نشریه دانشگاه علوم پزشکی بیرجند
سال هفدهم شماره 2 (پیاپی 43، تابستان 1389)

Progress in the diagnosis of fetal abnormalities and early diagnosis of maternal life threatening diseases has resulted in an increased number of second trimester pregnancy terminations. The present study aimed at comparing the therapeutic effects of two different regimens of vaginal misoprostol administration (i.e. every 6 hours vs every 12 hours) on the 2nd trimester pregnancy termination.

In this randomized clinical trial, 140 women with14-28 weeks of gestation who had volunteered to undergo termination of pregnancy for various indications, were randomly divided into 2 equal groups. The first group received 400µg vaginal misoprostol every 6 hours and the second one every 12 hours. If expulsion of fetus did not occur within 48 hours, high dose of oxytocin was administered. Induction-abortion interval, mean dose of misoprostol, high dose oxytocin administration need and side-effects in the two groups were recorded. The obtained data was analyzed using SPSS statistical software (version 12) at the significant level P<0.05.

There was no significant difference in the mean induction-abortion interval between the two groups. Average dose of misoprostol was higher (P<0.001) in the 6-hour group (1600±761 µg) compared to the 12-hour group (1200±385µg). There was not any need for administration of high dose of oxytocin in either of the groups. Incidence of fever was slightly higher in the 6- hour group, which was not statistically significant.

For termination of second trimester pregnancy, administration of 400µg vaginal misoprostol every 12 hours can be as useful as every 6 hour administration of the drug.

Although some studies have shown that supportive care during labor improves mother's prognosis in relation to infant, no sufficient scientific information have been reported. Thus, the present study was carried out aiming at determining the effect of midwife’s supportive care during labor on exclusive breastfeeding in primipara women in Ommolbanin hospital in Mashhad.

In this clinical trial study, 80 primipara women with the gestational age of 38-42 weeks, a single live fetus with cephalic presentation, intact membranes and cervical dilatation of 3-4 cms, no history of complications during pregnancy, and no evidence of cephalopelvic disproportion or fetal distress were randomly divided into two groups; namely a supportive care group (receiving supportive care) and a usual care group. All mothers recorded the daily frequency of their infants’ breast feeding from birth until six weeks later in a check-list. Means of data collection were interview, examination and measuring, checklist, visual analogue scale, Speilberger anxiety scale, and breastfeeding experience scale. The obtained data was analyzed using t test, Mann-Whitney, Chi-Square and Fisher exact tests.

The frequency of exclusive breastfeeding in the fourth and in the sixth week after birth in the supportive care group was significantly higher than its frequency in the usual care group (P= 0.023 and 0.017, respectively).

A midwife’s supportive care has a positive influence on breastfeeding. Therefore, supportive care is recommended as a strategy to promote exclusive breastfeeding and keeping health of the infant.

Caring for patients with multiple sclerosis brings about a lot of tension for the care-givers and the family. Implementation of an empowerment program leads to self-control and preventive behaviors. This study aimed at determining the effects of a family-centered empowerment model on knowledge, attitude and skill of care givers of multiple sclerotic patients.

This clinical-trial study was done on 70 care givers of multiple sclerotic patients who were divided into case and control groups. Family-centered empowerment model was applied for three months and then the questionnaires regarding skill, attitude, and knowledge of the participants were collected. The obtained data was analyzed by means of SPSS software (version 11.5) and dedicational statistical tests at the significant level of P<0.05.

Independent T-test revealed that there was no significant difference in the mean knowledge, attitude, and skill scores in the case and control groups before intervention (P>0.05); whereas the difference was significant three months after intervention (P=0.001). Besides, mean knowledge, attitude and skill scores of the caregivers in the case group significantly increased three months after intervention (P=0.001), but there was no significant difference in the mentioned factors in the care-givers of control group after three months (P>0.05).

Empowerment of caregivers for patients with multiple sclerosis promotes their knowledge, attitude and skills leading to more efficient care for these patients. Planning and implementing more effective programs for those caring for chronic diseases is recommended.

Excessive energy intake and subsequent obesity increase the incidence of chronic diseases and decrease life expectancy. Energy restriction, while considering adequate nutrient intake, decreases the risk of developing chronic diseases. The aim of this study was to evaluate the effect of energy restriction on biomarkers of longevity and inflammation in rats.

In this experimental study, 50 male wistar rats were randomly divided into 2 groups for 11 weeks: control (ad libitum diet), and energy restriction (40% energy restriction of baseline energy requirements). Weight, BMI, body temperature, and level of glucose, insulin, leptin, TNF-α, and IL-6 in serum were measured at the end of the study. The obtained data was analysed by means of SPSS (version 11.5) and independent t-test, at the significant level P<0.05.

Energy restriction decreased weight (P=0.001), BMI (P=0.001), body temperature (P=0.001), and also the serum level of glucose (P=0.035), insulin (P=0.021), IL-6 (P=0.045) and leptin (P=0.001) significantly, but no significant change happened in TNF-α (P=0.3).

Two biomarkers of longevity (fasting insulin level and body temperature) decreased due to energy restriction, which may be a sign of metabolic rate reduction. Moreover, efficacy of energy restriction in the reduction of inflammation biomarker (IL-6) indicates that ER can attenuate inflammatory process, which is a common risk factor for many chronic diseases.

Breathing exposure to cement dust containing an amount of heavy metal compounds has many different local and systemic effects. The aim of the present study was to survey the extent of cement factory worker's pulmonary exposure to metal ions (Cadmium, Cobalt, Chromium and Nickel).

In this cross-sectional research, environmental sampling of the factory's packing section was performed to monitor metal ions in the air and fluid in a condition similar to that of the lungs. Data analysis was done using SPSS software (version 11.5) at the significant level of P<0.05.

Comparing mean concentration of the studied metals with their maximum threshold level showed that it was less than the level (P<0.05). Maximum metal ion concentration in the air was that of Chromium (1.75 µg/m3) and the minimum concentration belonged to Cadmium (0.01 µg/m3). The level of metal ions of Cadmium, Cobalt, Chromium and Nickel in the floating particulates of the packing section was 0.74±0.41, 9.31±3.38, 81.96±53.35, 32.5±27.83; and the amount of the extracted metals with the simulated alveoli fluid from the samples of the air in the packing section of the factory in the in-vitro were 0.006±0.002, 0.02±0.009, 0.53±0.12, and 0.14±0.03 µg/g of the collected air dust, respectively. The result of Spearman's correlation coefficient test showed that the relationship between meal ions concentration in the air and the amount of simulated liquid was not statistically significant (P>0.05).

Although there was not any significant relationship between the amount of metal ions in the air and the simulated fluid, it is essential to investigate these exposures because of the high percentage of Cadmium solubility under simulated lung alveoli conditions.

University teachers are among the main pillars of higher educational system and their evaluation is constantly done through different ways including student's evaluation. While some teachers are opposed to evaluation by weak students, the present study was designed and carried out in Birjand University of Medical Sciences to determine the relationship between teacher's evaluation scores and students with different educational development.

In this cross- sectional, descriptive and analytical study, which was performed at Birjand University of Medical Sciences in 2007, sixty-three faculty members were selected conducting a poll, and 2700 questionnaires were filled in by all medical students. The means of data collection were the questionnaires whose validity and reliability had been confirmed by the university's Education Development Center. The obtained data was analyzed by SPSS software (version 11.5) at the significant level P<0.05.

Mean evaluation scores by advanced, average and weak students were 55.59±11.46, 55.70±12.49, and 55.51±12.23 respectively (P=0.96). In surveying different aspects which were evaluated there was a significant difference between advanced students and weak ones regarding teacher's dignity score (P=0.03).

Regarding that a significant difference between faculty member's evaluation scores and students with different educational development levels was not observed, it seems that educational development of students has no effect on their evaluation and, therefore, this variable can not be considered as favoritism in the evaluation of teachers. The difference observed in the domain of professorial dignity can emphasize the necessity of better judgment on the part of professors in their dealing with students.

Rhabdomyolysis is a clinical and biochemical syndrome that results from acute poisonings. The present study aimed to investigate clinical and biochemical characteristics of rhabdomyolysis in patients with severe acute poisonings.

Out of 450 patients with severe acute poisonings who admitted in the Toxicology Intensive Care Unit of Loghman Hakim Hospital in Tehran between April and September 2006, 165 subjects with serum creatine kinase at least five fold of normal range (≤975 IU/L) after disproving any other causes, were enrolled in this sectional study. Poisoning diagnosis was based on the history of toxins usage and clinical findings. The toxins usages were approved by the appropriate toxicological tests. Demographic data, clinical findings and laboratory studies were recorded for all patients. The obtained data was analyzed using SPSS software (version 11.5) at the significant level of P<0.05.

Frequency of rhabdomyolysis in the poisoned patients was 36.6%. The most common intoxications inducing rhabdomyolysis were opium (28%), tricyclic antidepressant drugs (14%) and benzodiazepines (14%). Acute renal failure was diagnosed in 23 (15%) patients. There was a linear correlation between serum creatine kinase and serum creatinine (P<0.05).

Patients with severe acute poisoning are at risk of rhabdomyolysis and acute renal failure is its main coincident complication.