledge and awareness about puberty health concepts, reasons and causes of specific changes in puberty period and familiarity with related health risk factors can prevent many youth problems. The present quasi-experimental study was performed to survey the effects of puberty health education on health behavior of secondary school girl students of Chabahar. The girl students of the third year of a secondary school in Chabahar were divided into experimental and control group (each consisting 40 students). A questionnaire was used to assess the subjects’ knowledge, attitude and practice, concerning puberty health concepts. An educational program in 12 training sessions was performed for the experimental group. The experimental and control groups were similar in demographic variables and economic condition. There was a significant increase in the experimental group’s knowledge, attitude and practice scores concerning health behavior (p<0.0001). An appropriate educational program significantly improves girls’ knowledge, attitude and practice about puberty health. Therefore, more emphasis should be placed on the health education program to improve girls’ healthy behavior.

Nurses’ self awareness of their own level of clinical competence is essential in maintaining high standards of care and identifying areas of educational need and professional development. Self-assessment is a method for measuring clinical competence, and encourages nurses to use reflective thinking and take an active part in the learning process. Although nurse competence may vary between hospitals, very few studies have been done on this subject. In this cross sectional study, we analyzed clinical competency of 190 registered nurses working in different hospitals in Bushehr by self assessment method. The instrument for data collection was a valid and reliable questionnaire consisting of 73 items from seven categories which were devised from Benner's “from Novice to Expert” framework. The level of competence was assessed on a scale of 0-100 and the frequency of using the competencies was assessed on a Likert scale. the nurses reported their overall level of competence as “good” (51-75). They felt more competent in the categories of “managing situations” and “helping role” (with maximum score of 79.54) and least competent in “teaching – coaching” and “ensuring quality” categories (with minimum score of 61.15). The frequency of practicing competencies had a positive correlation with the level of nursing clinical competence. The level of nursing competence and frequency of using competencies varied in different hospitals. Although the nurses reported their overall level of competence as good, we should be concerned about 24% of competencies which are not used by the nurses, especially in "teaching – coaching" and "ensuring quality" categories.

One potential coping strategy frequently offered by university counseling services is time management for studying. Besides stress relief, time management skills will positively influence key outcomes such as academic performance, problem-solving ability, and health. Thus, it is necessary to investigate how college students manage their timing for studying. The aim of the present study was to assess the pattern of college student's time management in Kerman University of Medical Sciences. This cross-sectional study was conducted on 300 students who were selected by stratified random sampling method among students of Kerman University of Medical Sciences. Information about how students managed their study time during their educational course was collected using a questionnaire which consisted time management stages such as planning, prioritizing, time allocation, listing all study-related tasks and goal setting. Study time management was measured according to Likert scale in range of “never” to “always”. There was a significant difference between the course of study and the mean of study duration (p<0.004). Mean scores of the study time management showed that the medical students (mean=67.5 ±12.87) had the highest scores and the bachelor students (mean= 61.1±15.1) had the lowest scores, but the ANOVA test did not show any significant difference between the mean scores of study time management and the course of study (p=0.07). The majority of students (186 persons=62%) “occasionally” and only 48 persons (16%) “always” were managing their study time. A total of 26.2% of medical students always managed their study time, and in this criterion they had the highest scores in comparison with others. There was no significant difference between the course of study and the pattern of study management (p<0.05). Most of the students of medical sciences have no scheduled programming for their study time management. So it is necessary to teach time management programming to the college students to internalize the necessity of time management attitudes and behavior.