مجله دانشگاه علوم پزشکی اراک
سال دوازدهم شماره 4 (پیاپی 49، زمستان 1388)

Information on patient's physical and mental disabilities, their lifestyle during rehabilitation period and probably their death due to severe head injury in acute phases is too insufficient and in some cases, it does not exist at all. The aim of this study is to determine the outcome of patients who were hospitalized in Vali-asr Hospital of Arak according to Glascow Coma Scale (GOS). In this cross-sectional retrospective study, using the patient's files in Vali-asr Hospital which is situated in Arak, the patients, who had been hospitalized with severe head injury during 2005-06, were identified. Based on the information existing in their files or visiting them individually in their place of living, 24 months after their release from hospital, their physical and mental performances were examined according to Glascow Outcome Scale (GOS) and were compared to the time of their release from the hospital. Out of 130 patients, 55.4% died within 2 years after the hospitalization period. Among those dead, 32% died in the first 24 hours of hospitalization, 44.4% after the first 24 hours and before release from the hospital and 23.6% after being released from the hospital. The mean of GOS score, from the time of release until 2 years after that, improved from 2.7 to 3.3. Noticing the fact that more than half of the patients died after getting to hospital either in acute level or during rehabilitation, the need is felt for making revisions in the programs for taking care of these patients in different phases of treatment

Noticing the daily advancement of the role of electromagnetic field generators in human life, examination of the biologic impacts of these waves has come to be extensively appreciated by researchers. During pregnancy, vitamin A is extremely essential for the development of fetus and its lack, insufficiency or excess can result in embryonic malformations. This study investigated the synergetic effects of vitamin A and extremely low frequency electromagnetic fields on the development of embryo skin in Balb/C mice. This study was experimental in nature. Eighteen pregnant mice were divided into control, sham-exposed and experimental groups. The mice in the experimental group were given an intra-peritoneal injection of 15000 IU/kg vitamin A on the 10.5th day of gestation and were, then, exposed to a 50Hz electromagnetic field 4 hours a day from 10 through 12th day of gestation. The animals were dissected and investigated morphologically and histologically on 17.5th day of gestation. The results showed an increase in the mean weight of fetuses in the experimental group in comparison to the sham- exposed group (p<0.05). Also, Crown-Rump of fetuses in the experimental group increased in comparison to those in the sham- exposed group (p<0.001). Epidermis thickness increased significantly in experimental group in comparison to sham- exposed (p<0.05), while the average number of basal, spinous cells and hair follicles decreased significantly in the experimental group compared to the sham- exposed (p<0.001). The findings indicate that vitamin A usage and synergetic exposure to low frequency electromagnetic fields (50Hz) profoundly affect the development and growth of skin epidermis in the fetus of Balb/C mouse.

Since cardiac surgeons have not kept up with advancements in pacing technology, there has been a tendency to limit the implantation of pacemakers by surgeons. This study compares two eras of pacing therapy including pacemaker implantation by cardiac surgeons and pacemaker set-up by a group of cardiologists in Shahid Rajaee Hospital in Tehran. In this cross-sectional study, we compared the existing data from all pacemaker implantations in the first half of 1999 (surgical era, era 1) to that of the first half of 2001 (cardiologists era, era 2). During era 1, a total 114 pacemakers (46.5% male, mean age 63.3 ±18.4) and during era 2, 299 pacemakers (63.9% male, mean age 63.9±18.2) had been implanted. Indications for implantation were nearly similar, with AV block as the most common reason in 21.9% and 19.1% of implantations in eras 1 and 2, respectively. Single chamber pacemakers comprised 86% of implantations during era 1 compared to 54% during era 2 (p<0.01). The mean duration of admission was 18 days during era 1 while it was 10 days during era 2. Pacemaker malfunctions were detected following 7.9% of implantations in era 1 compared to 0.3% of cases in era 2 (p<0.01). Re-do procedures were performed after 2.7% of implantations during era 1 in comparison to 0.3% during era 2 (p<0.01). Pacemaker implantation was performed better by a coordinated pacemaker service run by cardiologist trained in pacemaker implantation.

Diabetes Mellitus is a heterogeneous group of different metabolic disorders that are characterized by chronic increase of blood glucose and proteins, lipids and carbohydrates metabolism disorder. The aim of this study was to investigate the effect of 8 weeks of aerobic exercise on metabolic factors, quality of life and mental health of women with type II diabetes. In this semi-experimental investigation, 18 women with type П diabetes referring to Arak Petroleum Company Clinic were selected and divided into two groups: aerobic (10 participants) and control (8 participants). Aerobic group performed selected exercises in 8 weeks (three 30-50 min sessions per week). In this investigation, we used metabolic factors (such as total cholesterol, triglycerides, HDL, VLDL, LDL, FBS, HbA1c and Insulin serum) and SF-36 quality of life (QOL) and GHQ mental health (MH) questionnaires. The level of significance was considered to be 95% (P<0/05). There were significant differences between the means of pre-test and post-test measures of FBS, HbA1C, Insulin serum, QOL and MH in aerobic group. There were no significant differences between the means of pre-test and post-test measures of TC, HDL, LDL, VLDL and triglycerides in aerobic group and all factors in the control group (P<0/05). Aerobic exercise affects metabolic factors, QOL and MH in type П diabetic patients and it results in their improvement.

Maternal diabetes is associated with an increased risk of several complications in the offspring, such as the growth of congenital disturbances and malformations. In the present study, we examined the effects of maternal hyperglycemia on the volume of brain and lateral ventricle in newborn Wistar rats. In this experimental study, on the 7th day of pregnancy, hyperglycemia was induced by a single injection (i.p.) of streptozotocin (55 mg kg-1) and the animals in control group were given an equal volume of citrate buffer. After parturition on the first day of birth, a litter was randomly selected from each mother, their brains dissected and fixed in 10% formalin. Then they were sectioned with 7μm thickness and stained by H.E. Through the use of stereological techniques and systematic random sampling scheme, the volume of the brain and lateral ventricles were estimated. Statistical analyses showed significant increases (p<0.05) in the volume of the brains and lateral ventricles in the experiment group in comparison to the control group. By affecting blood brain barrier permeability in newborn rats, maternal diabetes can generate a large amount of CSF. These effects can bring about brain disorders such as hydrocephalus.

The existence of estrogen and progesterone receptors, p53, human epidermal receptor-2(HER-2) and cathepsin-D are among the prognostic markers for breast cancer. In this study, we investigated the relationship between these factors and lymph-node involvement. In this case-control analytic study, 105 patients with breast cancer were investigated. After detecting breast mass, surgical biopsy was done and the status of the estrogen and progesterone receptors, p53, HER-2, and cathepsin-D were studied. Collected data were registered in a checklist and were subjected to analysis. There was no relationship between lymph-node involvement and estrogen and progesterone receptors, p53, cathepsin-D and HER-2. In order to get more precise results about hormonal receptors, p53, HER-2 and cathespin-D, a similar research with a larger sample size over a longer period of time is needed.

Ischemia/reperfusion-induced acute renal failure causes excretory functional disorders of nephrones. Ischemia/reperfusion injury increases iNOS expression in the renal tissue. Inhibition of iNOS expression and its activity can ameliorate ischemia/reperfusion-induced renal injury. The aim of this study was to determine the role of iNOS on progression of renal functional disturbances over the immediate post-ischemic reperfusion period. In this experimental study, renal hemodynamic and excretory functions were evaluated in male Sprague-Dawley rats. First, a 30-min control clearance period was taken. Then following bilateral renal artery clamping for 30 minutes, four consecutive 30-min clearance periods were taken during reperfusion, while saline or L-NIL as a selective iNOS inhibitor was infused. In plasma and urine samples, Cr and sodium concentration levels were measured. Renal ischemia for 30 minutes decreased glomerular filtration rate and urine osmolality during reperfusion and increased urine flow and sodium excretion. L-NIL did not change the glomerular filtration rate and urine osmolality prior to ischemia but it improved them during reperfusion and there were progressive increases in urine flow. Additionally, L-NIL lowered ischemia-induced rises in sodium excretion. iNOS had a considerable role in the development of disorders in hemodynamic and excretory renal functions during early hours after ischemia.

The use of proper contrast agents is very effective in improving the quality of medical imaging. In this study, we dealt with the effect of high PH blackberry juice accompanied with omeprozole in reducing the upper fluid artifact in MRCP images. This single blinded before-after clinical trial was done with the enrollment of 34 patients. After receiving official agreement from the patients and applying the enrollment criteria, they were ordered to take two 20mg omeprozole capsules the night before the exam. The next day, while they had been held NPO, they were exposed to the first MRCP. After this, they drank 300cc blackberry juice and were re-examined after 15 minutes. The related checklists were printed and three radiologists independently inspected the reduction of artifact checklists and the resolution of images. Eventually, the quality of images and the mean of artifact reductions in the images before and after black berry Juice consumption were compared. Reduction of artifact scores due to gastrological secretions did not show any significant differences before and after black berry juice consumption (2.97±0.37 and 2.89±0/87, respectively). Additionally, no significant changes were observed in the visibility of gall bladder, water ampoula, common hepatic duct, intrahepatic ducts and head of pancreatic duct images. There was a decrease in the common bile duct visibility (p=0.01). In the case of pancreatic duct tail and body visibility, images showed improvements (p=0.04 and 0.03, respectively). Blackberry juice, as a contrast agent, does not seem to have enough paramagnetic metals and does not improve the quality of MRCP.

Tension headaches are the most basic reasons for referring to physicians throughout the world. Iron anemia, on the other hand, is the most common type of anemia among women who are in productive age in the world. This study was done to investigate the relationship between vascular headaches and iron anemia and to see the effect of iron tablets administration on the treatment of these headaches in women who are in productive age. In this quasi-control study, 50 women in reproductive age who had iron anemia and vascular headaches, referring to the neurologic clinic of Vali-asr Hospital in Arak, were selected and treated with ferrous sulfate tablets for three months. For verifying the treatment, patient's hemoglobin was monitored after one month, and in case of any significant increases in this value, the patients discontinued participating in the study. The number of headache attacks and the number of analgesics used before, through and three months after beginning the administration of ferrous sulfate were noted for all of the patients. The mean number of the headache attacks one month before treatment, during the treatment and three month after the treatment were 19.6±28, 14.2±11.2, 13.3±11.8, respectively (p=0.0001). In addition, the mean number of used analgesics before the treatment, through the treatment and three month after the treatment were 30.1±14.1, 14.3±11.2, 13.1±16.1, respectively (p=0.0001). It seems that using iron tablets can be useful in treatment of vascular headaches.

Considering some evidence on anti-diabetic potential of Allium ursinum (AU), this study was conducted to evaluate the effect of oral administration of AU on contractile responsiveness of thoracic aorta in diabetic rats. In this experimental study, 40 male Wistar rats were divided into control, AU-treated control, diabetic, glibenclamide-treated, and AU-treated diabetic groups. For inducing diabetes, streptozotcin (STZ) was administered (60 mg/Kg). AU-treated group received AU mixed with standard pelleted food at a weight ratio of 1% for 2 months. Serum glucose level was measured at weeks 4 and 8. Eventually, contractile responsiveness of thoracic aortic rings to KCl and noradrenaline (NA) was evaluated. Serum glucose level, at weeks 4 and 8, in the AU-treated diabetic group was significantly lower than that in the diabetics group (p<0.01 and p<0.005, respectively). In addition, the maximum thoracic aorta contractile responsiveness to NA in the AU-treated diabetic group was significantly less than the diabetic group (p<0.05); however, such a significant reduction was not observed for KCl. Oral administration of AU for 2 months is of a moderate hypoglycemic effect and attenuates the contractile responsiveness of the vascular system in diabetic rats. Considering some evidence on anti-diabetic potential of Allium ursinum (AU), this study was conducted to evaluate the effect of oral administration of AU on contractile responsiveness of thoracic aorta in diabetic rats. In this experimental study, 40 male Wistar rats were divided into control, AU-treated control, diabetic, glibenclamide-treated, and AU-treated diabetic groups. For inducing diabetes, streptozotcin (STZ) was administered (60 mg/Kg). AU-treated group received AU mixed with standard pelleted food at a weight ratio of 1% for 2 months. Serum glucose level was measured at weeks 4 and 8. Eventually, contractile responsiveness of thoracic aortic rings to KCl and noradrenaline (NA) was evaluated. Serum glucose level, at weeks 4 and 8, in the AU-treated diabetic group was significantly lower than that in the diabetics group (p<0.01 and p<0.005, respectively). In addition, the maximum thoracic aorta contractile responsiveness to NA in the AU-treated diabetic group was significantly less than the diabetic group (p<0.05); however, such a significant reduction was not observed for KCl. Oral administration of AU for 2 months is of a moderate hypoglycemic effect and attenuates the contractile responsiveness of the vascular system in diabetic rats.

Myopia is the most common refractive defect and degenerative myopia is one of the five causes of blindness in the world. The aim of this study is to examine degenerative myopia and its related risk factors. In this cross-sectional study, the data was collected through a questionnaire along with the auto-refraction apparatus, which was utilized for determining the myopic degree. The inclusion criteria for this study were the age above the 10, myopia or astigmatic myopia, apparent media (in fonduscopic examination), and the absence of age related retinal defect. A total 65 patients participated in this study 51% of whom had degenerative myopia. Choroid neovascularization was observed in 17.65% of the subjects. There was a significant difference in the relationship between hypertension(r=28%), diabetes mellitus (r =22%) and glaucoma, and degenerative myopia; however, this difference was not observed between cataract and myopia. The correlation coefficients between hypertension and diabetes mellitus, and degenerative myopia were 28% and 22%, respectively. This correlation was very low in the case of glaucoma. The greatest correlation existed between the myopic crescent and hypertension (r=0.295%). In all of the cases, the correlation coefficient between diabetes mellitus and all the myopic complications was positive but below 40%. The majority of the patients had degenerative myopia. Hypertension and diabetes mellitus were the most common co-existing diseases. Noticing the correlation coefficient existing between hypertension and myopia, the need for controlling hypertension and diabetes mellitus for preventing retinal complications is emphasized. Also, for preventing the adverse effects of degenerative myopia in retinal defects, controlling glaucoma is suggested.

All members of society should have equal access to necessary health care. The main goal of this research is to determine the status of health care access in eight selected countries and to suggest a new model for Iran. This study was done comparatively on eight countries. In order to define a framework for categorizing the countries Jordan scales was employed. In this method, based on the kind of insurance system, countries are divided into 4 groups, from each 2 countries were selected. Data obtained from each country were placed in comparative tables. For presenting the final model, Delphi technique was utilized in two stages. To increase equity in their health care systems, all the countries in this study utilized such strategies as insurance coverage for all, defined health care packages, appropriate human resources, family physicians, referral system and high level of GNP in health sector. Also, low direct payment by patients, expansion of insurance coverage and the existence of out of pocket pay limit in pharmaceutical and medical services were also very helpful. These policies have been made in a way that the level of individual's income did not affect the access to such services. Equitable access to health care services in Iran necessitates the establishment of national health insurance system aiming at omission of parallel insurance, provision of medical care coverage for all the basic medical services especially health care coverage for the elderly and patients with chronic psychological problems.

Clinical research suggest a relationship between epilepsy and hypogonadism. The aim of this study is to identify the impact of epilepsy induced by kindling with pentylenetetrazol (PTZ) on hormones and some reproductive parameters in male rats. Adult male rats (NMRI strain) were divided into control and kindling groups. Kindling was induced by 40 mg/kg PTZ with a 48 hour interval through intraperitoneal injection. Each animal received 13 doses. At the end of the thirteenth dose, animals were weighed and uthenaized with ether and blood samples, collected from their hearts, were used for testosterone, prolactin and FSH, LH assay. In order to examine motility and morphology of sperms, tissue samples from epidydimis were isolated and minced in DMEM/F12 culture medium and were incubated for 15 minutes. Then sperm morphology and motility were studied. Testis were also isolated and weighed. Kindling with PTZ decreased serum levels of testosterone and LH, but it increased rolactin. However, there was no difference in serum level of FSH between the two groups. Sperm motility in kindling group decreased significantly. There were no significant differences in testis weight, but the amount of animal weight losses in the kindling group was more than that of the control group. By changing the serum level of sexual hormones and decreasing sperm motility, PTZ kindling induced epilepsy exerts diminishing negative effects on reproduction.

Job burnout is a common consequence of job stress among nurses which has negative impacts on the quality patient care and physical and mental health status of nurses and it imposes some expenses on health care system. This research aiming at comparing burnout level among the nurses in Markazi province can offer some solutions for reducing burnout and improving self-esteem in nurses. In this descriptive cross-sectional survey, via stratified random sampling, 66 nurses working in the clinical sections of governmental hospitals in Arak, Khomein and Saveh and 33 nursing instructors and nursing faculty members of Arak University of Medical Sciences who had their BSc or MSc in nursing were selected. Maslach Burnout Inventory was then administered to the participants. Mean of Job burnout (40.84%) in this research was higher than that of other similar studies. Mean of emotional exhaustion scores, depersonalization and personal accomplishment were 28.38, 9.41 and 29.31, respectively. The difference between occupational burnout in nurses working in the clinical sections and those in the educational departments were significant in the domain of depersonalization. But in other domains, no statistically significant differences were seen between the two groups. Job burnout among educational and clinical nurses is generally high in Markazi province. This can be decreased through such special ways as increasing job stability and freedom of action, clarification of individual responsibility regarding personal performance and dividing tasks among the members for lowering workload.

The effectivity of applying antiseptics in preparation of the operative site on the reduction of post-operative infections is not quite clear and controversies exist about the best method for doing this. The aim of this study is to compare the traditional two-stage method of first, washing the site with povidone iodine scrub and then painting with aqueous povidone iodine with the method of washing the site only with povidone iodine scrub. In this retrospective study, patients who had been under knee arthroscopy in 2 separate hospitals by the same surgeon were compared with regard to post operative infection. In one hospital, the operative site was only washed with povidone iodine scrub, while in the other hospital this same procedure was followed by painting with aqueous povidone iodine. The primary goal of this study was to identify the patients who had manifested clinical and laboratory signs of superficial or deep infection or septic arthritis one month postoperatively. A total 300 patients were studied in two equal groups. All the patients had only been under diagnostic or curative non-bony operations. No superficial or deep infection or septic arthritis were seen in any of the patients in the two groups. Preoperative preparation of the knee with povidone iodine scrub is a safe method for prevention of infection and can be used instead of the common two-stage method of using povidone iodine scrub and then painting with aqueous povidone iodine since this can decrease the time and cost of surgery.

Adolescents, as a large age group in the world, face many physical, mental and social problems in their puberty period. Health education proper to their needs and through new educational methods is of great importance. This study mainly aims to examine the impact of peer education approaches on girl's performance regarding pubertal physical health. In this experimental study, through random sampling, 100 female pupils were divided into two groups of experimental (n=50) and control (n=50). The self-made questionnaire, employed in this study, was based on peer approach. After 1.5 months, the participant's performance was evaluated through the post-test and compared to the pre-test results for the two groups. Scoring was conducted out of 100 and the scores under 50 indicated weak performance, those between 50 and 75 showed an average performance while scores above 75 indicated good performance. Peer based educational approaches improved adolescent girls physical health. Statistical tests also revealed a significant difference between the mean of awareness and practice score in the two groups (p<0.001). Peer education methods result in the empowerment of adolescents, the provision of opportunities for them to participate in activities, and the improvement of communication between mothers and their daughters.