نشریه دانشگاه علوم پزشکی بیرجند
سال پانزدهم شماره 4 (پیاپی 37، زمستان 1387)

Hot flash is one of the most prevalent problems in postmenopausal period.Considering the controversies on hormonal replacement therapy, the aim of this study was to evaluate the effect of a nonhormonal drug, i.e. flouxetine, on hot flash and to compare it with a placebo. In this randomized clinical trial, 80 Postmenopausal women were divided into two equal groups. One group (n=40) were treated with flouxetine (20mg per day) and the other with placebos for 8 weeks. Frequency and duration of baseline hot flashes were recorded one week before the start of the treatment and during the following eight weeks (2nd, 4th, and 8th week). The obtained data was statistically analyzed by means of SPSS, using 2, t-test and correlation analysis at the significant level P≤0.05. The mean rate of frequency and duration of hot flash before treatment were matched in both groups. Positive clinical response was more in fluoxetine group (75%), but in the placebo group it was less (42.5%), (P=0.01). The incidence of side-effects was the same in both groups. Considering the effectiveness of flouxetine in the treatment of hot flash in postmenopausal period with few side-effects, inexpensiveness and availability, it can be used instead of hormonal replacement therapy.

Respiratory distress is one of the fundamental problems of preterm infants. Various studies have indicated that favourable auditory stimulation influences on saturation pressure oxygen (Spo2) amount through regulating respiratory rate and rhythm. Thus, this study was done to examine the effect of lullaby music on SPO2 in preterm infants in NICU. In this clinical-trial study 40 preterm infants that were hospitalized in the NICU wards of Imam-Reza and Qaem hospitals in Mashhad in 2005 were assessed. The infants were randomly assigned to either of two equal groups; the music group (case group) and control group. The infants in both groups were observed and assessed every day for forty minutes for a period of eight days. Percent of oxygen saturation was measured and recorded by means of a pulse oximeter. Then, the music group received 20 minutes of recorded Iranian traditional musical lullaby sung by a woman (db:65-75) per-day for 8 days but the control group received their everyday care with no music. The obtained data was analyzed by SPSS software (11.5), using Chi-square, paired t, independent t, and general linear tests to control intervening variables; and P≤0.05 was taken as the significant level. Results showed that mean change in oxygen saturation level increased in the music group significantly (P=0.001). Increased oxygen saturation level in this group remained stable after the music was off and the difference between the two groups was statistically significant (P=0.019). Lullaby song or music may be introduced into NICU as a more predictable and stable source of stimulation which masks intermittent and unpredictable sounds; because it decreases the amount of distress and interruption experienced by the infant. Keeping SPO2 at a high level with the least oxygen amount received is an important medical goal. Therefore, if an intervention plan can have a favourable effect on the quality and rate of respiration- and as a result on SPO2- it will be a great help to preterm infants.

One of the main objectives of anesthesia is “loss of ability to feel pain (analgesia) and there are different methods and drugs to acquire this. Spinal anesthesia with lidocaine 5% is a method of causing analgesia whose period is about 60 minutes. Since lengthier analgesia is required in some surgeries and using opiates is one of the methods to prolong anesthesia, in this research sufentanil and fentanyl were used in spinal anesthesia to discover which is a more effective drug. In this clinical trial research 80 men aged between 50 and 60 years who had been hospitalized in Gonabad Panzdeh-e-khordad hospital in 2006 for inguinal hernia operation were studied. The patients were randomly divided into two equal groups of 40 each. In one group(F) 20µg fentanyl with 100mg lidocaine 5% and in the other group (S) one 5µg sufentanil together with the same dose of lidocaine was used for spinal anesthesia. A check-list and a questionnaire were used to record the necessary data. The obtained data was analyzed by means of SPSS software using statistical t-test; and P<0.05 was taken as the significant level. Mean of analgesia period in group F was 99.37±18.61 minutes and in group S it was 153.62±26.62 minutes; so there was a significant difference between the two groups regarding the period of analgesia (P<0.001). In group F the occurance of hypotension was 37.5%, bradycardia 27.5%, and nausea and vomiting was 10%;but in group S they were 40%, 32.5%, and 15% respectively. The difference was not statistically significant. Regarding the results of this study, analgesia in spinal anesthesia with sufentanil was lengthier than analgesia caused by fentanyl; and there was a significant difference between the effects of the two drugs (P<0.001). But there was not significant differences in hypotension, bradycardia; and nausea and vomiting. So it is recommended to use sufentanil instead of fentanyl in spinal anesthesia if analgesia for more than100 minutes is required.

Abstract: Quality of life remains low for many patients after coronary heart surgery. The purpose of this study was to design and evaluate an educational program in the improvement of life quality in patients after coronary artery bypass graft (CABG) surgery. In this experimental clinical-trial 110 patients were randomly devided into case and control groups six weeks after coronary artery bypass surgery. Planning of the educational programme was done according to PRECEDE-PROCEED Model. Before implementing the programme, life-quality questionnaires (Sf-36), self-designed questionnaires, and standard questionnaires-according to PRECEDE-PROCEED model- were filled out for both groups. The experimental group received the educational intervention, and the control group received only routine cardiac rehabilitation care. Both group members were followed up immediately and 4 weeks after intervention and the previous questionnaires were filled out for them again. Finally the obtained data was statistically analysed by means of SPSS using Chi-Square, t-test, and variance analysis test at the significant level P≤0.05. Significant improvement was found in the following components of life quality in the cases after their participation in the educational program compared to the controls: physical functioning (P<0.001), physical role (P<0.05), bodily pain (P<0.01), general health (P<0.01), vitality (P<0.01), social functioning (P<0.05), mental role (P<0.01), and mental health (P<0.01). The findings suggest beneficial effects of educational intervention based on the PRECEDE-PROCEED Model on improving quality of life in patients after CABG.

Breast cancer is the most prevalent cancer among women, because one out of every seven women is prone to develop breast cancer. Early diagnosis of the disease has an effective role in its treatment. One of the screening methods is Breast Self-Examination (BSE). If this simple method is taught to women, they can diagnose malignant tumors in their breasts in 90 percent of cases and receive due treatment. This study was done to investigate the effects of various educational methods on knowledge, attitude, and practice of women regarding BSE and compare these effects. In this quasi-experimental study 90 ladies over 40 years referring to Tehran Shahid Kalantari clinic were divided into three equal groups. One group (30 women) was taken as the control group and the other two as the cases. The following educational methods were applied to the two case groups respectively: A group discussion method, B. eclectic method (i.e. films, lectures, face-to-face-instruction, etc.). Data collection tools were a questionnaire consisting of demographic queries, KAP (knowledge, attitude, and practice) questions and a check-list for visible BSE performing on the part of the cases. The obtained data was analysed by means of the statistical software of SPSS, using parametrical statistical tests (i.e. one-way variance analysis, paired-t) and non-parametrical tests (W., C., and 2); and P≤0.05 was taken as the significant level. This research indicated that education by means of both methods raises the level of knowledge, attitude and practice in ladies regarding BSE (P<0.0001). Besides analysis of variances showed that KAP level had a significant difference compared with that of the control group (P<0.0001). Correlation test showed no significant difference between demographic characteristics on one side and level of KAP on the other. Considering the findings about the effect of instruction on KAP of women with respect to BSE, using any of available facilities such as individual or group education as well as audio- visual methods in health care centers would be advantageous.

Brucellosis has widespread prevalence and is one of the endemic diseases in our country, Iran. It is estimated that every year almost 500000 cases of Brucellosis - mostly Brucella Melitensis-occur in the world. Any type of brucellosis demands a specific treatment. Thus, this study was conducted to compare reduction of Brucellosis anti-antibody level in the serum one year after treatment with two regimens, i.e. Streptomycin + Doxycyclin and Rifampin + Doxycyclin. This experimental study was performed on 100 patients with Brucellosis based on the clinical findings; wright ≥ 1/80 and 2ME ≥ 1/80. The cases were randomly divided into two groups; one received Streptomycin + Doxycyclin (50 cases), and the other group was treated by Rifampin + Doxycyclin (50 cases). Then 3, 6 and 12 months after treatment Wright and 2ME tests were performed and their results compared by means of statistics using Chi-Square test. The findings of the study showed that age of the cases ranged between 13 and 78 years and 46% of them were 39-48 years old. Results of the tests revealed no significant differences before treatment, but immediately after treatment significant differences were observed in the two groups (Wright: P=0.05, 2ME: P=0.005) as in the first group tests tended to be negative more rapidly than in the second group. Wright’s test after 3 months showed significant differences in the two groups (P= 0.05) but there were no significant differences at 6 and 12 months following treatment. Regarding the rapidity of negative titers of tests in the first group immediately and 3 months after treatment, it could be inferred that Streptomycin regimen leads to a more effective treatment with rapid recovery which is also accompanied by reduction in the disease anti–antibody level in the serum.

Increased oxidative damage due to overproduction of free radicals in diabetic patients has already been reported. Complications in lipid membrane, as a consequence of free radicals’ activities, have proved to be associated with an increase in serum malondialdehyde (MDA); a lipid peroxidation end-product marker. Therefore, this study was performed to assess the effect of controlling diabetes on lipid peroxidation in type II diabetic patients. This case-control study was conducted on 127 type II diabetic patients who were divided into two groups with respect to their serum HbA1C Level. Sixty four patients in the controlled group (6%≤HbA1C≤8%) and 63 cases in the uncontrolled group (8%< HbA1C) were studied. Serum biochemical parameters such as fasting blood sugar, triglyceride, cholesterol, HDL-C, LDL-C and variables such as age, duration of diabetes, cigarette smoking, body mass index (BMI), were determined in the two groups. The obtained data was statistically analysed by means of SPSS, independent t, and Chi-Square at the significant level P≤0.05. Serum MDA level in the uncontrolled diabetic patients was significantly higher (P=0.025) compared to the controlled ones (2.01±0.88 and 1.63±1.01 nmol/mL, respectively). The levels of fasting blood sugar (208.6±61.6, 159.9±33.0 mg/dL) and triglyceride (223.9±131.8, 182.2±95.4 mg/dL) were significantly higher (P=0.001 and P=0.43, respectively). In the uncontrolled group, mean age of patients in the controlled group was significantly higher (P=0.036) than that of the uncontrolled group (57.73±9.25 and 54.38±8.59, respectively). The results indicate increased lipid peroxidation in the uncontrolled diabetic patients. Thus, controlling diabetes as a prophylactic procedure can reduce complications resulted from this increase in type II diabetic patients.

Epilepsy is the second leading cause of CNS morbidity after CVA. Its cause is abnormal synchronous discharge of a group of CNS neurons that cause recurrent seizure. Approximately half to one percent of the world population are affected. Epidemiology of the disease is affected by different factors such as: age pyramid, diet, geographical variations, etc. Hence, studying of the disease is essential and can help to diagnose and treat the patients. This investigation was designed to assess the epidemiology and clinical aspects of epilepsy in Birjand city between 2004 and 2006. This analytical and descriptive survey was done on 222 epileptic patients hospitalized in Vali-e-Asr hospital between 2004 and 2006. Data was gathered by means of a questionnaire which was then analyzed by using chi-square, T-test and ANOVA applying SPSS software; and P<0.05 was taken as the significant level. Our findings showed that epilepsy is more prevalent in males (59.5%) than females (40.5 %).The relative frequency of age in epileptic patients was in the order of 10-19 years (36.9%); 20-29 years 23.9 %, and 50-59 year old group (2.7%). The onset of the disease was in the order of 0-9 years (38.7%), 10-19 years (37.4%), and 50-59 year old group (1.4%). With respect to type of epilepsy, generalized and focal seizure accounted for 51.4% and 48.6% of the cases, respectively. The dominant hand was the right hand (77.5%) and the remainders were left–handed. No significant statistical relationships were found between kind of seizure-in one hand-and epilepsy type, age of onset, sex, hand dominancy, familial history and Todd’s palsy; on the other. According to the findings of this study, high frequencies of the disease, which had unfavorable effects on their lives, belonged to active age-group of the population. Thus, a larger study with more population and for a longer period of time is recommended for a better and more accurate survey of epilepsy in the region.

Noise induced hearing loss is one of the most common occupational diseases in the world. It is thus introduced as one of the ten principle work-related diseases. According to the estimation of WHO, noise approximately causes a daily loss of 4 million US dollars throughout the world. This cross-sectional and analytical study was carried out on 100 workers of Taban textile factory in Yazd to assess hearing loss in the left and right ear of the staff at weaving, spinning and mechanical sections. This was done at 250, 500, 1000, 2000, 4000, and 8000 Hz frequency by means of audiometer. Besides, mean noise intensity in the auditory system of the workers (who had already been examined) was measured during their own shifts. The obtained data was statistically analysed by means of SPSS software and ANOVA; and LSD (less significant difference) was calculated. P≤0.05 was taken as the significant level. Mean age and work history were 38.9810-43 and 13.836.1 respectively. Findings indicated that noise induced hearing loss (NIHL) would be 0.18, if sound intensity increased one degree and work history were stable. But if sound intensity were stable, NIHL would be 0.37 when work history increased one degree. ANOVA statistical test (at the confidence level 95%) showed that the increase in NIHL is different in various occupational groups. Hearing loss was observed at different levels and at all frequencies in textile factory workers. However, hearing loss in the work begins at 4000 Hz and according to regression analysis the effect of work history on NIHL is more than the effect of sound.

One of the first steps in diagnosing neoplasms is their epidemiological study. Being aware of the epidemiological condition of different kinds of neoplasms can help us a lot in educational planning and research; and cure the disorder as necessitated in a certain area. The present study was done to epidemiologically investigate the neoplasms in woman’s internal genital system in Birjand between 1996 and 2006. This analytical and descriptive study was done on 2979 biopsy dossiers of the internal genital system of women who had referred to Birjand pathology labs between 1996 and 2006. The dossiers whose pathological reports were benign and malignant neoplasms, preneoplasic damages, and ovary physiologic cyst were selected from the biopsy dossiers. Then a check-list, which demanded demography information, sampling place and time, pathological diagnosis, primary diagnosis, and the damaging process, was filled out. Finally, the obtained data was analysed by means of SPSS software using Chi-Square and t-test at the significant level of P≤0.05. Most Pathologic cases were found in patients aged between 40 and 59 years (47%). Most of the patients (79.9%) who were studied were urbanites. The number of the cases of the malignant neoplasma in rural areas was twice that of urban areas, and the number of the cases of preneoplasic damages in villages was three-fold. The most malignancy rate of women’s internal genital was that of the cervix. In uterus, most cases of benign neoplasms were leiomyoma, and most cases of preneoplasic damages were complete moles and the majority of the cases of malignant neoplasms included adenocarcinoma. But the most cases of benign preneoplasic tumors were endocervical polyps. The most number of malignant tumors were Squamous Cell carcinoma (SCC). Out of ovary pathogenecity, 73.1% were physiologic cysts from which 50.7% were luteal ones. In addition, adult teratoma, as the most percentage of benign neoplasms, amounted to 30.7% and epithelial carcinoma, as the most percentage of malignant tumor, reached 53.5%. Thus, it was found that the frequency of malignant cases gradually increased during this period of 10 years (from 2.3% in 1996 to 21% in 2006). Regarding the high frequency of cervical malignancies, studying risk factors such as marital age, number of pregnancies, socioeconomical status, and infections are very necessary. Moreover, planning to do right and accurate screening of women especially in rural areas is of critical importance.

Diabetic foot complication and its amputation is one of the most physical and emotional disabilities in diabetic patients. Since much of the care of the patients is on their own part and it is not possible for them to be under the medical attention of physicians, nurses and health workers, the best way is to care for their feet at home. The aim of this study was to survey the care of the feet based on Health Belief Model in type II diabetics referring to Kermanshah diabetes research center. In this cross-sectional study 108 type II diabetic patients referring to Kermanshah diabetes center were selected randomly. Data collecting was done by means of a questionnaire having 59 questions and covering, 5 sections including: demography, knowledge, health belief model (perceived susceptibility, severity, benefits, barriers, and cues of action) foot care at home, and the checklist. The findings showed that 33.3% of the subjects got only 40% of knowledge scores and 14.8% had not acquired at least 30% of the scores. The patient's perceived susceptibility was low, so that 32.4% of them were not aware of the risk of diabetic foot and only 2.8% of them knew foot-care benefits completely. The findings showed that there was a significant relationship between the mean score of perceived benefits scores and the level of perceived susceptibility with the level of foot care (P< 0.05); because only 2.8% of the patients took everyday necessary care of their feet at home. According to this study knowledge and attitude of the subjects (i.e. two aspects of Health Belief Model) were at an average level but their behavior regarding foot care was lower than average. It seems that the use of theoretical based models such as Health Belief Model and self-efficacy theory can be effective on promoting foot care level.

Diabetes mellitus is a major health problem throughout the world. This biochemical disorder is characterized by hyperglycemia, impaired metabolism of carbohydrates, fats, and proteins; and accompanied by absolute or relative insulin deficiency of the body. It is estimated that by 2025 about 300 million will have got diabetes in the world. Self-efficacy is proposed as a concept of social learning theory and a construct of health belief model, particularly when the model is used for predicting simple life-style changes in chronic diseases. This study was designed and carried out to determine the status of this construct and its related factors in addition to its correlation with self-care behaviors among diabetic patients. This cross-sectional study was carried out on 120 patients referring to Yazd diabetes research center. A questionnaire whose validity and reliability had been assessed and approved was used to record perceived self-efficacy and self-care behavior constructs through interviewing each subject in private. Besides, the subject's demographic variables such as age, sex, education level, job, period of having diabetes, and type of diabetes were inquired. The subjects scored 59.9% of self-efficacy. Among self-care behaviors, keeping blood glucose at normal range when under stress and managing hyper/hypoglycemia well, received the lowest perceived self- efficacy score, but performing the prescribed number of daily insulin injections or taking drugs in due course received the highest score. Men had a higher level of self-efficacy, while it was also positively correlated with education level. Level of self-efficacy was also higher in female employees in comparison with housewives. Self-efficacy was positively correlated with self-care behaviors and its respective variance was 38% Respondents gave average self-efficacy ratings on their ability to manage all aspects of their disease. Self-efficacy, as the most important diabetes-related self-care, got a high level of importance. Therefore, self-efficacy must be reinforced in these patients especially in women who seem to be weaker in this domain.

Cephalometery is a branch of anthropometry science. This research was conducted in view of the importance of anthropometric indices in forensic medicine, plastic surgery, anatomy and orthodoncy with regard to face shapes of young males in the ethnic groups of Gorgan. This descriptive and cross-sectional study was done on the face shapes in Fars and Turkman ethnic groups of 398 normal 17-20 year old males using cephalometric measures. The length and width of faces were determined by using classic cephalometery technique; Martin Saler Cephalometer having the accuracy of 0.5 mm and T ruler; and the shape of faces were classified according to 5 international types. Then, mean and percent of face shapes in the ethnic groups of Fars and Turkman males were compared. To determine morphological indices in the ethnic groups chi-square test was used and for comparison of the means of the anthropometric findings Student’s t (=0.05) was applied. The dominant type of face shape in the native Fars and Turkman males was mesoprosopic; 44 % and 38.4%, respectively. The rare type of face shape in native Fars and Turkman males was hyperleptoprosopic; 4% and 8.6 %, respectively. Mean of prosopic index in the two ethnic groups was not significant. This study, in addition to determining face shapes in the area, indicated that diversity of face shapes in the ethnic groups is due to genetic factors.

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary nodal status and obviating the need for axillary lymph node dissection (ALND) in patients with breast cancer. The aim of this study was to assess the accuracy of the SLN biopsy in the correct prediction of ALN involvement. Thirty three patients with breast cancer that had been operated in Ayatollah Taleghani and Mehr hospitals in Tehran were enrolled in a prospective study. In these patients, at first SLN biopsy and then ALND was performed. SLN was found via radionuclide scintigraphy and blue dye during the surgery. Both SLN and ALN involvement were assessed by a pathologist. Mean age of the cases was 52.03±8.4. Accuracy of SLN in predicting ALN involvement was 90.91% (Confidence Interval: CI=95%: 77.88%-96.60%), sensitivity was 92% (Confidence Interval =95%: 75.03%- 97.78%) and specificity was 87.5% (CI =95%: 52.91%-97.76%). Success rate of SLN finding was high; so SLN biopsy can be used to determine the stage of breast cancer in hospitals and the centers which have these equipments.

Peripartum Cardiomyopathy (PPCM) is a rare and specific form of dilated and fatal cardiomyopathy which leads to systolic complication of the left ventricle. The disease usually begins slowly but its progression is fatal. Thus, the prognosis of the disease is often poor. Because of the low prevalence of the disease, extensive epidemiologic and clinical studies are not available. Few papers, most of which are retrospective studies, are available in Iran in this regard. The reported case was a 29 year old woman who matched all the criteria of PPCM presented in Braunwald textbook of cardiology. Contrary to ordinary ones, our patient had a sudden onset – with severe pulmonary edema after cesarean section; while she used to be absolutely healthy before the surgery. In spite of severe clinical condition and very low left ventricular ejection fraction (LVEF) on admission, her response to treatment was excellent and remained healthy in a 2 year’s follow- up, with a normal LVEF.