مجله دانشگاه علوم پزشکی شهرکرد
سال یازدهم شماره 1 (پیاپی 41، بهار 1388)

In spite of many researches about low back pain treatment, there is no agreement regarding the most appropriate intervention. This study aimed to compare the effects of McKenzie exercises with lumbar stabilization training on the chronic low back pain and functional improvement. Thirty-two patients with chronic low back pain were selected through simple non-probability sampling for this double-blind randomized clinical trial. Subjects were randomly assigned to either a stabilization exercise group (n=16) or a McKenzie exercise group (n=16). Before and after intervention, we assessed pain (ordinal) through McGill Pain Questionnaire (MPQ), disability (ordinal) with the Oswestry Disability Index (ODI), range of lumbar flexion (centimeter) using Schober test and lumbar lordosis (degree) with flexible ruler. A 10 session daily exercise program, one hour per session was performed for both groups. Independent t-test or Mann-Whitney U and paired t-test or Wilcoxon were used for comparison between the pretreatment and post treatment test results between groups and within groups, respectively. The mean pain disability and lumbar lordosis decreased in both group (P<0.001). The mean range of lumbar flexion increased only in the McKenzie group (P<0.001). After treatment, there was no significant difference between two groups regarding related variables (P>0.05). Both lumbar stabilization and McKenzie exercises cause decreasing in pain, disability and lumbar lordosis in patients with chronic low back pain. McKenzie exercises also cause increasing in range of lumbar flexion. However, one treatment method was not more effective than the other.

Smoking is one of the main reversible risk factors for coronary artery disease. Incidence of arrhythmia induced by myocardial infarction is the most important reason for death in these patients. Mortality rate in smoking myocardial infarction patients is grater than non smoking patients, but the aim of this study was to compare the incidence of arrhythmias between smoking and non smoking myocardial infarction patients. In this case and control descriptive analytic study, 200 myocardial infarction patients (100 smoking & 100 non-smoking patients) who were referred to cardiac care unite in Hajar university hospital were selected. Data were collected using questionnaires, filing the form of physiological variables, laboratory findings and finally types of arrhythmias and myocardial infarctions. Data were analyzed by the independent-t test and the Fishers exact test. The average age in smoking patients was 54.23±8.12 and it was 55.23±8.11 in non-smoking patients. Type of myocardial infarctions in 70.5% of the cases was anterior myocardial infarction and the rest was inferior myocardial infarction. Our study showed that the type of arrhythmia in smoking group was different than non-smoking group. Sinus tachycardia, Atrial Flutter, preventricular heart beat, ventricular tachycardia and ventricular fibrillation were higher in smoking group compared to the non-smoking group (P<0.05) According to this study, the incidence of arrhythmia in smoking patients with myocardial infarction is greater than non-smoking patients. Therefore, more attention should be focused on smoking patients with myocardial infarction for arrhythmia.

Young girls often intend to use food restricted diets to loose their body weight and to be fit. This study was carried out in order to determine the effect of food restriction on the changes of body weight, body fatness, aerobic capacity and energy intake in young women in Tehran. In a Quasi-experimental study, 40 volunteers were selected from girl students. Their weight, height, body fatness (by measuring Triceps Skin fold (TSF) Thickness), aerobic capacity (VO2max) and energy intake were measured at the beginning of the study. The students were asked to skip one of their meals per day for a period of four weeks. At the end of 4 weeks, all variables were measured again and compared with the previous data. Data were analyzed using paired t test. No significant differences were seen in weight, BMI, TSF and VO2max (P>0.05). We also did not find any significant difference in energy intake following the skipped meal in young women (P>0.05). The results of this study demonstrate that the food restriction for four weeks in young women has no significant effect in body weight and fatness. It seems that there is a physiological adaptation in energy intake and expenditure.

It has been shown that contraceptive pills, which are commonly used orally, have some side effects, such as vomiting, nausea, high blood pressure. Vaginally usage of the contraceptive pills reduces these side effects. This study aimed to evaluate and compare the effect of orally and vaginally usage of low dose contraceptive pills on bleeding pattern in dysfunctional uterine bleeding. In this clinical trial study, 100 women who had been referred to the Shahid-Beheshti and Al-Zahra hospitals of Isfahan as having dysfunctional uterine bleeding were divided into two equal groups. Groups 1 were given contraceptive pills orally and group 2 vaginally. Using pictorial bleeding assessment, the amount and duration of uterine bleeding were measured at the beginning and end of the study. In addition, the side effects of the pills were evaluated at the end of the study from both groups. Data were analyzed using Chi- square test. Low dose contraceptive pill in vaginal route decreased bleeding amount and duration of bleeding more effectively than oral rout (P<0.05). The side effects of contraceptives, such as nausea and vomiting was significantly higher in orally-used group compared to the vaginally-used group (P<0.05), but vulvo-vaginitis was significantly higher in vaginally-used group (P<0.05). Using the contraceptive pill by vaginal rout is a safe method with few side effects compared with the oral rout.

Hepatitis B virus (HBV) is one of the main causes of hepatitis and can lead to hepatic cirrhosis. Health services staffs are at high risk to this disease and are recommended to be vaccinated against HBV virus. The purpose of this study was to determine antibody levels against hepatitis B surface antigen (HBsAb) in Shahrekord Hajar hospital staffs. In this cross sectional study, 275 people from the Hajar hospital personnel were evaluated for their levels of HBsAb. The level of HBsAb was measured by Eliza test. Data were statistically analyzed with Chi – Square test. From 257 people, 21 persons (8.2%) were not immune, 91 people (35.4%) were partially immune and 145 persons (56.4%) were completely immune. 56.4 percent of those personnel who had received their last vaccination within previous 5 years were immune (P<0.05). Our study showed that the level of HBsAb in health services personnel in Hajar hospital was good enough to protect them from hepatitis. In addition, maximum acquired immunity time is five years.

Carpal tunnel syndrome (CTS) is a collection of sensory-motor signs and symptoms which are created due to mechanical pressure on median nerve at wrist. A considerable portion of these patients are pregnant women. The aim of this study was evaluate functional disabilities of upper limb due to CTS in pregnant women. A descriptive and analytical study was performed on 267 pregnant women, who had received health care service in Obstetrics and Gynecology clinics of Shariati & Sepahan hospitals in Isfahan Iran, 2005. From the total number of the pregnant women, 52 women who were affected by carpal tunnel syndrome (CTS) and 54 women who had not shown the symptoms of CTS were divided in two different groups. Minor and background data were obtained from conversation and physical examination. Scores of functional disability of upper limb were obtained from DASH questionnaire. Student’s t test and Man-Whitney test were used to compare the difference between groups. 52 out of 267 pregnant women (19.47%) suffered from carpal tunnel syndrome (CTS) with average age of 25±4.3 years. 51.9% of the women were experiencing their first pregnancy (primigravida). 82.7% of the pregnant women affected carpal tunnel syndrome (CTS) in third trimester of their pregnancy. The average weight gain in affected carpal tunnel syndrome women was significantly more than the asymptomatic women (P<0.001). The total score and mean score of other parts of DASH scoring system in affected carpal tunnel syndrome women were significantly higher than the asymptomatic women (P<0.001). Carpal tunnel syndrome (CTS) in pregnant women, especially during third trimester, can lead to functional disabilities in their upper limb. As a result, it can cause undesirable effects on personal efficiency. So, it is needed to teach and give more information to the pregnant women about these disabilities.

Measurement of serum enzymes levels, such as lactate dehydrogenaze (LDH) and its isoenzymes is a routine way for diagnosis of myocardial infarction. One of these isoenzymes is LDH-1 which is raised after myocardial infarction. The purpose of this study was to evaluate total-LDH / heat resistant- LDH ratio in patients with acute myocardial infarction and unstable pectoral angina. In an descriptive analitical study 220 patients with suspected myocardial infarction (MI) or unstable pectoral angina (UA), hospitalized in CCU ward of Ekbatan Hospital in Hamedan city were studied. Using WHOs criteria, 110 were classified as having myocardial infarction and 110 as having unstable pectoral angina. The serum level of total-LDH and heat resistant- LDH was measured by NADH exchange method, 24 to 48 hours after their admission to the hospital. Data were analyzed by student-t test and Mann-Witheny test. Our study showed that total-LDH / heat resistant- LDH ratio in MI patients was 1.27±0.18 and it was 2.51±1.39 in UA patients (P<0.001). In our study, we found that when total LDH/ heat resistant- LDH ratio is decreased the severity of myocardial infarction (number of involved leads) and creatine phosphokinase (CPK) is increased (P<0.01). We did not find any relationship between total LDH/ heat resistant- LDH ratio with sex, age, type of MI (Q-wave & Non Q-wave), block after MI and arrhythmia following MI. Our results revealed that measuring heat resistant- LDH can be used as a method for accurate diagnosis of MI. This simple method can be used in centers where other accurate tests are not available.

Acute renal failure (ARF) is defined as an abrupt severe decrease in glomerular filtration rate (GFR). ARF is commonly seen in neonates admitted to neonatal intensive care unit. In this article, we have studied incidence, etiology, predisposing factors, management and mortality in neonates affected by ARF. A descriptive study was took placed at NICU of Qhaem hospital over a period of one year, between December 2005 and December 2006. 750 neonates were evaluated for ARF, according to having two of three following criteria: 1- oliguria: U/A < 1/2cc/kg/h 2- BUN> 20 mg/dl 3- Cr>1/2 mg/dl Patients were assessed for B.S (blood sugar), BUN, Cr, urine index (FENa, Uosm, BUN/cr, U/P osm, RFI, Una), ABG and kidney sonography. According to patient’s response to the fluid therapy and kidney sonography, they were divided into two pre-renal and renal failure groups. Data were analyzed using descriptive statistics. From 750 neonates admitted in NICU, 38 patients (%5) demonstrated ARF. Pre-renal failure was found in 29 newborns (%76/4) and 9 neonates (%23/6). Predisposing factors for ARF were as following: Asphyxia (%42), Respiratory distress syndrome (RDS) (%26/7), sepsis (%13), sever dehydration (%13) and congenital heart disease (CHD) (%5). Nine infants (%23/6) were died. Mortality was significantly higher in intrinsic renal failure (%88). ARF is still an important etiology of mortality in newborns. Diagnosis of predisposing factors (prematurity, asphyxia, RDS, ventilation and careful kidney control in newborn is essential in this problem.

There is no obvious etiology for cardiac syndrome X (CSX). Some mechanisms, such as endothelial dysfunction and estrogen deficiency have been involved. In this study, we tried to find the association between Helicobacter pylori (HP) infection and cardiac syndrome X. In this case control study in year 2007, 54 cardiac syndrome X-affected patients and 168 referred patients to the Taleghani hospital for elective surgery were included. Data were collected by interview physical examination, laboratory and angiographic findings. Then, Serum anti-Helicobacter pylori antibody (IgG) was determined by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using Chi-square, and Mantel- Hanzel tests with SPSS software. According to the results of this study, 54 patients were considered as case group and meeting diagnostic criteria for cardiac syndrome X. The mean age of subjects was 54.54±8.99 years (range=38 to 72 years). From the total 54 case group patients, 44 patients (81.5%) were positive for helicobacter pylori and from 168 control patients, 95 patients (56.5%) were positive (P<0.001). There was no significant difference between history of diabetes and blood pressure in H.pylori-positive cardiac syndrome X-affected patients According to the results of this study, a probable role for HP infection seems to be involved in the pathogenesis of CSX.

In spite of high prevalence of conversion disorder, there is no widely acceptable effective treatment for it. In this study, we compared four ways of treatment in acute conversion disorder and it’s recurrent after one month.

In a clinical trial study, we selected 80 patients with acute conversion disorder using simple sampling method. They were divided randomly into four treatment groups. (Suggestion, simple muscle relaxation, hypnosis, and diazepam injection) The speed of syndrome elimination, recovery frequency, and one month’s recurrence were compared. The results were analyzed with chi-square, Fisher’s exact test and ANOVA.

Mean recovery time was significantly less in muscle relaxation group compared to the hypnosis and diazepam injection groups (P<0.05). In patients with co-morbidity, the mean recovery time was shorter than the mean recovery time in none co-morbidity (P<0.05). There was no significant relation between one month recurrent and way of treatment or other variables.

All four ways of treatments bring significant recovery, but in muscle relaxation, recovery is faster than hypnosis and diazepam infusion

Anxiety is a complicated process appearing from low to high which may reduce the learning ability. It is common among nurses as they struggle to cope with increasingly complicated stressors such as examinations, article preparation and practical experiences. The aim of this study was to evaluate the effect of muscle relaxation on reduction of anxiety in nursing students before starting the internship program. In this study, 40 nursing students who were going to start their internship program were randomly divided into two equal groups. Before starting the internship program, all students were asked to fill a questionnaire (Spielberger Test Anxiety) to measure their anxiety. In addition, physiological parameters (blood pressure, pulse, respiration, temperature) were collected before and after the study in both groups. During a 45-min session, muscle relaxation training was given to the test group. Muscle relaxation practice was continued three times per day for two weeks. Two weeks after starting the internship, Spiel Berger Test Anxiety and physiological parameters were collected again in both groups. Data were analyzed using Chi-square and t tests. The average age of the students in both groups was 22.7±2 (range=21 to 25 years) and the majority of the students were female (75%). No significant difference was observed between two groups for willingness to the nursing profession, birth rank and the average scores of the students from the previous years. The average anxiety score in control group before and after the study was 27.5±10.2 and 28.3±8.8 respectively (P>0.05). Average anxiety score in test group before and after the study was 25.4±19.5 and 29.2±14.1 respectively (P<0.05). To alleviate stressors associated with practical practice and create a healthy work environment for practice, it is recommended that nursing students have some progressive muscle relaxation before entering practical environments.

Renal cell carcinoma (RCC) is a common type of kidney cancer which demonstrates different symptoms such as uncommon metastasis and paraneoplastic syndrome. Description of the patient: A sixty year man was diagnosed as having a left renal cell carcinoma and underwent for nephrectomy surgery seven years ago. After seven years from the surgery, he referred with complain for feeling a mass in the right hemi-scrotum. In his pathology report, he was diagnosed for metastatic RCC in his contralateral spermatic cord and underwent for orchidectomy surgery.

This case is the first report for this type of metastasis. RCC can spread through retrograde flow from the renal vein to spermatic veins, so suggesting that a careful examination of the external genitalia should be performed in patients with RCC during the follow up period to exclude hidden metastases in these patients.